A Survey of Changes in the Proportions of Ambulatory Training in Internal Medicine Clerkships and Residencies from 1986–87 to 1996–97

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Abstract
To determine changes from 1986–87 to 1996–97 in the proportions of time devoted to education in ambulatory settings within clerkships and internal medicine residencies. In 1997, a questionnaire was sent to the departments of internal medicine of all 125 U.S. medical schools. The response rate was 73%. Training in ambulatory settings increased greatly over the decade. The percentages of time in ambulatory settings increased for clerkships from 6% to 28%, and for residencies from 14% to 30%. In 1986–87, two thirds of clerkships provided no ambulatory training; by 1996–97, only 5% were exclusively inpatient. In 1986–87, 56% of residencies devoted 10% or less of their time to ambulatory education. By 1996–97, no residency program was in this category, while 87% devoted at least 20% of their time to ambulatory training. All programs used hospital clinics for ambulatory education; more than half used private physicians' offices, while fewer used health centers, home care services, and HMOs. Problems in expanding ambulatory training included inadequate numbers of sites or patient volumes (58% of programs), insufficient instructors (55%), and costs. There has been a major increase in the proportions of time devoted to ambulatory education in clerkships and residencies. Significant problems impede the reported desire of program directors further to increase these proportions.

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