Measuring the costs of primary care education in the ambulatory setting.

In 1995, the authors obtained cost, operations, and educational activity data from 98 ambulatory care sites across the United States in which primary care teaching was occurring and compared those data with the corresponding data from 84 ambulatory care sites where no teaching was going on. The teaching sites in the sample were found to have 24-36% higher operating costs than the non-teaching sites. This overall difference in costs is approximately the same difference in costs earlier estimated for university teaching hospitals compared with non-teaching hospitals. These costs are shared by all involved in the ambulatory education process: sponsors, sites, and faculty. In a related finding, the authors discovered that 30-50% of all ambulatory care sites thought not to be involved in education are in fact teaching at a high level of involvement. Further research into not only the costs but the value of education in the clinical setting is encouraged. The authors also hope that the publication of this report will encourage accrediting bodies and professional organizations to improve the information available about ambulatory care training in general.

An interdisciplinary community-based educational model.

The purpose of this article is to describe an innovative partnership among academic, community, and service to better meet the health care needs of underserved populations. The Center for Community Health Education, Research, and Service--a coalition of Boston education institutions, health services providers, and community agencies--was formed with a grant from the W. K. Kellogg Foundation. The initial goal was to establish academic community health centers comparable to the large teaching hospitals that combine service, education, and research as the corner-stone of their mission. With faculty based in the neighborhood health centers, students have learning opportunities to assess, plan care, and treat individuals and families using a community-based primary care model. The nature of the partnership, including the structure and process of implementation, is described. The developmental socialization of advanced practice nursing students in a community based-setting is discussed. Educational and service outcomes are identified.

Research practicum. Linking education to practice.

Integration of nursing theory, research, and practice is a long-standing goal. The authors describe the development and implementation of an innovative sequence of research courses at one graduate school of nursing. The research sequence engages graduate nursing students in the "real life" aspects of conducting research in a practice discipline. The experience allows students to develop and use research skills as they actively experience both the excitement and frustration inherent in the research process.

Developing nurse leaders for today and tomorrow. Part 2, Implementing a model of leadership for community-based practice.

In part 1 of this two-part series, the authors described the Manager as Developer Model and its use in acute care settings and a community-based nursing administration curriculum. In this article, they predict its use to guide development of leadership and education for the future of community-based practice.