Ambulatory Clinics: Learning Through Reflection

Today, our discussion focused on learning in the ambulatory clinics setting and the publications on this topic. Ambulatory clinics constitute a significant component of many Internists’ practice and yet our exposure to the ambulatory settings is often limited. For example, our own clerkship only includes 4 half-days of ambulatory clinics. Although students often enjoy their ambulatory experience, it sometimes feels as if we have just oriented ourselves before we leave again. My interest in learning more through the ambulatory care setting was one of the reasons that drew me to this selective.

What is the benefit of ambulatory care education and how can we optimize it? The importance of this type of experience lies in the fact ambulatory care is quite different in nature from the inpatient experience. Ambulatory practices often involving managing more complex and chronic conditions, through short but longitudinal visits (Bowen et al., 2005). This means that management plans need to be developed quickly but there is expanded opportunity to see the long-term response to treatments.

Publications on teaching in the ambulatory clinic setting emphasize a few strategies for optimizing learning (Bowen et al., 2005; S. Lipsky, 1999).

1. Matching learning and expectations to learner’s level e.g. through sharing learning goals, consistent relationship between learner and teacher.

2. Encourage students to formulate hypothesis and explain rationale to promote active engagement in clinical decision making.

3. Encourage reflection, journaling of ideas, and identifying personal learning issues.

The last point point is perhaps the most fascinating, as with blogging and our daily discussions, reflection has certainly been an active component of this selective. Reflection is considered a valuable part of clinical learning as it targets readings and helps create meaning from experience. For myself, I find that reflection helps put ideas into context, flush out my questions and learning goals, and encourage exploration of interesting topics. I hope to continue daily reflection as a part of my future routine. :)

-Jenny