The Impact of the Location and Structure of an Ambulatory Rotation on Cognitive Knowledge and Performance

Abstract

With the increasing shift to community-based ambulatory education, it is essential to gain a better understanding of the impact of these changes. To assess the impact of the location and structure of an ambulatory internal medicine clerkship rotation on cognitive knowledge and clinical performance, students were assigned to one of the following: (a) a multi-disciplinary ambulatory clerkship (MAC), (b) the office of a community-based general internist, or (c) a university-based internal medicine ambulatory clinic. The groups were compared on the internal medicine clerkship examination and preceptor ratings controlling for introduction to clinical medicine course performance via analysis of covariance. MAC students were rated lower than the other two groups by their preceptors. There were no other statistically significant differences. The structure and location of the rotation had little impact on cognitive knowledge. The impact of the structure of the rotation on clinical performance is less clear suggesting that further research is needed.

Get full access to this article

View all access options for this article.

References

Biddle, B. , Siska, K. , & Erney, S. (1994). A description of ambulatory teaching in a longitudinal primary care program. Teaching and Learning in Medicine, 6, 185-190.

Bock, R. D. (1975). Multivariate statistical methods in behavioral research. New York: McGraw-Hill.

Grum, C. M. , Richards, P. J. , & Woolliscroft, J. O. (1996). Consequences of shifting medical-student education to the outpatient setting: Effects on performance and experiences. Academic Medicine, 71(1), S99-S101.

Irby, D. M. (1995). Teaching and learning in ambulatory care settings: A thematic review of the literature. Academic Medicine, 70(10), 898-931.

Lally, D. K. , & Stinson, M. S. (1996). Ambulatory training during the basic medicine clerkship: Is acquisition of knowledge affected? Journal of General Internal Medicine, 11, 104-104.

Lesky, L. G. , & Hershman, W. Y. (1995). Practical approaches to a major educational challenge. Archives of Internal Medicine, 155, 897-904.

Speer, A. J. , Solomon, D. J. , & Ainsworth, M. A. (1996). An innovative evaluation method in an internal medicine clerkship. Academic Medicine, 71(1), S76-S78.

Stagnaro-Green, A. , Packman, C. , Backer, E. , & Elnicki, D. M. (1995). Ambulatory education: Expanding undergraduate experience in medical education a CDIM commentary. American Journal of Medicine, 99, 111-115.