Ambulatory primary care medical education in managed care and non-managed care settings.
OBJECTIVE
The transformation of health care delivery to a managed care approach has implications for community-based clinical education in family medicine. In this study, we compare students' clerkship experiences in managed and non-managed care environments.


METHODS
Student clerkship encounter logs were used to compare clinical content, level of student-patient interactions, and types of preceptor supervision and teaching activities in five clusters of community-based practice sites. Three of the groups represented managed care settings, and two represented non-managed care settings.


RESULTS
The clinical content of students' experiences at the five types of teaching sites was not significantly different. However, teaching methods and responsibility levels were different. Observational student-patient interactions occurred more frequently, and comprehensive, direct student-patient interactions occurred less frequently in both managed and non-managed care private practices. Preceptor observation of students occurred less frequently in two managed care site clusters. A transition of variable degree and timing from observational to direct student-patient interactions occurred in all but one teaching cluster. Intra-site variation existed in both student-patient interactions and preceptor teaching and supervision.


CONCLUSIONS
Clinical education can be successfully conducted in managed care settings. Differences in practice settings influence student-patient interactions and preceptor teaching. These differences have implications for faculty development and student education.
Prislin
M D
MD
Department of Family Medicine, University of California, Irvine, USA.
Fitzpatrick
C
C
Munzing
T
T
Oravetz
P
P
Radecki
S
S
D000553:Ambulatory Care; D002140:California; D016009:Chi-Square Distribution; D002982:Clinical Clerkship; D003153:Community Health Services; D003479:Curriculum; D005194:Family Practice / Q000193:education*; D006801:Humans; D008329:Managed Care Programs; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011365:Professional Practice Location; D015397:Program Evaluation