title: The internal medicine clerkship and ambulatory learning experiences: results of the 2010 clerkship directors in internal medicine survey.
abstract: BACKGROUND
  Education in the ambulatory setting should be an integral part of undergraduate medical education. However, previous studies have shown education in this setting has been lacking in medical school. Ambulatory education occurs on some internal medicine clerkships. The extent of this education is unclear.
  
  
  OBJECTIVE
  The purpose of this survey was to assess the structure, curriculum, assessment methods, and barriers to implementation of ambulatory education on the internal medicine clerkship.
  
  
  METHODS
  An annual survey of institutional members of the Clerkship Directors in Internal Medicine (CDIM) was done in April 2010. The data were anonymous and descriptive statistics were used to summarize responses. Free text results were analyzed using qualitative techniques.
  
  
  RESULTS
  The response rate was 75%. The majority of respondents had a required ambulatory component to the clerkship. Ambulatory experiences distinct from the inpatient internal medicine experience were common (46%). Integration with either the inpatient experiences or other departmental clerkships also occurred. The majority of ambulatory educational experiences were with generalists (74%) and/or subspecialists (45%). The most common assessment tool was the National Board of Medical Examiners (NBME) ambulatory shelf exam. Thematic analysis of the question about how practice based learning was taught elicited four major themes: Not taught; taught in the context of learning evidence based medicine; taught while learning chronic disease management with quality improvement; taught while learning about health care finance. Barriers to implementation included lack of faculty and financial resources.
  
  
  CONCLUSIONS
  There have been significant increases in the amount of time dedicated to ambulatory internal medicine. The numbers of medical schools with ambulatory internal medicine education has increased. Integration of the ambulatory experiences with other clerkships such as family medicine occurs. Curriculum was varied but difficulties with dissemination and assessment in these disparate settings was noted. Overall, the results of this study demonstrate increased implementation and recognition of the importance of ambulatory education in internal medicine.
authors.affiliation: Department Clinical Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA. Shaheen@med.unc.edu
authors.forename: Amy
authors.initials: A
authors.lastname: Shaheen
authors.forename: Klara K
authors.initials: KK
authors.lastname: Papp
authors.forename: Dario
authors.initials: D
authors.lastname: Torre
mesh_terms: D000553:Ambulatory Care; D002170:Canada; D002982:Clinical Clerkship; D003430:Cross-Sectional Studies; D003479:Curriculum; D004504:Education, Medical, Undergraduate; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D008297:Male; D018794:Problem-Based Learning; D011795:Surveys and Questionnaires; D014481:United States