We found the comments of Martin et al interesting and encouraging. It is good to know that there are others who are so actively involved with the same issues in ambulatory resident training.
We, too, had three-month ambulatory rotations at one time in our program but moved toward a shorter rotation block to reduce resident fears that they were going to lose out on the early acquisition of inpatient skills. The use of three- to five-week outpatient rotations is a satisfactory compromise be- tween outpatient continuity and development of knowledge of inpatient needs.
The notion of modifying inpatient medical subspecialty services to include more ambulatory experience is very important. We also agree that outpatient-oriented nonmedical specialty rotations will best contribute to the general training of medical residents. We have been successful in negotiating these changes. The alternative strategy of using emergency room physicians to train medical residents in ears, nose,