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Academia and the Profession |

Educating Physicians and Treating Patients in the Ambulatory Setting: Where Are We Going and How Will We Know When We Arrive?

ROBERT H. BROOK, M.D., Sc.D.; ARLENE FINK, Ph.D.; JACQUELINE KOSECOFF, Ph.D.; LAWRENCE S. LINN, Ph.D.; WENDY EVERETT WATSON, Sc.D.; ALLYSON ROSS DAVIES, Ph.D.; VIRGINIA A. CLARK, Ph.D.; CAREN KAMBERG, M.S.P.H.; and THOMAS L. DELBANCO, M.D.
[+] Article and Author Information

Grant support: by grant 5318 from the Robert Wood Johnson Foundation.

The views expressed herein do not necessarily represent those of the Robert Wood Johnson Foundation.

▸Requests for reprints should be addressed to Robert H. Brook, M.D.; Department of Medicine, UCLA Center for Health Sciences; Los Angeles, CA 90024.


© 1987 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1987;107(3):392-398. doi:10.7326/0003-4819-107-2-392
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We evaluated 15 group practices in general internal medicine in university hospitals with regard to access to and quality of care, patients' satisfaction with that care, and quality of residency education provided. We used these data to speculate about potential changes in ambulatory care programs in university teaching hospitals. All 15 practices participated for 4 years. One third of their patient population had no medical insurance. Practice patients had twice as many chronic illnesses as did the general population, and two fifths of patients stayed at least 2 years in the practice. Few faculty members spent more than 14 hours weekly in the practices, and housestaff worked an average of 4 hours per week. Patient waiting times did not meet ideal standards, but patient satisfaction was higher than in a general population. Compliance with quality of care criteria was not exceptional; for example, 10% of eligible patients received an annual influenza vaccination. Housestaff assigned a relatively low ranking to their educational experience in the practices. We recommend the institution of additional experimental programs in ambulatory care and housestaff education to improve the quality of care in the ambulatory setting.

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