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Justifying the Need and Exploring Learning Opportunities for Clinical Teaching to Medical Students in Ambulatory Settings


1 Medical Education Unit Coordinator and Member of the Institute Research Council, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India
2 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth – Deemed to be University, Ammapettai, Nellikuppam, Chengalpet District, Tamil Nadu, India

Date of Submission28-Mar-2021
Date of Decision15-Jun-2021
Date of Acceptance26-Jun-2021
Date of Web Publication11-Oct-2021

Correspondence Address:
Saurabh RamBihariLal Shrivastava,
MD,FAIMER, PGDHHM, DHRM, FCS, ACME, Professor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (SBV) – Deemed to be University, Thiruporur - Guduvancherry Main Road, Ammapettai, Nellikuppam, Chengalpet District - 603108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mamcjms.mamcjms_32_21

  Abstract 


As the ultimate aim of medical education is to produce a competent medical student who can meet the needs of the community they serve, the acquisition of clinical skills and other attributes carries immense importance in the training period. Keeping this in mind, the clinical teaching offered to the medical students is a crucial component of training and all efforts should be taken by the administrators and teachers to increase the number of opportunities available to medical students for teaching and learning. Owing to the changing dynamics in patient care, the ambulatory care settings end to neutralize all the limitations attributed to the ward teaching. In conclusion, clinical teaching in the field of medical education has gradually moved from the wards to the ambulatory settings. These settings precisely reflect the true spectrum of health and disease in the community and it is the need of the hour to expose the medical student to these wide ranges of learning opportunities and help them to become self-directed learners.

Keywords: Ambulatory care, clinical teaching, medical students



How to cite this URL:
Shrivastava SR, Shrivastava PS. Justifying the Need and Exploring Learning Opportunities for Clinical Teaching to Medical Students in Ambulatory Settings. MAMC J Med Sci [Epub ahead of print] [cited 2021 Dec 3]. Available from: https://www.mamcjms.in/preprintarticle.asp?id=328061




  Introduction Top


As the ultimate aim of medical education is to produce a competent medical student who can meet the needs of the community they serve, the acquisition of clinical skills and other attributes such as professional approach, better communication skills, etc., carries immense importance in the training period. Keeping this in mind, the clinical teaching offered to the medical students is a crucial component of training and all efforts should be taken by the administrators and teachers to increase the number of opportunities available to medical students for teaching and learning.[1] Moreover, additional emphasis has also been given toward early clinical exposure and this again justifies the need for strengthening of clinical teaching.[1]

Clinical Teaching in Ambulatory Settings

It would not be wrong to document that medical students learn clinical skills, including critical thinking, clinical reasoning, and problem-solving, by being a part of the daily care of the patient, obviously under the supervision of teachers.[1],[2] However, owing to the changing dynamics in patient care, gradually the nodal point for teaching clinical skills has shifted from wards to ambulatory settings.[2] Ambulatory care in hospital setup refers to those places wherein patients are offered clinical care (such as consultation, diagnostic, or therapeutic procedure) without being admitted as inpatients (or without night stay in hospitals), and can range from routine outpatient departments, casualty, clinical investigation units, radiology department, etc.[3]

Necessity of Clinical Teaching in Ambulatory Settings

The clinical teaching in ambulatory care has attracted more attention as only critical patients are being admitted in hospital for long-term and they are usually not representative of the medical problems prevalent in the region. At the same time, most of the admitted patients are in acute active management and thus the extent of cooperation from them in clinical teaching to a large group of students is questionable (in terms of the amount of time available for each student for patient contact).[2],[3] Moreover, most of the patients prefer to get discharged at the earliest and there has been a rising trend for day-care procedures, which further reduces the probability of interaction between medical students and clinical materials. All these existing scenarios favor the encouragement of clinical teaching in ambulatory settings, wherein students can be exposed to a wide spectrum of clinical illnesses and learning opportunities.[1],[2],[3]

Additional Considerations

In ambulatory care settings, the medical students are generally exposed to common medical problems, which are representative of the medical illnesses and thus prepares the students for the future. Moreover, the patients attending outpatient clinics often give detailed history and have also specific physical findings and thus helps the learner to master basic skills, which is not always possible in case of inpatients.[1],[3] Further, owing to the large number of patients visiting ambulatory settings, a large number of students can be accommodated and their learning needs are also met. In addition, clinical teaching in ambulatory settings helps the students to improve their relationship with patients/teachers, exposes them to a wide range of clinical topics, and makes the learning process enjoyable.[3]

Ambulatory settings create ample opportunities for near-peer teaching, wherein senior students or postgraduate residents can also teach the medical students.[4] In fact, a number of strategies such as maintenance of logbooks (documentation of clinical interactions with reflections), employment of task-based learning or study guides or handbooks, or adoption of a learner-centered approach can be used to facilitate teaching in such settings.[2],[3] However, for the successful implementation of clinical teaching in ambulatory settings, a system has to be established which not only includes the framework for clinical teaching, but also gives due importance to the logistic requirements to deal with large number of students.[3] Moreover, a periodic review of such teaching also should be conducted to improve upon the existing practices with an ultimate intention to benefit medical students.[3]


  Conclusion Top


In conclusion, clinical teaching in the field of medical education has gradually moved from the wards to the ambulatory settings. These settings precisely reflect the true spectrum of health and disease in the community and it is the need of the hour to expose the medical student to these wide ranges of learning opportunities and help them to become self-directed learners.

Contribution details

SRS contributed in the conception or design of the work, drafting of the work, approval of the final version of the manuscript, and agreed for all aspects of the work. PSS contributed in the literature review, revision of the manuscript for important intellectual content, approval of the final version of the manuscript, and agreed for all aspects of the work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hassan BA, Elfaki OA, Khan MA. The impact of outpatient clinical teaching on students’ academic performance in obstetrics and gynecology. J Family Community Med 2017;24:196-9.  Back to cited text no. 1
    
2.
Figueiró-Filho EA, Amaral E, McKinley D, Bezuidenhout J, Tekian A. Minimal supervision out-patient clinical teaching. Clin Teach 2014;11:365-9.  Back to cited text no. 2
    
3.
Dent JA. AMEE Guide No 26: clinical teaching in ambulatory care settings: making the most of learning opportunities with outpatients. Med Teach 2005;27:302-15.  Back to cited text no. 3
    
4.
Ince-Cushman D, Rudkin T, Rosenberg E. Supervised near-peer clinical teaching in the ambulatory clinic: an exploratory study of family medicine residents’ perspectives. Perspect Med Educ 2015;4:8-13.  Back to cited text no. 4
    




 

 
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