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To the Editor.—The article by Dr Frank and colleagues¹ examines a number of issues involved with shifting undergraduate medical education to the outpatient ambulatory setting. This important topic has received little attention in the literature to date. Using the Medical Outcomes Study 9-item visit rating scale,² the authors determined that patient satisfaction did not decrease when medical students were involved. However, the authors note that students were substantially more likely to see patients who were poorer (with Medicaid) and who were members of a minority group, independent of other potential confounding variables such as reason for visit, severity of illness, and insurance status. Previous research³ has suggested that patients from a lower social class tend to have significantly more positive attitudes about student involvement in their care than do patients from other demographic groups. Thus, the conclusion by Frank and colleagues on this issue is drawn into question. Measuring . . . [Full Text of this Article]

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Direct Observation of Community-Based Ambulatory Encounters Involving Medical Students
Scott H. Frank, Kurt C. Stange, Doreen Langa, and Michael Workings
JAMA. 1997;278(9):712-716.
ABSTRACT