Ce. Hunt et al., Medical students' education in the ambulatory care setting: Background paper 1 of the Medical School Objectives Project, ACAD MED, 74(3), 1999, pp. 289-296
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.