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Learning medicine in the community

BMJ 1995; 310 doi: (Published 11 February 1995) Cite this as: BMJ 1995;310:343
  1. Jenny Field,
  2. Ann-Louise Kinmonth
  1. Senior lecturer Professor Primary Medical Care, University of Southampton, Southampton SO1 6ST

    Learners should be where the patients are

    “Medical Education is a reflection of medical practice; it is not the education that will change the practitioners, but reformed practice that will redesign medical education.”1 George Silver, professor of epidemiology and public health at Yale, wrote in 1983, reflecting on repeated and ineffective attempts over the years to improve medical care through education. We are now undergoing just such a reformation in the delivery of health care. Patients in hospital are likely to be very sick indeed or admitted briefly for minimally invasive surgery or investigation. Much of the natural course of those chronic disorders that put the greatest burden on our society can now be best observed outside hospital. Students based in the community can follow up patients over longer periods than before and, by accompanying these patients when they go into hospital, can see secondary care in an appropriate context.

    The General Medical Council recently recommended that medical students should gain more experience in outpatient clinics, general practice, and community health services.2 Pioneering steps have already been taken by King's medical firm in the community,3 the Cambridge community …

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