The factors that have encouraged an increasing shift of medical education and training from inpatient hospital wards to the ambulatory setting are likely to intensify during the 1990s. Changes in the patterns of disease, with a greater prevalence of chronic conditions caused by multiple risk factors, cost-containment pressures to limit length of hospital stay, growth of managed care organizations, hospital sponsorship of expanded ambulatory services onsite and offsite, and improved ambulatory diagnostic and treatment modalities, will all encourage the expansion of ambulatory care and the contraction of inpatient services. Lesky and Borkan1 in this issue of the Archives present a useful set of recommendations to help faculty make better use of the learning opportunities presented by the expansion of ambulatory care in academic medical centers.
The authors address the special challenges of restricted time for patient care and teaching in a busy ambulatory setting and the isolation and vulnerability of
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