Ambulatory care education in an emergency room setting: effects of house officer specialty and prior experience

Largely because of financial constraints in medical care and the ongoing restructuring of the health care delivery system, there has been a concerted effort to shift the management of many traditional inpatient medical conditions to outpatient settings. This expansion of ambulatory services is reflected in the increased number of short-stay units, which eliminate the need for hospital admission for many acute conditions. Undergraduate and graduate medical education programs have responded to these changes by concurrently decreasing the time on the inpatient services by medical students and residents. Beginning in July 1994 the Accreditation Council for Graduate Medical Education required an additional month of emergency medicine in the third year for internal medicine residents. In 1998 it projected that the ambulatory care requirement will be increased from 25% to 33% of the internal medicine residency program.

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