From forms to focus. A new teaching model in ambulatory medicine

We have developed a simple generalizable model of teaching ambulatory medicine that adopts successful elements of inpatient teaching and addresses deficiencies in traditional ambulatory forums. This model combines resident analysis of the patient encounter via a 'clinical encounter form' (CEF) with faculty-led ambulatory medicine rounds (AMR). Its objectives are to integrate teaching and quality assessment; be explicit about the relation between the record and the physician's clinical thinking; teach around every patient; focus on selected aspects of a case in limited time; and permit appropriate rounds preparation by faculty. The CEF-AMR model, like inpatient rounds, allows teaching to be focused on real patient issues; all patients are reviewed and quality is assured, and interesting teaching points can be selected, prepared, and discussed efficiently in limited time. It is the 'classroom' complement to faculty 'bedside' precepting and has made teaching ambulatory medicine feasible, clinically relevant, and well-informed. Perhaps most importantly, the CEF-AMR model encourages self-analysis of clinical decisions and makes explicit the key elements of clinical judgement.