Ambulatory primary care medical education in managed care and non-managed care settings.

Abstract

BACKGROUND AND OBJECTIVES: The transformation of health care delivery to a managed care approach has implications for community-based clinical education in family medicine. In this study, we compare students' clerkship experiences in managed and non-managed care environments. METHODS: Student clerkship encounter logs were used to compare clinical content, level of student-patient interactions, and types of preceptor supervision and teaching activities in five clusters of community-based practice sites. Three of the groups represented managed care settings, and two represented non-managed care settings. RESULTS: The clinical content of students' experiences at the five types of teaching sites was not significantly different. However, teaching methods and responsibility levels were different. Observational student-patient interactions occurred more frequently, and comprehensive, direct student-patient interactions occurred less frequently in both managed and non-managed care private practices. Preceptor observation of students occurred less frequently in two managed care site clusters. A transition of variable degree and timing from observational to direct student-patient interactions occurred in all but one teaching cluster. Intra-site variation existed in both student-patient interactions and preceptor teaching and supervision. CONCLUSIONS: Clinical education can be successfully conducted in managed care settings. Differences in practice settings influence student-patient interactions and preceptor teaching. These differences have implications for faculty development and student education.