Intended for healthcare professionals

Practice Teaching Rounds

Teaching in an ambulatory care setting

BMJ 2008; 337 doi: (Published 03 September 2008) Cite this as: BMJ 2008;337:a1156
  1. Caroline Sprake, senior medical tutor1,
  2. Peter Cantillon, senior lecturer2,
  3. Jane Metcalf, senior lecturer1,
  4. John Spencer, professor1
  1. 1School of Medical Sciences Education Development, Newcastle University, Newcastle upon Tyne NE2 4HH
  2. 2Department of General Practice, National University of Ireland, Galway
  1. Correspondence to: John Spencer j.a.spencer{at}

    Four third-year medical students are coming to the clinic for half a day a week. They have just finished their basic clinical skills training and the aim of their attendance is to further develop their history taking and examination skills in the maelstrom of clinical practice. What organisational issues do you need to consider?

    Medical education is on the move. In the past, clinical education was provided almost exclusively in hospital, but now the emphasis is increasingly on learning in ambulatory settings.1 2 Ambulatory care has been defined as that delivered to patients who are not residing in a healthcare institution—so ambulatory settings comprise outpatient clinics, emergency rooms, and primary care.3 Learning in an ambulatory setting offers a number of advantages. Patients are generally less sick than in hospital and are often easier for students to interact with. It is also more likely that patients are known to the healthcare team, which in turn leads to more complete understanding of illness and its impact on patients’ lives. Ambulatory based teaching can also provide multiple exposures to the same clinical problems, allowing undergraduate and postgraduate learners to build more complex and transferrable knowledge.4 Further, important areas such as health promotion are more often practised in ambulatory environments, and patients are encountered closer to their own social context.4

    What to teach in ambulatory care?

    Most of the knowledge, skills, and attitudes required for professional practice can be learnt in ambulatory settings. The diverse contexts offer different opportunities. In hospital outpatients, for example, learners can attend specialist clinics and learn about diagnosis and management of specific diseases. In primary care, learners can see early presentation of disease or observe the long term impact of disease on patients and families. Ambulatory investigation centres allow learners to observe diagnostic procedures, understand the underlying rationale, and appreciate patients’ …

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