Medical students' education in the ambulatory care setting: Background paper 1 of the Medical School Objectives Project

The present article is the first MSOP Background Paper. In planning the Med ical School Objectives Project (MSOP), the Association recognized that cert ain changes in medical students' education were occurring already in some s chools, and that it would be important to gain insight into and monitor the se changes to provide ideas and information to help schools design curricul ar changes to foster students' achievements of the objectives and recommend ations set forth in the MSOP Reports published in 1998 and reprinted in Aca demic Medicine. This background paper provides an overview of the strategies being develope d by medical schools to carry out education in the ambulatory care setting. This report is based on site visits in 1997 to 26 U.S. medical schools con ducted by two of the authors (CEH and GAK), who also used information from 12 additional schools that were not visited and consulted individuals respo nsible for the evaluation of five grant programs dedicated to national curr iculum reform. The authors define and discuss in detail the use of the three main strategi es that their research uncovered: (1) longitudinal preceptorships, (2) mult ispecialty clerkships, and (3) activities that are community oriented and p opulation based to provide medical students the kinds of educational experi ences they need to understand and practice in the ambulatory care setting. The authors then discuss issues and challenges related to the implementatio n of these curricular changes: curricular management issues; developing and maintaining a network of practicing physicians willing to serve as precept ors; evaluating curricular innovations; and assessing students' performance s. The authors conclude with general observations about the need for ambula tory care education, the difficulties that have been-and continue to be-met and overcome to implement it, and the recommendation that relevant learnin g experiences should be incorporated into existing course work or clinical experiences.