Perspectives on ambulatory programs: Barriers and implementation strategies

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Abstract
In this article, we share strategies used at several institutions to address common issues in establishing ambulatory experiences. The issues are grouped under three major headings: institutional/policy issues (institutional resistance, financing, faculty incentives), administrative/implementation issues (sites, patients, and space; recruiting faculty; recruiting/placing students), and curricular/academic issues (planning the experience, faculty development, program evaluation). First we review the rationale for ambulatory experiences and then briefly describe the programs involved. Next, for each topic area, we outline specific issues and strategies found useful at our institutions, including a variety of perspectives that should help readers find approaches that may be especially useful in their own environment.