Are ambulatory care‐based learning experiences different from those on hospital clinical teaching units?

Abstract

Background: Because of concerns about the educational value of hospitalized patients, there has been a recent upsurge of interest in ambulatory care settings for learning. Although it is assumed that such settings are better for student and resident education, there is very little evidence comparing the experiences and their relative values in the 2 settings. Purpose: We carried out a study to evaluate tutor and trainee perceptions of the differences between educational experiences on 2 inpatient clinical teaching units and in an ambulatory care medical clinic. Methods: Over a 6‐month period, 69 internal medicine trainees in the 2 settings evaluated education‐related aspects of their patient interactions using a 3‐part questionnaire. Faculty tutors completed a 2‐part questionnaire concerning education‐related aspects of patients usually seen in the ambulatory care clinic. Results: There was a broader case mix in the ambulatory care clinic, but trainees perceived that experiences with patients on the inpatient units were more relevant for learning clinical skills. The inpatient‐related experiences more frequently exposed trainees to new, undiagnosed problems, whereas patients seen in the ambulatory care clinics frequently presented no new challenges. There was a mismatch between faculty perceptions of the learning experiences available in the ambulatory care clinics and the trainees’ perceptions of their actual experiences. Conclusions: Although the ambulatory care medical clinic experience exposed trainees to a broad range of health problems, our results suggest that inpatient‐based learning experiences are better for learning than are those in the ambulatory care setting.