Teaching in the outpatient clinic. Practical tips.

F or teachers of medicine, the outpatient clinic promises many unique educational opportunities including more complete observation of chronic diseases, closer relationships between teachers and learners, and a more appropriate forum for teaching preventive medicine, medical interviewing, and psychosocial aspects of disease. Despite these educational benefits, teachers face many challenges in the clinics. Not only do most teachers feel there is inadequate time to teach, 1 they also have little control over the distribution and organization of this time. Unlike teachers in hospital wards, who often focus on only two or three patients during teaching rounds, outpatient teachers must address the concerns of each patient while the patient is still in the clinic, leaving little or no time for more elaborate instruction (typically 1 minute or less per case). 2 Furthermore, teaching about a single well-defined complaint often fails in the ambulatory setting because many problems occur simultaneously, organic findings are intertwined with psychosocial issues, and diagnostic questions are settled more often by observation or empiric treatment than by laboratory testing. In a recent, comprehensive review of educational research on ambulatory education, 3 four important points were made. First, the environmental variables of a particular outpatient clinic—case mix of clinic, pace of workload, structured time for teaching, space for teaching— have little if any impact on the overall ratings of teaching effectiveness. 4,5 Second, the behavior of teachers strongly influences the perceived success of the ambulatory experience. 6–8 Effective teachers ask questions, show interest, define goals, demonstrate competence, and, most importantly, spend time with the learner. 9,10