Medical student clinics: the basis for a clerkship in family practice.

In this paper, the authors describe a popular elective clerkship in family practice a Community Hospital, Santa Rosa, California. The key element in the clerkship for the past six years has been the student's General Medical Clinic. Here, under the supervision of a family physician teacher, senior medical students care for patients with a wide variety of problems. The students work as a team with family nurse practitioners. The clinic has succeeded in offering patients an alternative to the emergency room and an entrance to the hospital's Model Family Practice Center. The students give the clerkship a very high rating as an educational experience. It has also been viable economically.     

Medical care costs of AIDS in Massachusetts

Previous investigation has suggested that the direct cost of medical care for the 24,011 reported patients with acquired immunodeficiency syndrome (AIDS) may be as high as $147,000 per patient. To evaluate the use and cost of medical services for patients with AIDS in Massachusetts, we performed a one-year cost of illness study of 45 AIDS patients. Sociodemographic and clinical data as well as information on medical utilization were obtained from review of outpatient and hospital records. Patients with AIDS required a mean of 3.3 (+/- 3.2) hospitalizations per year and 18.4 (+/- 21.8) ambulatory visits per year. Overall, medical costs averaged $46,505 +/- $38,720 per patient per year, with 91% of these expenditures related to use of inpatient services. These results suggest that the cost of medical care for AIDS patients may be substantially less than previously estimated.     

A year-long clerkship in ambulatory care

Decreased availability of hospitalized patients for medical student education, a changing clinical environment in both hospital and outpatient settings, and the need for teaching the specific skills of primary ambulatory care mandate the development of outpatient-based clinical clerkships. A required third-year clerkship at Michigan State University College of Human Medicine combines a long-term structure and a defined curriculum with a wealth of clinical encounters. New approaches to the basic clinical education of medical students are needed to connect clinical resources, specialty expertise, and the special knowledge and skills needed for primary care. The clerkship described in the present paper represents a model for such clinical education.