PURPOSE: The majority of health care, both for acute and chronic conditions, is delivered in the ambulatory setting. Despite repeated
proposals for change, the majority of internal medicine residency training still occurs in the inpatient setting. Substantial
changes in ambulatory education are needed to correct the current imbalance. To assist educators and policy makers in this
process, this paper reviews the literature on ambulatory education and makes recommendations for change.
METHODS: The authors searched the Medline, Psychlit, and ERIC databases from 2000 to 2004 for studies that focused specifically on
curriculum, teaching, and evaluation of internal medicine residents in the ambulatory setting to update previous reviews.
Studies had to contain primary data and were reviewed for methodological rigor and relevance.
RESULTS: Fifty-five studies met criteria for review. Thirty-five of the studies focused on specific curricular areas and 11 on ambulatory
teaching methods. Five involved evaluating performance and 4 focused on structural issues. No study evaluated the overall
effectiveness of ambulatory training or investigated the effects of current resident continuity clinic microsystems on education.
CONCLUSION: This updated review continues to identify key deficiencies in ambulatory training curriculum and faculty skills. The authors
make several recommendations: (1) Make training in the ambulatory setting a priority. (2) Address systems problems in practice
environments. (3) Create learning experiences appropriate to the resident’s level of development. (4) Teach and evaluate in
the examination room. (5) Expand subspecialty-based training to the ambulatory setting. (6) Make faculty development a priority.
(7) Create and fund multiinstitutional educational research consortia.
Key Words ambulatory - graduate medical education - curriculum - faculty development - internal medicine
The authors have no conflicts of interest to report.
See editorial by Holly Humphrey, p. 1189