Science / Medicine : Wider Training for Doctors

Doctors must receive training in outpatient settings, not just teaching hospitals, because skyrocketing costs “now keep all but the sickest patients out of the hospital,” researchers said last week. Traditional internship and residency in strictly hospital settings, the researchers said, no longer reflect a health-care system in which increasing numbers of procedures are performed in ambulatory facilities.

“There are whole topics of medicine, diseases, observations, actions and decisions that are just not encountered in the care of hospitalized patients any longer,” Dr. Daniel D. Federman of Harvard Medical School wrote in an editorial accompanying two articles in the New England Journal of Medicine.

“Because some patients are no longer admitted and others stay in the hospital for only a short part of their illness, today’s inpatient services offer a less useful setting for clinical education,” said three researchers from the Assn. of American Medical Colleges in Washington.

Moreover, a profound change in the financing of medical education is “essential” if the healers of the 21st Century are to be properly trained, said Dr. John M. Eisenberg of the University of Pennsylvania.