Ambulatory medical education: teachers' activities, teaching cost, and residents' satisfaction.

PURPOSE: To assess faculty activities and costs in supervising ambulatory patient care at a family practice clinic, and to assess resident satisfaction with access to ambulatory care teaching.
METHOD: This time-and-motion study was conducted in 1993 over two three-week periods (at the end of one academic year and at the beginning of another) in a family practice clinic affiliated with the University of Iowa College of Medicine. Observers recorded time spent by 14 faculty on teaching and non-teaching activities. Thirty-two residents were surveyed about their satisfaction with access to teaching.
RESULTS: Over 59 half-days, 2,644 faculty service events were recorded; 47% were teaching events (supervising care delivered by residents) and 53% were non-teaching events (providing care for other clinic patients). Mean teaching time was greater for first-year residents; they consulted faculty more frequently and required more teaching time per consultation. The most common non-teaching activities were telephone calls out, telephone calls in, and inquiries from nurses and office staff. Ten percent of non-teaching activities interrupted teaching, and 17% of the residents reported their teaching had been interrupted. Eighty percent of the residents were satisfied with their access to teaching, but 12% reported they had had to postpone discussing pressing patient problems. Resident dissatisfaction correlated with longer perceived waiting time, interruption of teaching, and faculty inaccessibility.
CONCLUSION: Faculty should plan to spend two to three times longer to teach lower-level residents than upper-level residents. By delegating some non-teaching activities to other personnel, faculty can reduce teaching costs and increase resident satisfaction.