Population-Based Medicine: A Case Study from a Traditional School

  • Mutya San Agustin
Conference paper


In the United States, physician education developed within and was formed by two institutions: the medical school and the teaching hospital, the first emphasizing basic science and second emphasizing, supervised clinical experience (Swanson 1984; Ebert 1985; Dasco 1989). Within those settings excellent institutional competencies were developed: undergraduate and postgraduate teaching by full-time faculty and attending physicians with faculty appointments employed a full range of teaching techniques, student participation in laboratory and clinical research, a variety of teaching modalities (lectures, seminars, grand rounds, and bedside teaching), and close supervision built into the learning process (Abbott 1989). The medical schools and teaching hospitals were constructed to accommodate the needs of students with libraries, classrooms, ongoing medical records, laboratories, and ever increasing technology. As part of the process patients were expected to submit themselves to the needs of education, persuaded through economic necessity, or by the belief that the best patient care was provided in teaching hospitals (Schroeder et al. 1989). These patients were regarded as “teaching material.” The poorest allowed their bodies to be used for the educational process in return for free care. In addition, expectations of patients were in large part dependent on what services were made available. In practice, the three institutional aims of patient care, education, and research were often impossible to identify separately.


Primary Care Medical School Emergency Medical Service Ambulatory Care Primary CARE Team 
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  1. Abbott, L. 1989. Medical student education in ambulatory care. Acad Med 64: S9 - S15.PubMedCrossRefGoogle Scholar
  2. Alpert, J.J., and Charney, E. 1973. The Education of Physicians for Primary Care. U.S. Dept. of Health, Education and Welfare. DHEW Pub. No. (HRA) 74–3113.Google Scholar
  3. Arneill, B.P., and Nuelsen, P.H. 1978. Functional components of the ambulatory care facility. J Ambul Care Manage 1: 23–40.PubMedGoogle Scholar
  4. Barnett, P.G., and Midtling, J.E. 1989. Public policy and the supply of primary care physicians. J Am Med Assoc 262: 2864–2868.CrossRefGoogle Scholar
  5. Brezenoff, S., and Farrell, G. 1984. The Pediatric Protocol System: Improving the quality of outpatient health care. Public Papers of the Fund for the City of New York 3: 1–8.Google Scholar
  6. Cobliner, W.G., Quijano, E., and San Agustin, M. 1989. Family dynamics: An important risk factor in teenage pregnancies. Paper presented at the 19th International Congress of Pediatrics, July 28, Paris.Google Scholar
  7. Daley, J., Gertman, P.M., and Delbanco, T.L. 1988. Looking for quality in primary care physicians. Health Affairs 7: 107–113.PubMedCrossRefGoogle Scholar
  8. Dasco, C.C. 1989. Factors influencing ambulatory care education in the U.S. Department of Veterans Affairs. Acad Med 64: S4 - S8.CrossRefGoogle Scholar
  9. Demeny, D., San Agustin, M., Quijano, E., Davis, A., and Maclin, G. 1985. J Adolescent Health Care 6: 206–210.CrossRefGoogle Scholar
  10. Dickman, R.L., and Milligan, S. 1987. An end to patchwork reform of health care. N Engl J Med 317: 1086–1088.PubMedCrossRefGoogle Scholar
  11. Ebert, R.H. 1985. The medical school revisited. Health Affairs 4: 47–59.PubMedCrossRefGoogle Scholar
  12. Feltovich, J., Terrill, A.M., and Soler, N.G. 1989. Teaching medical students in ambulatory settings in Departments of Internal Medicine. Acad Med 64: 36–41.PubMedCrossRefGoogle Scholar
  13. Ginzberg, E. 1985. Academic health centers: A troubled future. Health Affairs 4: 5–21.PubMedCrossRefGoogle Scholar
  14. Ginzberg, E. 1986. From Health Dollars to Health Services. New Jersey: Rowman & Allanheld.Google Scholar
  15. Girard, D.E., Elliot, D.L., Linz, D.H., and Cooney, T.G. 1984. The general medicine clinic: Making the ugly duckling fly. Arch Intern Med 144: 2217–2219.PubMedCrossRefGoogle Scholar
  16. Greer, D.S. 1990. Faculty rewards for the generalist clinician teacher. J Gen Int Med 5: S53 - S58.CrossRefGoogle Scholar
  17. Kroenke, K. 1986. Ambulatory care: Practice imperfect. Am J Med 80: 339–342.PubMedCrossRefGoogle Scholar
  18. Levenson, D. 1984. Montefiore: The Hospital as Social Instrument. New York: Farrar, Strauss & Giroux.Google Scholar
  19. Nardone, D.A., and Webb, D.W. 1989. Administration in ambulatory care. Acad Med 64: S28 - S34.PubMedCrossRefGoogle Scholar
  20. Navarro, V. 1989. Why some countries have national health insurance, others have national services, and the United States has neither. Int J Health Sery 19: 383–404.CrossRefGoogle Scholar
  21. New York City Department of Health. 1987. Vital Statistics by Health Areas and Health Center Districts. Bureau of Health Statistics and Analysis. New York.Google Scholar
  22. New York City Health & Hospitals Corporation. 1984. Annual Report. New York.Google Scholar
  23. New York State Commission on Graduate Medical Education. 1986. Report of the New York State Commission on Graduate Medical Education. New York.Google Scholar
  24. New York State Council on Graduate Medical Education. 1988. First Annual Report. New York.Google Scholar
  25. North Central Bronx Hospital. 1989. Annual Report of the Department of Ambulatory Medicine. New York.Google Scholar
  26. Nutting, P.A. 1986. Community-oriented primary care: An integrated model for practice, research and education. Am J Prevent Med 2: 140–147.Google Scholar
  27. Paccione, G.A., Cohen, E., and Schwartz, C.E. 1989. From forms to focus: A new teaching model in Ambulatory Medicine. Arch Intern Med 149: 2407–2411.PubMedCrossRefGoogle Scholar
  28. Perkoff, G.T. 1986. Teaching clinical medicine in the ambulatory setting: An idea whose time may have finally come. N Engl J Med 314: 27–31.PubMedCrossRefGoogle Scholar
  29. Petersdorf, R.G. 1975. Issues in primary care: The academic perspective. J Med Educ 50 (Part 2): 5–13.PubMedGoogle Scholar
  30. Quijano, E.C., Cobliner, W.G., San Agustin, M., and Joseph, M. 1985. Life experience of the teenager and its role in unwanted pregnancy. Paper presented at the American Public Health Association Annual Meeting, November 17–21, Washington, D.C.Google Scholar
  31. Reagan, M.D. 1987. Physicians as gatekeepers: A complex challenge. N Engl J Med 317: 1731–1734.PubMedCrossRefGoogle Scholar
  32. Roemer, M.I. 1981. Ambulatory services in America: Past, Present and Future. Rockville, Maryland: Aspen Systems Corporation.Google Scholar
  33. Rogers, D.E. 1982. Community-oriented primary care. J Am Med Assoc 248: 1622–1625.CrossRefGoogle Scholar
  34. Rogers, D.E., and Gastel, N. (Eds.). 1988. Clinical Education and the Doctor of Tomorrow. New York: The New York Academy of Medicine.Google Scholar
  35. Rosenblatt, R.A. 1988. Current successes in medical education beyond the bedside. J Gen Intern Med 3: 544 - S61.CrossRefGoogle Scholar
  36. San Agustin, M., Goldfrank, L., Matz, R., Suberman, C., Hamerman, D., Bloom, R., and Pitter, D. 1976. Reorganization of ambulatory health care in an urban municipal hospital. Arch Intern Med 136: 1262–1266.CrossRefGoogle Scholar
  37. San Agustin, M. 1978. Primary care in a tertiary care center. Ann NY Acad Sci 310: 121–128.PubMedCrossRefGoogle Scholar
  38. San Agustin, M., Madhaven, S., and Fassig, J. 1984. The Role of Triage in Emergency Room and Primary Care Practice within a Hospital Based Ambulatory Care Setting. North Central Bronx Hospital, Department of Ambulatory Medicine.Google Scholar
  39. Schroeder, S.A. 1984. Western European responses to physician oversupply: Lessons for the United States. J Am Med Assoc 252: 373–384.CrossRefGoogle Scholar
  40. Schroeder, S.A., Zones, J.S., and Showstack, J.A. 1989. Academic medicine as a public trust. J Am Med Assoc 262: 803–812.CrossRefGoogle Scholar
  41. Seidel, H.M. 1975. Organization of model systems for primary care practice and education: Problems and issues. J Med Educ 50: 23–28.PubMedGoogle Scholar
  42. Singer, A.M. 1989. Projections of physician supply and demand: A summary of HRSA and AMA studies. Acad Med 64: 235–239.PubMedCrossRefGoogle Scholar
  43. Skeff, K.M. 1988. Enhancing teaching effectiveness and vitality in the ambulatory setting. J Gen Intern Med 3: S26 - S33.PubMedCrossRefGoogle Scholar
  44. Smith, C.T. 1985. Health care delivery system changes: A special challenge for teaching hospitals. J Med Educ 60: 1–8.PubMedGoogle Scholar
  45. Starfield, B., and Pless, B. 1973. Research in ambulatory pediatrics. In: Advances in Pediatrics, Schulman, I. (Ed.), Vol. 20, Chicago: Yearbook Medical Publishers.Google Scholar
  46. Starfield, B. 1986. Primary care in the United States. Intern J Health Sery 16: 179–198.CrossRefGoogle Scholar
  47. Swanson, A.G. 1984. Medical education in the United States and Canada. J Med Educ 59: 35–56.Google Scholar
  48. Tarlov, A.R. 1983. The increasing supply of physicians, the changing structure of the health services system, and the future practice of medicine. N Engl J Med 308: 1235–1244.PubMedCrossRefGoogle Scholar
  49. Tarlov, A.R. 1988. The rising supply of physicians and the pursuit of better health. J Med Educ 63: 94–107.PubMedGoogle Scholar
  50. Taylor, C.M., Kornblatt, J.E., and Kindig, D.A. 1984. Lessons learned from the urban health network program. J Ambul Care Manage 7: 12–24.PubMedGoogle Scholar
  51. United Hospital Fund of New York. 1988. New York City Community Health Atlas. New York.Google Scholar
  52. Wooliscroft, J.O., and Schwenk, T.L. 1989. Teaching and learning in the ambulatory setting. Acad Med 64: 644–648.CrossRefGoogle Scholar

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© Springer-Verlag New York Inc. 1992

Authors and Affiliations

  • Mutya San Agustin

There are no affiliations available

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