Abstract
Devising a strategy for the implementation of a generalist medical educational program can be aided by grouping the many issues to be addressed into developmental stages. In this way, problems can be anticipated and resources marshalled. Initially, leadership and institutional support for the program must be developed. Next, detailed financial, curricular, and site planning must be undertaken. Implementation of the program must contend with faculty, site, and trainee concerns while consolidating financial and institutional support. Finally, in institutionalizing the program, financing must be secured and ongoing evaluation should provide information necessary to regularly reassess the program and renew its goals.
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References
Levine A. Why Innovation Fails. Albany, NY: State University of New York Press, 1980.
AAMC policy on the generalist physician: as adopted October 8, 1992. Acad Med. 1993;68:1–5.
Koop CE. Revitalizing primary care: a 10-point proposal. Hosp Prac. Oct 15, 1993:87–94.
Colwill JA. Where have all the primary care applicants gone? N Engl J Med. 1992;326:387–93.
Krakov SK, Packman CH, Regan-Smith MG, Birskovich L, Seward SJ, Baker SD. Perspectives on ambulatory programs: barriers and implementation strategies. Teach Learn Med. 1993;5:243–50.
Council on Graduate Medical Education. Improving Access to Health Care Through Physician Workforce Reform. 3rd Report. Washington, DC: Public Health Service, Health Resources and Service Administration, October 1992.
Bloom SW. Institutionalizing innovation. In: Kaufman A (ed). Implementing Problem-based Medical Education: Lessons from Successful Innovations. New York: Springer Publishing, 1986.
Kaufman A, Menin S, Waterman R, et al. The New Mexico Experiment: educational innovation and institutional change. Acad Med. 1989;64:285–94.
Schroeder SA, Showstack JA, Gerbert B. Residency training in internal medicine: time for a change? Ann Intern Med. 1986;104:554–61.
Fisher R, Ury W, Patten B. Getting To Yes. 2nd ed. New York: Penguin Books, 1991.
Siegel BS. Organization of the primary care team. Pediatr Clin North Am. 1974;21:241–51.
Kantrowitz M, Kaufman A, Mennin S, Fulop T, Guilbert JJ. Innovative Tracks at Established Institutions for the Education of Health Personnel. Offset Publication No 101. Geneva, Switzerland: World Health Organization, 1987.
Riley K, Myers W, Gordon MJ, et al. A collaborative approach to a primary care preclinical preceptorship for underserved settings. Acad Med. 1991;66:776–7.
Barker LR. Curriculum for ambulatory care training in medical residency: rationale, attitudes and generic proficiencies. J Gen Intern Med. 1990(suppl);6:S3–14.
Thane M, Noble J. The Curriculum of Boston University-Boston City Hospital Primary Care Training Program. Program Directors Manual, Section 18. Washington, DC: Association of Program Directors in Internal Medicine, 1988.
Felice ME, Friedman SB. Teaching behavioral pediatrics to pediatric residents: the state of the art and description of a program. J Dev Behav Pediatr. 1982;3:225.
Phillips WR, Rosenblatt RA, Gordon MJ, Fletcher RM. Clinical content of the WAMI community clerkship in family medicine. J Med Educ. 1982;57:615–20.
The Education Committee of the Ambulatory Pediatric Association. Educational Guidelines for Training in General/Ambulatory Pediatrics. McLean, VA: Ambulatory Pediatric Association, 1985.
Kahn N (ed). Residency Assistance Program Criteria for Excellence in a Family Practice Residency Program. 3rd ed. Kansas City, MO: Residency Assistance Program, 1993.
Schroeder SA. Expanding the site of clinical education: moving beyond the hospital walls. J Gen Intern Med. 1988;3S:S5–14.
Perkoff GT. Teaching clinical medicine in the ambulatory setting. N Engl J Med. 1986;314:27–31.
Sargent JR, Osborn LM, Roberts KB. Establishment of a primary care continuity experience in community pediatrician offices: nuts and bolts. Pediatrics. 1993;91:1185–9.
Isaacs JC, Madoff MA. Undergraduate medical education in prepaid health care plan settings, J Med Educ. 1984;59:615–24.
Siegel BS. Developing the interdisciplinary team. In: Satin DG (ed). The Clinical Care of the Aged Person; An Interdisciplinary Perspective. New York: Oxford University Press, in press 1994.
Vorhees JD, Kaufman A, Heffran W, et al. Teaching preclinical medical students in a clinical setting. Fam Pract. 1977;5:464–5.
Gravdal J, Glasser M. Integration of the student into ambulatory primary care: a decade of experience. Fam Med. 1987;19:457–62.
Rosenblatt RA. Current successes in medical education beyond the bedside. J Gen Intern Med. 1988;3S:S44–62.
Eisenberg JM. Financing ambulatory care education in internal medicine. J Gen Intern Med. 1990;5S:S70–80.
Garg M, Boero JF, Christiansen RG. Medical education in ambulatory settings: issues of teaching, physician productivity and costs. Acad Med. 1991;66:348–53.
Delbanco TL, Calkins DR. The costs and financing of ambulatory medical education. J Gen Intern Med. 1988;3S:S34–43.
Kirz H, Larsen C. Costs and benefits of medical student training to a health maintenance organization. JAMA. 1986;256:734–9.
Bentley JD, Knapp RM, Petersdorf RG. Education in ambulatory care—financing is one piece of the puzzle. N Engl J Med. 1989;320:1531–4.
Gunzberger LA. Foundations that support medical education and health care: their missions, accomplishments, and unique role. Acad Med. 1994;69:8–17.
Skeff KM. Enhancing teaching effectiveness and vitality in the ambulatory setting. J Gen Intern Med. 1988;3S:S26–33.
Wilkerson L, Armstrong E, Lesley L. Faculty development for ambulatory teaching. J Gen Intern Med. 1990;5S:S44–53.
Greer DS. Faculty rewards of the generalist clinician teacher. J Gen Intern Med. 1990;5S:S53–58.
Levey GS. Internal medicine and the training of international medical graduates: a time for open discussion. Ann Intern Med. 1992;117:403–7.
Greer T, Schneeweiss R, Baldwin L. A comparison of student clerkship experience in community practices and residency-based clinics. Fam Med. 1993;25:322–6.
Brazeau NK, Potts MJ, Hickner JM. The Upper Peninsula Program: a successful model for increasing primary care physicians in rural areas. Fam Med. 1990;22:350–5.
Noble J, Friedman RH, Starfield B, Ash A, Black C. Career differences between primary care and traditional trainees in internal medicine and pediatrics. Ann Intern Med. 1992;116:482–7.
McPhee SJ, Mitchell TF, Schroeder SA, Perez-Stable EJ, Bindman AB. Training in a primary care internal medicine residency program: the first ten years. JAMA. 1987;258:1491–5.
Kellogg Community Partnerships Program. Center for Community Health, Education, Research, and Service (CCHERS). Northeastern University, Boston, MA.
Halperin AK, Kaufman A. Ambulatory medical education: a reconsideration of sites and teachers. J Gen Intern Med. 1990;5S: S35–44.
Spencer SS, Outcalt D. Commitment to Underserved People (C.U.P.) Program at the University of Arizona. Public Health Rep. 1980;95:26–8.
Boston University School of Medicine, Department of Pediatrics. Introduction to Medicine and Core Clerkship in Pediatrics.
Geiger HJ. Sophie Davis School of Biomedical Education at City College of New York prepares primary care physicians for practice in underserved inner city areas. Public Health Rep. 1980;95:32–7.
Baldwin DC, Baldwin MA, Edinberg MA, et al. A model of recruitment and service—the University of Nevada’s summer preceptorships in Indian communities. Public Health Rep. 1980;95:19–22.
Kaufman A, Holbrook J, Collier I, et al. Involving the southern rural students and students of health. Public Health Rep. 1980;95:23–5.
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Lemon, M., Greer, T. & Siegel, B. Implementation issues in generalist education. J Gen Intern Med 9 (Suppl 1), S98–S104 (1994). https://doi.org/10.1007/BF02598124
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DOI: https://doi.org/10.1007/BF02598124