Choosing a topic for my research project in this selective was difficult for a number of reasons. Firstly, the landscape of literature in medical education is simultaneously vast and vague. As I mentioned previously, there is no clear model for what a ‘good medical education’ comprises. One of the articles in our reading, ‘’Continuity’ as an Organizing Principle for Clinical Education Reform’ champions a longitudinal model of clerkship to emphasize a continuous learning environment, arguing that it encourages a sense of deep commitment to patients, is better suited to teaching the central themes such as professionalism, and can facilitate ambulatory care clinics as a source of high-quality interdisciplinary training.

At the same time, internal medicine residencies seem to be struggling with longitudinal clinical experiences. Some of the Canadian residency programs have previously implemented a cross-rotation ambulatory clinic into the second or third year of residency, only to eliminate them in recent curriculum redesign due to the Royal College’s exam schedule moving into the third year. Understandably, something needs to be readjusted for these changes, but I find it interesting that the longitudinal ambulatory clinic was eliminated given that recent research seems to support these experiences as some of the most valuable; at least, the most congruent with cutting-edge learning theory.

My experiences in ambulatory clinic have been varied, and overall they confirm that the value of clinic is realized in a longterm format. The current organization of this selective involves us making ‘guest appearances’ in clinics for a few hours, usually only once or twice in each clinic overall. There are some advantages to that method; our exposure is better, we see a variety of clinical microsystems, work with many different preceptors, and explore numerous high-yield clinical topics such as hypertension and COPD. The downsides, however, is that we cannot connect deeply with our patients or feel as though we are making a significant impact on their care, since we know their cases so much less than the other health care professionals involved. Similarly it is hard to establish a rhythm of learner autonomy with our preceptors; while all the staff physicians I’ve worked with have been exceptional teachers, three hours is not enough to reach the comfort level of working together and also truly benefit from the learning.

As I enter the last week of this selective, I can see that ambulatory medicine has so many benefits that ward medicine does not offer. Seeing patients in a mostly-healthy state is foreign to me; I am so used to seeing diseases at their most decompensated state. It has also exposed me to new sides of subspecialties that I am not familiar with, which is both clinically relevant and helpful for my future career selection. At the same time, from a research perspective, I did not feel familiar enough with this area of education to frame a rigorous question.

So what did I end up choosing? More about that in a future blog post. I ended up going in a direction that fit with another ‘personal project’ of mine, and will be presenting what I have so far on Tuesday. I look forward to consolidating my work so far over the next few days!

- Shara