Ambulatory Care Education: How Do Academic Medical Centers, Affiliated Residency Teaching Sites, and Community-Based Practices Compare?

Patricia (Patty) Carney, Scottie Eliassen, Catherine F. Pipas, Stephen H. Genereaux, David W. Nierenberg

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Purpose. Little is known about how different ambulatory sites compare as clinical educational settings. The authors used students' log data to compare the educational content and processes in academic medical center-based clinics (AMCs), affiliated residency teaching sites (ARTs), and local community-based practices (CBPs) at one medical school. Method. Students recorded their experiences with symptoms, counseling, procedures, and common medical conditions as well as characteristics of the learning process during a required eight-week third-year ambulatory clerkship in family medicine. Descriptive statistics, chi-square for differences in categorical variables, and analysis of variance and multivariate analysis of variance for differences in continuous variables were used to compare the educational settings. Results. Over 9,000 encounters were analyzed; 29.7% occurred in AMCs, 14.8% in ARTs, and 55.5% in CBPs. The proportion of continuity visits was lowest in the AMCs and highest in CBPs (13% versus 22%, respectively; p <.01). Students saw almost 57,000 symptoms and conditions. Of 19 symptoms compared, seven differed significantly among the three settings: back pain, cough, dyspnea, ENT (ears, nose, throat problems), fatigue, knee pain, and vomiting. All but one of these were least likely to occur in ARTs. Procedures were performed more frequently, whereas counseling skills were called upon less frequently in CBPs. Students reported being more likely to work unobserved while conducting physical examinations in ARTs and CBPs. Amount of feedback provided on clinical skills did not differ, but students reported receiving more teaching about patient management in ARTs and AMCs versus CBPs (74%, 72%, and 66% of encounters, respectively; p <.01). Conclusions. Academic and community settings can complement each other as learning sites for an ambulatory clerkship in family medicine, and common curricular expectations can be achieved. Settings' differences and similarities should be taken into account when developing, implementing, or revising clerkship programs and should be considered with students' interests and previous clinical experiences before assigning students to a teaching site.

Original languageEnglish (US)
Pages (from-to)69-77
Number of pages9
JournalAcademic Medicine
Volume79
Issue number1
DOIs
StatePublished - Jan 2004
Externally publishedYes

Fingerprint

Ambulatory Care
Internship and Residency
Teaching
Students
Education
community
education
student
Analysis of Variance
educational setting
analysis of variance
pain
Counseling
counseling
Medicine
Learning
medicine
educational content
Clinical Competence
Back Pain

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Education

Cite this

Ambulatory Care Education : How Do Academic Medical Centers, Affiliated Residency Teaching Sites, and Community-Based Practices Compare? / Carney, Patricia (Patty); Eliassen, Scottie; Pipas, Catherine F.; Genereaux, Stephen H.; Nierenberg, David W.

In: Academic Medicine, Vol. 79, No. 1, 01.2004, p. 69-77.

Research output: Contribution to journalArticle

Carney, Patricia (Patty) ; Eliassen, Scottie ; Pipas, Catherine F. ; Genereaux, Stephen H. ; Nierenberg, David W. / Ambulatory Care Education : How Do Academic Medical Centers, Affiliated Residency Teaching Sites, and Community-Based Practices Compare?. In: Academic Medicine. 2004 ; Vol. 79, No. 1. pp. 69-77.
@article{65fea2ac88b041c8852b7b4b9a41d2a3,
title = "Ambulatory Care Education: How Do Academic Medical Centers, Affiliated Residency Teaching Sites, and Community-Based Practices Compare?",
abstract = "Purpose. Little is known about how different ambulatory sites compare as clinical educational settings. The authors used students' log data to compare the educational content and processes in academic medical center-based clinics (AMCs), affiliated residency teaching sites (ARTs), and local community-based practices (CBPs) at one medical school. Method. Students recorded their experiences with symptoms, counseling, procedures, and common medical conditions as well as characteristics of the learning process during a required eight-week third-year ambulatory clerkship in family medicine. Descriptive statistics, chi-square for differences in categorical variables, and analysis of variance and multivariate analysis of variance for differences in continuous variables were used to compare the educational settings. Results. Over 9,000 encounters were analyzed; 29.7{\%} occurred in AMCs, 14.8{\%} in ARTs, and 55.5{\%} in CBPs. The proportion of continuity visits was lowest in the AMCs and highest in CBPs (13{\%} versus 22{\%}, respectively; p <.01). Students saw almost 57,000 symptoms and conditions. Of 19 symptoms compared, seven differed significantly among the three settings: back pain, cough, dyspnea, ENT (ears, nose, throat problems), fatigue, knee pain, and vomiting. All but one of these were least likely to occur in ARTs. Procedures were performed more frequently, whereas counseling skills were called upon less frequently in CBPs. Students reported being more likely to work unobserved while conducting physical examinations in ARTs and CBPs. Amount of feedback provided on clinical skills did not differ, but students reported receiving more teaching about patient management in ARTs and AMCs versus CBPs (74{\%}, 72{\%}, and 66{\%} of encounters, respectively; p <.01). Conclusions. Academic and community settings can complement each other as learning sites for an ambulatory clerkship in family medicine, and common curricular expectations can be achieved. Settings' differences and similarities should be taken into account when developing, implementing, or revising clerkship programs and should be considered with students' interests and previous clinical experiences before assigning students to a teaching site.",
author = "Carney, {Patricia (Patty)} and Scottie Eliassen and Pipas, {Catherine F.} and Genereaux, {Stephen H.} and Nierenberg, {David W.}",
year = "2004",
month = "1",
doi = "10.1097/00001888-200401000-00016",
language = "English (US)",
volume = "79",
pages = "69--77",
journal = "Academic Medicine",
issn = "1040-2446",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Ambulatory Care Education

T2 - How Do Academic Medical Centers, Affiliated Residency Teaching Sites, and Community-Based Practices Compare?

AU - Carney, Patricia (Patty)

AU - Eliassen, Scottie

AU - Pipas, Catherine F.

AU - Genereaux, Stephen H.

AU - Nierenberg, David W.

PY - 2004/1

Y1 - 2004/1

N2 - Purpose. Little is known about how different ambulatory sites compare as clinical educational settings. The authors used students' log data to compare the educational content and processes in academic medical center-based clinics (AMCs), affiliated residency teaching sites (ARTs), and local community-based practices (CBPs) at one medical school. Method. Students recorded their experiences with symptoms, counseling, procedures, and common medical conditions as well as characteristics of the learning process during a required eight-week third-year ambulatory clerkship in family medicine. Descriptive statistics, chi-square for differences in categorical variables, and analysis of variance and multivariate analysis of variance for differences in continuous variables were used to compare the educational settings. Results. Over 9,000 encounters were analyzed; 29.7% occurred in AMCs, 14.8% in ARTs, and 55.5% in CBPs. The proportion of continuity visits was lowest in the AMCs and highest in CBPs (13% versus 22%, respectively; p <.01). Students saw almost 57,000 symptoms and conditions. Of 19 symptoms compared, seven differed significantly among the three settings: back pain, cough, dyspnea, ENT (ears, nose, throat problems), fatigue, knee pain, and vomiting. All but one of these were least likely to occur in ARTs. Procedures were performed more frequently, whereas counseling skills were called upon less frequently in CBPs. Students reported being more likely to work unobserved while conducting physical examinations in ARTs and CBPs. Amount of feedback provided on clinical skills did not differ, but students reported receiving more teaching about patient management in ARTs and AMCs versus CBPs (74%, 72%, and 66% of encounters, respectively; p <.01). Conclusions. Academic and community settings can complement each other as learning sites for an ambulatory clerkship in family medicine, and common curricular expectations can be achieved. Settings' differences and similarities should be taken into account when developing, implementing, or revising clerkship programs and should be considered with students' interests and previous clinical experiences before assigning students to a teaching site.

AB - Purpose. Little is known about how different ambulatory sites compare as clinical educational settings. The authors used students' log data to compare the educational content and processes in academic medical center-based clinics (AMCs), affiliated residency teaching sites (ARTs), and local community-based practices (CBPs) at one medical school. Method. Students recorded their experiences with symptoms, counseling, procedures, and common medical conditions as well as characteristics of the learning process during a required eight-week third-year ambulatory clerkship in family medicine. Descriptive statistics, chi-square for differences in categorical variables, and analysis of variance and multivariate analysis of variance for differences in continuous variables were used to compare the educational settings. Results. Over 9,000 encounters were analyzed; 29.7% occurred in AMCs, 14.8% in ARTs, and 55.5% in CBPs. The proportion of continuity visits was lowest in the AMCs and highest in CBPs (13% versus 22%, respectively; p <.01). Students saw almost 57,000 symptoms and conditions. Of 19 symptoms compared, seven differed significantly among the three settings: back pain, cough, dyspnea, ENT (ears, nose, throat problems), fatigue, knee pain, and vomiting. All but one of these were least likely to occur in ARTs. Procedures were performed more frequently, whereas counseling skills were called upon less frequently in CBPs. Students reported being more likely to work unobserved while conducting physical examinations in ARTs and CBPs. Amount of feedback provided on clinical skills did not differ, but students reported receiving more teaching about patient management in ARTs and AMCs versus CBPs (74%, 72%, and 66% of encounters, respectively; p <.01). Conclusions. Academic and community settings can complement each other as learning sites for an ambulatory clerkship in family medicine, and common curricular expectations can be achieved. Settings' differences and similarities should be taken into account when developing, implementing, or revising clerkship programs and should be considered with students' interests and previous clinical experiences before assigning students to a teaching site.

UR - http://www.scopus.com/inward/record.url?scp=0346963299&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0346963299&partnerID=8YFLogxK

U2 - 10.1097/00001888-200401000-00016

DO - 10.1097/00001888-200401000-00016

M3 - Article

C2 - 14691001

AN - SCOPUS:0346963299

VL - 79

SP - 69

EP - 77

JO - Academic Medicine

JF - Academic Medicine

SN - 1040-2446

IS - 1

ER -