Medical Training in both the Inpatient and Ambulatory Settings

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Historically, most third-year medical student clerkships have been confined primarily to inpatient settings in order to take advantage of what was thought of as a “limitless patient supply.” Early studies of ambulatory education noted an increasing shift in patient volume to the outpatient setting, and many felt that because such volume shifts reflected the future of medical practice, training for the outpatient setting needed to be represented more fully in medical school curricula. , , (Perkoff, 1986), (Davidson, 1989), (Ogrinc, et al, 2002).

Those observing these shifts towards ambulatory care also began to advocate for “rigorous and coherent research on the learning process in these settings and the desired outcomes of these educational experiences” , (Bordage et al., 1998; see also Irby, 1990). Subsequent studies demonstrated unique opportunities for teaching and learning in the ambulatory care setting, such as the one-minute preceptor (Irby et al, 1991; Irby 1994) , In addition, interest in the cognitive implications of learning specific to the ambulatory setting emerged. (Gruppen, 1997)

At the time the present study was conceptualized, the scope of medical student learning on ambulatory sites was still not entirely known, nor were the methods or structure of effective teaching in an ambulatory setting (Whitcomb, 2002). Thus, the research question identified at the time focused on the extent to which the ambulatory setting provides a unique learning experience to medical students, when compared to their traditional inpatient experience.

Today, a gap still exists in understanding the true scope of medical student learning in traditional ambulatory settings as compared to inpatient settings (citations). Particularly little is known about the perceived unique learning values of the inpatient and outpatient settings for building clinical competency (citations). We believe the data collected by the late Steve Miller in 2002 still contributes to the questions currently in the literature.

Rationale. We hypothesized (a priori) that the outpatient, or ambulatory, experience touches on skills that rely on repetitive practice, and its strengths are in students’ frequency of patient interaction and breadth of exposure. For example, the high quantity of patients seen in outpatient, or ambulatory, clinical experiences affords a venue for learning a wide breath of diagnostic reasoning skills.
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