Community-Based Teaching: A Guide to Developing Education Programs for Medical Students and Residents in the Practitioner’s Office

Deutsch SL, Noble J; eds. 284 pages. Philadelphia: American Coll Physicians; 1997. $25.00. ISBN 0943126592. Order phone 800-523-1546, extension 2600. Field of medicine: Medical education. Format: Softcover book. Audience: Course directors newly charged with developing community-based educational programs and community-based faculty interested in medical education. Purpose: As medical care shifts from an inpatient to an outpatient focus and as academic health centers struggle to compete in a managed care environment, successful innovation in medical student and resident education in community-based settings is necessary. This book explains how to plan teaching programs with volunteer faculty in office and community settings. Content: The book discusses how to recruit, train, and maintain a quality cadre of community-based faculty; how to develop, evaluate, and enhance curricula and teaching methods in a community-based setting; the financial implications for the medical school and the practitioner; and the expectations and needs of the student, resident, and practitioner. Four model programs that have successfully integrated community-based training into academic teaching programs are presented. Highlights: This is a useful, easy-to-read, concise book on an increasingly important topic. The appendix of 25 frequently asked questions serves as a brief summary of the book’s major take-home points. A first-person tale of a day in the life of a rural Maine preceptor and his medical student shows how a practicing physician balances the requirements of day-to-day patient care with the educational needs of the student. The reader comes to understand the advantages and challenges of being a community-based teacher. The chapter on curriculum development and the appendix on program documentation serve as shortcuts to developing goals, objectives, and evaluative methods for community-based programs. Limitations: The book is limited in its discussion of the emerging concerns of community-based teachers, such as managed care, new Medicare documentation requirements for billing when patients are seen by medical students and residents, the medical-legal aspects of allowing learners to participate in the care of patients, and Medicare’s regulations on graduate medical education funding in ambulatory settings. More explicit discussion about medical students and residents with interpersonal problems, deficiencies in knowledge and clinical skills, and conflicts or disagreements with faculty would be helpful. An expanded bibliography about the economic costs to practicing physicians who teach in the office would be useful, especially as volunteer teachers and managed care organizations look more closely at the bottom line. Context: The community-based teacher wishing to improve his or her own teaching skills will be better served by a book such as The Physician as Teacher, by Whitman and Schwenk (Whitman Associates, 1996). The user-friendly Preceptor Education Project materials published by the Society of Teachers of Family Medicine will be of use for those interested in developing workshops to introduce and train faculty in community-based teaching. These two practical resources nicely complement the more pedagogical Community-Based Teaching. Reviewer: Rick Kellerman, University of Kansas School of Medicine, Wichita, Wichita, Kansas. Commentary: Medical education is changing from hospital-centered to outpatient-oriented training. With the expansion of managed care in the 1990s, medical educators have an obligation to students and residents to provide training in real-life settings. This transition is painful and filled with uncertainty. Many traditional medical educators are apprehensive about turning over aspects of medical education to volunteer, community, non-university-based clinician-educators. Community-Based Teaching is a basic handbook for those who are responsible for making the transition and is a good reference for medical educators who are anxious about the whole affair.