Advantages and Perspectives of Teaching in Outpatient Clinics: A Systematic Review
Author(s)
Hani Almoallim1,2,3,
Joan Minguet1,
Khaled Albazli1,4,
Manal Alotaibi1,2,
Samar Alwafi1,5,
Maun Feteih6
Affiliation(s)
1 Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia. 2 Department of Medicine, Medical College, Umm Alqura University, Makkah, Saudi Arabia. 3 Department of Medicine, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia. 4 Department of Medicine, Medical College in Alqunfudah, Umm Alqura University, Makkah, Saudi Arabia. 5 Department of Dermatology, King Abdulaziz Medical City, Jeddah, Saudi Arabia. 6 Department of Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
1 Alzaidi Chair of Research in Rheumatic Diseases, Umm Alqura University, Makkah, Saudi Arabia. 2 Department of Medicine, Medical College, Umm Alqura University, Makkah, Saudi Arabia. 3 Department of Medicine, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia. 4 Department of Medicine, Medical College in Alqunfudah, Umm Alqura University, Makkah, Saudi Arabia. 5 Department of Dermatology, King Abdulaziz Medical City, Jeddah, Saudi Arabia. 6 Department of Medicine, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
ABSTRACT
Although the number of patients seen in outpatient clinics far surpasses those managed in inpatient settings, many medical training programs lack outpatient clinic teaching initiatives. Thus, we have conducted a systematic review of the literature in order to raise awareness of the important role that outpatient clinics can play in enhancing medical education, and to assess current perspectives on improving outpatient training. Our analysis reveals that outpatient clinics can offer an efficient and holistic view of patient care, while covering a wide range of general and specialty medical practices. Moreover, several fundamental skills can be acquired by students in outpatient clinics, which effectively combine elements encountered in routine ward-based teaching (etiology, history, physical examination, laboratory tests, and therapy) with those found in ambulatory care (continuity, context, health education, economics, and responsibility). Approaches to teaching in an outpatient setting vary greatly, with extensive differences in levels of supervision and feedback evident. It is clear that, at present, there is no general consensus on the best strategy for realizing the potential of outpatient clinics in the training of students and junior doctors. With the changing face of health systems, the identification of methods by which maximal benefits of this setting can be achieved would be highly advantageous for future medical trainees.
Although the number of patients seen in outpatient clinics far surpasses those managed in inpatient settings, many medical training programs lack outpatient clinic teaching initiatives. Thus, we have conducted a systematic review of the literature in order to raise awareness of the important role that outpatient clinics can play in enhancing medical education, and to assess current perspectives on improving outpatient training. Our analysis reveals that outpatient clinics can offer an efficient and holistic view of patient care, while covering a wide range of general and specialty medical practices. Moreover, several fundamental skills can be acquired by students in outpatient clinics, which effectively combine elements encountered in routine ward-based teaching (etiology, history, physical examination, laboratory tests, and therapy) with those found in ambulatory care (continuity, context, health education, economics, and responsibility). Approaches to teaching in an outpatient setting vary greatly, with extensive differences in levels of supervision and feedback evident. It is clear that, at present, there is no general consensus on the best strategy for realizing the potential of outpatient clinics in the training of students and junior doctors. With the changing face of health systems, the identification of methods by which maximal benefits of this setting can be achieved would be highly advantageous for future medical trainees.
Cite this paper
Almoallim, H. , Minguet, J. , Albazli, K. , Alotaibi, M. , Alwafi, S. and Feteih, M. (2015) Advantages and Perspectives of Teaching in Outpatient Clinics: A Systematic Review. Creative Education, 6, 1782-1789. doi: 10.4236/ce.2015.616181.
Almoallim, H. , Minguet, J. , Albazli, K. , Alotaibi, M. , Alwafi, S. and Feteih, M. (2015) Advantages and Perspectives of Teaching in Outpatient Clinics: A Systematic Review. Creative Education, 6, 1782-1789. doi: 10.4236/ce.2015.616181.
References
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http://dx.doi.org/10.1212/WNL.0000000000000333 [3] Almoallim, H., Chalmers, A., & Page, G. (2006). The High Clinic: A Pilot Project of a New Model for an Outpatient, Community-Based Teaching Clinic in Rheumatology. Medical Teacher, 28, 713-716.
http://dx.doi.org/10.1080/01421590601102956 [4] Azher, H., Lay, J., Stupart, D. A., Guest, G. D., & Watters, D. A. (2013). Medical Student Participation in a Surgical Outpatient Clinic: A Randomized Controlled Trial. ANZ Journal of Surgery, 83, 466-471.
http://dx.doi.org/10.1111/ans.12133 [5] Behmanesh, F., Ahanchian, H., Vakili, R., Ahanchian, N., & Bagheri, S. (2014). Teaching Final-Year Medical Students in a Paediatric Ambulatory Care Unit. The Clinical Teacher, 11, 361-364.
http://dx.doi.org/10.1111/tct.12150 [6] Bentley, J. D., Knapp, R. M., & Petersdorf, R. G. (1989). Education in Ambulatory Care—Financing Is One Piece of the Puzzle. The New England Journal of Medicine, 320, 1531-1534.
http://dx.doi.org/10.1056/NEJM198906083202306 [7] Bowen, J. L., & Irby, D. M. (2002). Assessing Quality and Costs of Education in the Ambulatory Setting: A Review of the Literature. Academic Medicine: Journal of the Association of American Medical Colleges, 77, 621-680.
http://dx.doi.org/10.1097/00001888-200207000-00006 [8] Busari, J. O., Weggelaar, N. M., Knottnerus, A. C., Greidanus, P. M., & Scherpbier, A. J. (2005). How Medical Residents Perceive the Quality of Supervision Provided by Attending Doctors in the Clinical Setting. Medical Education, 39, 696-703.
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http://dx.doi.org/10.1016/S0002-9610(96)00184-5 [11] Choudhury, T. R., Moosa, A. A., Cushing, A., & Bestwick, J. (2006). Patients’ Attitudes towards the Presence of Medical Students during Consultations. Medical Teacher, 28, e198-e203.
http://dx.doi.org/10.1080/01421590600834336 [12] Cook, D. A., Beckman, T. J., Thomas, K. G., & Thompson, W. G. (2008). Introducing Resident Doctors to Complexity in Ambulatory Medicine. Medical Education, 42, 838-848.
http://dx.doi.org/10.1111/j.1365-2923.2008.03108.x [13] Crawford, G. H., Gutman, A., Kantor, J., & James, W. D. (2005). Patients’ Attitudes toward Resident Participation in Dermatology Outpatient Clinics. Journal of the American Academy of Dermatology, 53, 710-712.
http://dx.doi.org/10.1016/j.jaad.2005.05.003 [14] Dent, J. A. (2005). Amee Guide No. 26: Clinical Teaching in Ambulatory Care Settings: Making the Most of Learning Opportunities with Outpatients. Medical Teacher, 27, 302-315.
http://dx.doi.org/10.1080/01421590500150999 [15] Dubey, S. G., Roberts, C., Adebajo, A. O., & Snaith, M. L. (2004). Rheumatology Training in the United Kingdom: The Trainees’ Perspective. Rheumatology (Oxford), 43, 896-900.
http://dx.doi.org/10.1093/rheumatology/keh192 [16] Fincher, R. M. E., & Albritton, T. A. (1993). The Ambulatory Experience for Junior Medical Students at the Medical College of Georgia. Teaching and Learning in Medicine, 5, 210-213.
http://dx.doi.org/10.1080/10401339309539624 [17] Flanagan, T., Mitchner, B., Weyl-Feyling, D., & Laros Jr., R. K. (1995). The Cost of Teaching Residents Outpatient Obstetrics and Gynecology in a University Medical Center. Obstetrics and Gynecology, 86, 1014-1017.
http://dx.doi.org/10.1016/0029-7844(95)00321-H [18] Gamble, J. G., & Lee, R. (1991). Investigating Whether Education of Residents in a Group Practice Increases the Length of the Outpatient Visit. Academic Medicine: Journal of the Association of American Medical Colleges, 66, 492-493.
http://dx.doi.org/10.1097/00001888-199108000-00019 [19] Gigante, J., & Swan, R. (2010). A Simplified Observation Tool for Residents in the Outpatient Clinic. Journal of Graduate Medical Education, 2, 108-110.
http://dx.doi.org/10.4300/JGME-D-09-00090.1 [20] Hajioff, D., & Birchall, M. (1999). Medical Students in Ent Outpatient Clinics: Appointment Times, Patient Satisfaction and Student Satisfaction. Medical Education, 33, 669-673.
http://dx.doi.org/10.1046/j.1365-2923.1999.00422.x [21] Harden, J. R., Crosby, M. H., Davis, M., & Friedman, R. M. (1999). Amee Guide No. 14: Outcome-Based Education: Part 5—From Competency to Meta-Competency: A Model for the Specification of Learning Outcomes. Medical Teacher, 21, 546-552.
http://dx.doi.org/10.1080/01421599978951 [22] Hecker, K. G., Norris, J., & Coe, J. B. (2012). Workplace-Based Assessment in a Primary-Care Setting. Journal of Veterinary Medical Education, 39, 229-240.
http://dx.doi.org/10.3138/jvme.0612.054R [23] Irby, D. M. (1995). Teaching and Learning in Ambulatory Care Settings: A Thematic Review of the Literature. Academic Medicine: Journal of the Association of American Medical Colleges, 70, 898-931.
http://dx.doi.org/10.1097/00001888-199510000-00014 [24] Kerfoot, B. P., & DeWolf, W. C. (2002). Does the Outpatient Setting Provide the Best Environment for Medical Student Learning of Urology? The Journal of Urology, 167, 1797-1799.
http://dx.doi.org/10.1016/S0022-5347(05)65213-5 [25] Kotur, P. F. (2012). Introduction of Evidence-Based Medicine in Undergraduate Medical Curriculum for Development of Professional Competencies in Medical Students. Current Opinion in Anaesthesiology, 25, 719-723.
http://dx.doi.org/10.1097/ACO.0b013e32835a1112 [26] Krackov, S. K., Birskovich, L., Packman, C. H., Seward, S. J., Ragansmith, M. G., & Baker, S. D. (1993). Perspectives on Ambulatory Programs: Barriers and Implementation Strategies. Teaching and Learning in Medicine, 5, 243-250.
http://dx.doi.org/10.1080/10401339309539631 [27] Lawson, M. M., F. (1993). Sharing Good Practice: Innovative Learning and Assessment. London: King’s Fund Centre. [28] MacDougall, J. (2003). On-the-Job Training: Ward and Clinic. The Obstetrician & Gynaecologist, 5, 221-225.
http://dx.doi.org/10.1576/toag.5.4.221.26936 [29] Mariam, D. H., Sagay, A. S., Arubaku, W., Bailey, R. J., Baingana, R. K., Burani, A. et al. (2014). Community-Based Education Programs in Africa: Faculty Experience within the Medical Education Partnership Initiative (Mepi) Network. Academic Medicine: Journal of the Association of American Medical Colleges, 89, S50-S54.
http://dx.doi.org/10.1097/ACM.0000000000000330 [30] McGee, S. R., & Irby, D. M. (1997). Teaching in the Outpatient Clinic. Practical Tips. Journal of General Internal Medicine, 12, S34-S40.
http://dx.doi.org/10.1046/j.1525-1497.12.s2.5.x [31] Meyers, F. J., Weinberger, S. E., Fitzgibbons, J. P., Glassroth, J., Duffy, F. D., & Clayton, C. P. (2007). Redesigning Residency Training in Internal Medicine: The Consensus Report of the Alliance for Academic Internal Medicine Education Redesign Task Force. Academic Medicine: Journal of the Association of American Medical Colleges, 82, 1211-1219.
http://dx.doi.org/10.1097/ACM.0b013e318159d010 [32] Moon, M., Taylor, H. A., McDonald, E. L., Hughes, M. T., & Carrese, J. A. (2009). Everyday Ethics Issues in the Outpatient Clinical Practice of Pediatric Residents. Archives of Pediatrics & Adolescent Medicine, 163, 838-843.
http://dx.doi.org/10.1001/archpediatrics.2009.139 [33] Neumayer, L., McNamara, R. M., Dayton, M., & Kim, B. (1998). Does Volume of Patients Seen in an Outpatient Setting Impact Test Scores? American Journal of Surgery, 175, 511-514.
http://dx.doi.org/10.1016/S0002-9610(98)00086-5 [34] Panayiotou, B. N., & Fotherby, M. D. (1996). Junior Hospital Doctors’ Views on Their Training in the UK. Postgraduate Medical Journal, 72, 547-550.
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http://dx.doi.org/10.4103/2249-4863.109935
[1] Al Ghamdi, K. M., Almohanna, H. M., Alkeraye, S. S., Alsaif, F. M., & Alrasheed, S. K. (2014). Perceptions, Attitudes, and Satisfaction Concerning Resident Participation in Health Care among Dermatology Outpatients. Journal of Cutaneous Medicine and Surgery, 18, 20-27. [2] Albert, D. V., Brorson, J. R., Amidei, C., & Lukas, R. V. (2014). Education Research: Case Logs in the Assessment of Medical Students in the Neurology Outpatient Clinic. Neurology, 82, e138-e141.
http://dx.doi.org/10.1212/WNL.0000000000000333 [3] Almoallim, H., Chalmers, A., & Page, G. (2006). The High Clinic: A Pilot Project of a New Model for an Outpatient, Community-Based Teaching Clinic in Rheumatology. Medical Teacher, 28, 713-716.
http://dx.doi.org/10.1080/01421590601102956 [4] Azher, H., Lay, J., Stupart, D. A., Guest, G. D., & Watters, D. A. (2013). Medical Student Participation in a Surgical Outpatient Clinic: A Randomized Controlled Trial. ANZ Journal of Surgery, 83, 466-471.
http://dx.doi.org/10.1111/ans.12133 [5] Behmanesh, F., Ahanchian, H., Vakili, R., Ahanchian, N., & Bagheri, S. (2014). Teaching Final-Year Medical Students in a Paediatric Ambulatory Care Unit. The Clinical Teacher, 11, 361-364.
http://dx.doi.org/10.1111/tct.12150 [6] Bentley, J. D., Knapp, R. M., & Petersdorf, R. G. (1989). Education in Ambulatory Care—Financing Is One Piece of the Puzzle. The New England Journal of Medicine, 320, 1531-1534.
http://dx.doi.org/10.1056/NEJM198906083202306 [7] Bowen, J. L., & Irby, D. M. (2002). Assessing Quality and Costs of Education in the Ambulatory Setting: A Review of the Literature. Academic Medicine: Journal of the Association of American Medical Colleges, 77, 621-680.
http://dx.doi.org/10.1097/00001888-200207000-00006 [8] Busari, J. O., Weggelaar, N. M., Knottnerus, A. C., Greidanus, P. M., & Scherpbier, A. J. (2005). How Medical Residents Perceive the Quality of Supervision Provided by Attending Doctors in the Clinical Setting. Medical Education, 39, 696-703.
http://dx.doi.org/10.1111/j.1365-2929.2005.02190.x [9] Carrese, J. A., McDonald, E. L., Moon, M., Taylor, H. A., Khaira, K., Catherine Beach, M. et al. (2011). Everyday Ethics in Internal Medicine Resident Clinic: An Opportunity to Teach. Medical Education, 45, 712-721.
http://dx.doi.org/10.1111/j.1365-2923.2011.03931.x [10] Chatenay, M., Maguire, T., Skakun, E., Chang, G., Cook, D., & Warnock, G. L. (1996). Does Volume of Clinical Experience Affect Performance of Clinical Clerks on Surgery Exit Examinations? American Journal of Surgery, 172, 366-372.
http://dx.doi.org/10.1016/S0002-9610(96)00184-5 [11] Choudhury, T. R., Moosa, A. A., Cushing, A., & Bestwick, J. (2006). Patients’ Attitudes towards the Presence of Medical Students during Consultations. Medical Teacher, 28, e198-e203.
http://dx.doi.org/10.1080/01421590600834336 [12] Cook, D. A., Beckman, T. J., Thomas, K. G., & Thompson, W. G. (2008). Introducing Resident Doctors to Complexity in Ambulatory Medicine. Medical Education, 42, 838-848.
http://dx.doi.org/10.1111/j.1365-2923.2008.03108.x [13] Crawford, G. H., Gutman, A., Kantor, J., & James, W. D. (2005). Patients’ Attitudes toward Resident Participation in Dermatology Outpatient Clinics. Journal of the American Academy of Dermatology, 53, 710-712.
http://dx.doi.org/10.1016/j.jaad.2005.05.003 [14] Dent, J. A. (2005). Amee Guide No. 26: Clinical Teaching in Ambulatory Care Settings: Making the Most of Learning Opportunities with Outpatients. Medical Teacher, 27, 302-315.
http://dx.doi.org/10.1080/01421590500150999 [15] Dubey, S. G., Roberts, C., Adebajo, A. O., & Snaith, M. L. (2004). Rheumatology Training in the United Kingdom: The Trainees’ Perspective. Rheumatology (Oxford), 43, 896-900.
http://dx.doi.org/10.1093/rheumatology/keh192 [16] Fincher, R. M. E., & Albritton, T. A. (1993). The Ambulatory Experience for Junior Medical Students at the Medical College of Georgia. Teaching and Learning in Medicine, 5, 210-213.
http://dx.doi.org/10.1080/10401339309539624 [17] Flanagan, T., Mitchner, B., Weyl-Feyling, D., & Laros Jr., R. K. (1995). The Cost of Teaching Residents Outpatient Obstetrics and Gynecology in a University Medical Center. Obstetrics and Gynecology, 86, 1014-1017.
http://dx.doi.org/10.1016/0029-7844(95)00321-H [18] Gamble, J. G., & Lee, R. (1991). Investigating Whether Education of Residents in a Group Practice Increases the Length of the Outpatient Visit. Academic Medicine: Journal of the Association of American Medical Colleges, 66, 492-493.
http://dx.doi.org/10.1097/00001888-199108000-00019 [19] Gigante, J., & Swan, R. (2010). A Simplified Observation Tool for Residents in the Outpatient Clinic. Journal of Graduate Medical Education, 2, 108-110.
http://dx.doi.org/10.4300/JGME-D-09-00090.1 [20] Hajioff, D., & Birchall, M. (1999). Medical Students in Ent Outpatient Clinics: Appointment Times, Patient Satisfaction and Student Satisfaction. Medical Education, 33, 669-673.
http://dx.doi.org/10.1046/j.1365-2923.1999.00422.x [21] Harden, J. R., Crosby, M. H., Davis, M., & Friedman, R. M. (1999). Amee Guide No. 14: Outcome-Based Education: Part 5—From Competency to Meta-Competency: A Model for the Specification of Learning Outcomes. Medical Teacher, 21, 546-552.
http://dx.doi.org/10.1080/01421599978951 [22] Hecker, K. G., Norris, J., & Coe, J. B. (2012). Workplace-Based Assessment in a Primary-Care Setting. Journal of Veterinary Medical Education, 39, 229-240.
http://dx.doi.org/10.3138/jvme.0612.054R [23] Irby, D. M. (1995). Teaching and Learning in Ambulatory Care Settings: A Thematic Review of the Literature. Academic Medicine: Journal of the Association of American Medical Colleges, 70, 898-931.
http://dx.doi.org/10.1097/00001888-199510000-00014 [24] Kerfoot, B. P., & DeWolf, W. C. (2002). Does the Outpatient Setting Provide the Best Environment for Medical Student Learning of Urology? The Journal of Urology, 167, 1797-1799.
http://dx.doi.org/10.1016/S0022-5347(05)65213-5 [25] Kotur, P. F. (2012). Introduction of Evidence-Based Medicine in Undergraduate Medical Curriculum for Development of Professional Competencies in Medical Students. Current Opinion in Anaesthesiology, 25, 719-723.
http://dx.doi.org/10.1097/ACO.0b013e32835a1112 [26] Krackov, S. K., Birskovich, L., Packman, C. H., Seward, S. J., Ragansmith, M. G., & Baker, S. D. (1993). Perspectives on Ambulatory Programs: Barriers and Implementation Strategies. Teaching and Learning in Medicine, 5, 243-250.
http://dx.doi.org/10.1080/10401339309539631 [27] Lawson, M. M., F. (1993). Sharing Good Practice: Innovative Learning and Assessment. London: King’s Fund Centre. [28] MacDougall, J. (2003). On-the-Job Training: Ward and Clinic. The Obstetrician & Gynaecologist, 5, 221-225.
http://dx.doi.org/10.1576/toag.5.4.221.26936 [29] Mariam, D. H., Sagay, A. S., Arubaku, W., Bailey, R. J., Baingana, R. K., Burani, A. et al. (2014). Community-Based Education Programs in Africa: Faculty Experience within the Medical Education Partnership Initiative (Mepi) Network. Academic Medicine: Journal of the Association of American Medical Colleges, 89, S50-S54.
http://dx.doi.org/10.1097/ACM.0000000000000330 [30] McGee, S. R., & Irby, D. M. (1997). Teaching in the Outpatient Clinic. Practical Tips. Journal of General Internal Medicine, 12, S34-S40.
http://dx.doi.org/10.1046/j.1525-1497.12.s2.5.x [31] Meyers, F. J., Weinberger, S. E., Fitzgibbons, J. P., Glassroth, J., Duffy, F. D., & Clayton, C. P. (2007). Redesigning Residency Training in Internal Medicine: The Consensus Report of the Alliance for Academic Internal Medicine Education Redesign Task Force. Academic Medicine: Journal of the Association of American Medical Colleges, 82, 1211-1219.
http://dx.doi.org/10.1097/ACM.0b013e318159d010 [32] Moon, M., Taylor, H. A., McDonald, E. L., Hughes, M. T., & Carrese, J. A. (2009). Everyday Ethics Issues in the Outpatient Clinical Practice of Pediatric Residents. Archives of Pediatrics & Adolescent Medicine, 163, 838-843.
http://dx.doi.org/10.1001/archpediatrics.2009.139 [33] Neumayer, L., McNamara, R. M., Dayton, M., & Kim, B. (1998). Does Volume of Patients Seen in an Outpatient Setting Impact Test Scores? American Journal of Surgery, 175, 511-514.
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