A SURVEY OF CHANGES IN THE PROPORTIONS OF AMBULATORY TRAINING IN INTERNAL-MEDICINE CLERKSHIPS AND RESIDENCIES FROM 1986-87 TO 1996-97

Purpose. To determine changes from 1986-87 to 1996-97 in the proportio ns of time devoted to education in ambulatory settings within clerkshi ps and internal medicine residencies. Method. In 1997, a questionnaire was sent to the departments of internal medicine of all 125 U.S. medi cal schools. The response rate was 73%. Results. Training in ambulator y settings increased greatly over the decade. The percentages of time in ambulatory settings increased for clerkships from 6% to 28%, and fo r residencies from 14% to 30%. In 1986-87, two thirds of clerkships pr ovided no ambulatory training; by 1996-97, only 5% were exclusively in patient. In 1986-87, 56% of residencies devoted 10% or less of their t ime to ambulatory education. By 1996-97, no residency program was in t his category, while 87% devoted at least 20% of their time to ambulato ry training. All programs used hospital clinics for ambulatory educati on; more than half used private physicians' offices, while fewer used health centers, home care services, and HMOs. Problems in expanding am bulatory training included inadequate numbers of sites or patient volu mes (58% of programs), insufficient instructors (55%), and costs. Conc lusion. There has been a major increase in the proportions of time dev oted to ambulatory education in clerkships and residencies. Significan t problems impede the reported desire of program directors further to increase these proportions.