PROTECTING TIME FOR TEACHING IN THE AMBULATORY CARE SETTING

The current drive for efficient clinical teaching threatens the educat ional mission of academic medical centers, With pressures to increase clinical productivity, protected time and compensation for teaching ha ve become scarce resources for clinical teachers in all settings, Alth ough it may yield new approaches ro education, the push for efficiency may ultimately result in insufficient time fur teaching and may cause some clinical preceptors to stop teaching completely. Further, it may lead to the illusion that comprehensive teaching truly requires littl e time, Since the future of American health care depends upon the prov ision of high-quality clinical education to young physicians, this sit uation presents a potential national crisis. In this article, the auth ors discuss the complex nature of teaching, its time requirements, and the special challenges of teaching in outpatient settings. To avoid o veremphasizing efficiency to the detriment of education they recommend adhering to two principles: (1) academic medical centers are educatio nal as well as training institutions, and therefore should provide a b road-based education as well as training in clinical skills; and (2) t he clinical teaching process is complex and adequate time must be prov ided for its many phases, including planning, instructing, and reflect ing. Finally, the authors make recommendations for ensuring the delive ry of high-quality education in ambulatory care settings.