Rationale And Special Features of Ambulatory Care Education

Most patients with medical illness do not require hospital admission

Chronic and acute conditions manifest a spectrum of severity from mild or early to severe or advanced. Only patients with severe forms of an acute illness or uncompensated exacerbations of chronic illness typically enter the hospital. To see the full spectrum of patients including those who are not yet diagnosed, newly diagnosed, or successfully managed, students must learn in clinics and private offices. Not all patients with coronary artery disease have heart failure. Not all patients with HIV disease have disseminated MAI. Not all patients with breast cancer have metastatic disease. The challenge for educators is to create clerkships in which students can develop accurate impressions of the spectrum of illness in these and other common chronic conditions.