The community continuity experience: generalist training for preclinical medical students.

Many medical schools are planning community-based experiences for preclinical students. In August 1994, The University of Texas Medical Branch at Galveston began placing all 200 first-year medical students in generalists' offices in a new course called the Community Continuity Experience. The office nurse served as site facilitator. Activities during the second term provided more opportunities for students to interview patients as well as to observe the site physicians. The course committee used feedback from student evaluations and focus groups to change the implementation of the curriculum. We found that nurses as site facilitators effectively managed the students' activities, that continuity of site was more important to students than breadth of exposure, that the optimum focus of activities was the examination room, that training in actual skill development (e.g., methods of patient education) was desired before site activities, and that careful integration of preclinical patient-oriented courses was important to expose students to a coherent approach to learning skills for patient assessment.