Teaching and learning in outpatients and beyond: how ambulatory care teaching can contribute to student learning in child health.

CURRENT CHALLENGES AND PROBLEMS Medical school teaching in child health has traditionally been focused on the clinical problems seen in children, as inpatients, in tertiary care teaching hospitals. In recent years there has been a move to reduce inpatient stays and develop a more ambulatory model, with children being seen in rapid access or review clinics, to try to minimise the frequency and duration of inpatient stays. It is therefore even more important that the teaching we offer in these outpatient settings is of high quality and exposes students to a wide range of paediatric health and illness profi les. Current experiences of teaching in paediatric outpatient departments may be less than satisfactory for both students and clinicians. The traditional model of students ‘sitting in’ clinic alongside a specialist has the potential to be a powerful learning opportunity, but this may not always be realised. There may be insuffi cient time to teach due to the demands of service provision, a lack of available space for students to see patients on their own and, for the clinician, the feeling that there is no one else with whom to share the teaching load. Dedicated ‘teaching clinics’ are often perceived as a luxury in an NHS focused on service delivery. To ensure quality of practice in the future care of children and young people, it is necessary that our medical students acquire competence in relating to children and their carers.