TRAINING GENERALIST PHYSICIANS - STRUCTURAL ELEMENTS OF THE CURRICULUM

To train more generalist physicians, structural changes must be made a long the continuum of medical education. Future generalists require in -depth exposure to primary care practice, with substantive experience in the longitudinal management of patient panels and the opportunity t o work with successful generalist role models. Clinical training and c ourse work must incorporate a wide range of skills and disciplines, in cluding areas now under-emphasized, such as epidemiology, health servi ces, and psychosocial medicine. Recommendations for structural changes to increase the generalist focus of medical education include: 1) the development within institutions of central authorities, involving dep artments of internal medicine, family medicine, and pediatrics, in joi nt efforts to foster all aspects of generalist training, including rec ruitment curriculum development, community linkages, innovative approa ches to training, and recognition and support for successful generalis t teachers; 2) commitment of a minimum of 50% of clinical training to ambulatory care settings at both medical school and residency levels; 3) required longitudinal care experiences for all medical students and a 20% or greater time commitment to longitudinal care for internal me dicine, pediatrics, and family medicine. residents; and 4) increased n umbers of generalist faculty and enhanced teaching skills among facult y in the outpatient environment, to guarantee increased exposure of me dical students and residents to generalist role models.