Student perspectives on learning in a prepaid group practice

Five individual learning experiences are related, illustrating some opportunities for learning which are unique to ambulatory and inhospital care in a prepaid group practice. There was ample opportunity for acquiring traditional skills in data collection and diagnosis, especially useful because it occurred in a primary care setting. Students followed a limited number of patients with their field preceptors over an extended period, learning the challenges of long term management of patients with somatic, emotional, financial, housing and other problems. Their intimate involvement in the health maintenance of a defined population served as a valuable contrast to the mainly curative activities in teaching hospital wards and emergency rooms. Patient oriented research opportunities and the chance to learn about pragmatic problems of administration, financing and health care organization within the group practice have also been valuable. Since the group practices have no historical precedent of student involvement, the students defined their own roles, and, after some experimentation, emerged as observers, consumer advocates, clinical and administrative apprentices, researchers, health accountants, and health care planners.