Creating Clinicians

November 18, 1999

Judith Zwolak

Before they are sent out into the real world as physicians, medical students and residents have years of clinical training dealing with actual patients. A new program at Tulane's School of Medicine aims to improve on those years through a pilot study of an experimental curriculum that focuses on the outpatient setting.

The school's new Ambulatory Healthcare Curriculum teams a medical student with a resident and introduces him or her to issues confronted in an outpatient setting, also referred to in the medical community as ambulatory care.

"We're setting up this curriculum because we think it's a good way to train students to practice medicine for the future in the outpatient setting," says Kevin Krane, principal investigator of the study and vice dean for academic affairs at the medical school.

Funded through a $301,000, three-year grant from the Quality Care Research Fund, which is sponsored through the Aetna Foundation, the program takes place one half-day per week over a 10-month period.

For two weeks each month, the student and resident spend half a day participating in a community physician's office. During the other two weeks, the team participates in a half-day, small-group seminar on topics related to ambulatory care.

These topics include understanding the healthcare system, performing a focused examination and promoting preventive medicine. Krane says the combination of didactic seminars and interaction with the community physicians should help students and residents encounter situations that will make them more effective clinicians.

"There are certain skills that are particularly important in the outpatient setting, for example, how to do a focused exam," he says. "In an outpatient setting, people are not always coming in for complete exams, they're coming in for a follow-up visit or evaluation of a specific problem, whether it's shoulder pain, back pain, diabetes, asthma or a headache."

"It takes a lot of specific skills for a student or resident to focus on the problem, do a limited exam and get the maximum amount of information in a very short period of time. Another goal of the program is to provide a longitudinal curriculum in the third and fourth years--the clerkship years--of medical school," Krane says. "We'd like the third and fourth years to be viewed as a two-year block of time rather than as separate years," he says.

The first group of 16 participants in the study--eight medical students and eight primary care residents--will begin the curriculum this fall. After 10 months, the study will evaluate the effectiveness of the curriculum through the schools Standardized Patient Program. In this program, trained teaching associates act as patients and evaluate the medical students and residents communication and examination skills.

The study will compare the participants' performances on the standardized patient exams with the performances of the students and residents in the traditional curriculum. An advisory group composed of community physicians, healthcare-industry representatives and faculty members from Tulane's schools of medicine and public health are developing the curriculum, Krane says.

"The program also includes professional development for the community physicians to aid their teaching efforts. If the pilot program is successful in teaching the knowledge, skills and attitudes necessary for dealing with patients in an outpatient setting," Krane says, "the program will expand to the rest of the students and primary-care residents."

Tulane University, New Orleans, LA 70118 504-865-5000