Medical students' education in the ambulatory care setting: background paper 1 of the Medical School Objectives Project.

The present article is the first MSOP Background Paper. In planning the Medical School Objectives Project (MSOP), the Association recognized that certain changes in medical students' education were occurring already in some schools, and that it would be important to gain insight into and monitor these changes to provide ideas and information to help schools design curricular changes to foster students' achievements of the objectives and recommendations set forth in the MSOP Reports published in 1998 and reprinted in Academic Medicine. This background paper provides an overview of the strategies being developed by medical schools to carry out education in the ambulatory care setting. This report is based on site visits in 1997 to 26 U.S. medical schools conducted by two of the authors (CEH and GAK), who also used information from 12 additional schools that were not visited and consulted individuals responsible for the evaluation of five grant programs dedicated to national curriculum reform. The authors define and discuss in detail the use of the three main strategies that their research uncovered: (1) longitudinal preceptorships, (2) multispecialty clerkships, and (3) activities that are community oriented and population based to provide medical students the kinds of educational experiences they need to understand and practice in the ambulatory care setting. The authors then discuss issues and challenges related to the implementation of these curricular changes: curricular management issues; developing and maintaining a network of practicing physicians willing to serve as preceptors; evaluating curricular innovations; and assessing students' performances. The authors conclude with general observations about the need for ambulatory care education, the difficulties that have been--and continue to be--met and overcome to implement it, and the recommendation that relevant learning experiences should be incorporated into existing course work or clinical experiences.