Advertisement

Journal of General Internal Medicine

, Volume 12, Supplement 2, pp S34–S40 | Cite as

Teaching in the outpatient clinic

Practical tips
  • Steven R. McGee
  • David M. Irby
Teaching Skills

Conclusions

One of the strengths of ambulatory education is the opportunity for learners to interact with patients and for teachers to model what they enjoy most about medicine without the intervening technology common to hospital wards. When medical students from the graduating class of 1990 were asked in a national survey what would make the specially of internal medicine more attractive as a career, the most common suggestion was to increase the ambulatory experience and the connections with patients that such an experience provides.

More research is necessary to identify which teaching techniques are effective in the clinic.3 Meanwhile, this article makes practical suggestions based on what is known about effective teachers and their behaviors. When teachers ask questions, present general rules, and model interactions, they create brief opportunities for teaching in an otherwise hectic day. Not only do learners recall these general rules, they subsequently want to emulate the teacher's caring attitude toward patients and organized approach to problem solving. Asking questions and modeling interactions help teachers share themselves and their love of medicine with their learners.

Keywords

Medical Student General Rule Ventricular Septal Defect Pyoderma Gangrenosum Clinical Teacher 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Feltovich J, Mast TA, Soler NG. Teaching medical students in ambulatory settings in departments of internal medicine. Acad Med. 1989;64:36–41.PubMedCrossRefGoogle Scholar
  2. 2.
    Knudson MP, Lawler FH, Zweig SC, Moreno CA, Hosokawa MC, Blake RL. Analysis of resident and attending physician interactions in family medicine. J Fam Pract. 1989;28:705–9.PubMedGoogle Scholar
  3. 3.
    Irby DM. Teaching and learning in ambulatory care settings: a thematic review of the literature. Acad Med. 1995;70:898–931.PubMedCrossRefGoogle Scholar
  4. 4.
    Irby DM, Ramsey PG, Gillmore GM, Schaad D. Characteristics of effective clinical teachers of ambulatory care medicine. Acad Med. 1991;66:54–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Little M, Rodnick JE. Evaluating student experiences in a family medicine clerkship. Fam Med. 1988;20:347–51.PubMedGoogle Scholar
  6. 6.
    Wolverton SE, Bosworth MF. A survey of resident perceptions of effective teaching behaviors. Fam Med. 1985;17:106–8.PubMedGoogle Scholar
  7. 7.
    Gjerde CL, Coble RJ. Resident and faculty perceptions of effective clinical teaching in family practice. J Fam Pract. 1982;14:323–7.PubMedGoogle Scholar
  8. 8.
    Stritter FT, Baker RM. Resident preferences for the clinical teaching of ambulatory care. J Med Educ. 1982;57:33–41.PubMedGoogle Scholar
  9. 9.
    Irby DM, Gillmore GM, Ramsey PG. Factors affecting ratings of clinical teachers by medical students and residents. J Med Educ. 1987;62:1–7.PubMedGoogle Scholar
  10. 10.
    Ramsey PG, Gillmore GM, Irby DM. Evaluating clinical teaching in the medicine clerkship: relationship of instructor experience and training setting to ratings of teaching effectiveness. J Gen Intern Med. 1988;3:351–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Packman CH, Krackov SK, Groff GD, Cohen J. The Rochester practice-based experience: an experiment in medical education. Arch Intern Med. 1994;154:1253–60.PubMedCrossRefGoogle Scholar
  12. 12.
    Butterfield PS, Libertin AG. Learning outcomes of an ambulatory care rotation in internal medicine for junior medical students. J Gen Intern Med. 1993;8:189–92.PubMedCrossRefGoogle Scholar
  13. 13.
    Papadakis MA, Kagawa MK. A randomized, controlled pilot study of placing third-year medical clerks in a continuity clinic. Acad Med. 1992;68:845–47.Google Scholar
  14. 14.
    Davis MH, Dent JA. Comparison of student learning in the outpatient clinic and ward rounds. Med Educ. 1994;28:208–12.PubMedCrossRefGoogle Scholar
  15. 15.
    Lublin JR. Role-modelling: a case study in general practice. Med Educ. 1992;26:116–22.PubMedGoogle Scholar
  16. 16.
    Quill TE. Medical resident education: a cross-sectional study of the influence of the ambulatory preceptor as a role model. Arch Intern Med. 1987;147:971–3.PubMedCrossRefGoogle Scholar
  17. 17.
    Williamson HA, Glenn JK, Spencer DC, Reid JC. The development of clinical independence: resident-attending physician interactions in an ambulatory setting. J Fam Pract. 1988;26:60–64.PubMedGoogle Scholar
  18. 18.
    Walter LL, Žweig SC, Hosokawa MD. A process evaluation of a required primary care clerkship. Fam Med. 1991;23:547–8.PubMedGoogle Scholar
  19. 19.
    Rowe MB. Wait time: slowing down may be a way of speeding up! J Teacher Ed. 1986;37(Jan–Feb):43–50.CrossRefGoogle Scholar
  20. 20.
    Irby DM. What clinical teachers in medicine need to know. Acad Med. 1994;69:333–42.PubMedGoogle Scholar
  21. 21.
    Brook RH, Fink A, Kosecoff J, et al. Educating physicians and treating patients in the ambulatory setting: where are we going and how will we know when we arrive? Ann Intern Med. 1987; 107:392–8.PubMedGoogle Scholar
  22. 22.
    Gennis VM, Gennis MA. Supervision in the outpatient clinic: effects on teaching and patient care. J Gen Intern Med. 1993;8:378–80.PubMedCrossRefGoogle Scholar
  23. 23.
    Ende J. Feedback in clinical medical education. JAMA. 1983;250: 777–81.PubMedCrossRefGoogle Scholar
  24. 24.
    Thomasson C, Levinson W, Acheson K, et al. Teaching tips for clinician-teachers. J Gen Intern Med. 1994;9:49–53.CrossRefGoogle Scholar
  25. 25.
    Cope DW, Linn LS, Leake BD, Barrett PA. Modification of residents' behavior by preceptor feedback of patient satisfaction. J Gen Intern Med. 1986;1:394–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Malone ML, Jackson TC. Educational characteristics of ambulatory morning report. J Gen Intern Med. 1993;8:512–4.PubMedCrossRefGoogle Scholar
  27. 27.
    Paccione GA, Cohen E, Schwartz CE. From forms to focus: a new teaching model in ambulatory medicine. Arch Intern Med. 1988;149:2407–11.CrossRefGoogle Scholar
  28. 28.
    Arsenau R. Exit rounds: a reflection exercise. Acad Med. 1995; 70:684–7.CrossRefGoogle Scholar
  29. 29.
    McMurray JE, Schwartz MD, Genero NP, et al. The attractiveness of internal medicine: a qualitative analysis of the experiences of female and male medical students. Ann Intern Med. 1993;119:812–8.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 1997

Authors and Affiliations

  • Steven R. McGee
    • 1
  • David M. Irby
    • 2
  1. 1.Seattle Veterans Affairs Medical Center (111M)Seattle
  2. 2.Department of Medical Education (DMI)University of WashingtonSeattle

Personalised recommendations