Teaching senior medical students in an office setting: the apprentice system revisited: a cardiologist's perspective.

The recent changes in medical school curricula, brought about by insurance companies, government agencies, and market forces have shifted the focus of patient care from hospital bedside to office or clinic. Classic approaches to the teaching of medical students in the subspecialties have become confused and inadequate. Students' confidence in their own clinical expertise has been hampered by lack of teaching and guidance, and these functions cannot be filled by higher technology. We have completed a successful four year project for fourth year students utilizing a busy practice of cardiology/internal medicine in monthly electives. Among the objectives were to share the real life practice of medicine primarily in an office setting thereby decentralizing patient care and teaching outside of the medical school; to help students gain experience and confidence in the clinical skills of diagnosis and to help them choose "high tech" procedures that are appropriate, and have acceptable cost/benefit ratios; and to recruit an enlightened teaching faculty from practicing physicians who will become medical student advocates, facilitators, and role models, especially for the difficult years of managed care ahead. The elective met with enthusiastic support from all students, whose follow-up letters from residencies confirmed the practical value of the course in clinical skills as well as in choice of appropriate higher technology. Although poorly compensated at present, a few plausible suggestions are offered. If structured and coordinated efficiently this practical experience for students can be a real incentive for continued education, inspiration, and pleasure for the faculty monitor, without compromising his or time or income.