Abstract
OBJECTIVE: To evaluate the training of graduating internal medicine residents to perform 13 common ambulatory procedures, 3 inpatient procedures, and 3 screening examinations.
DESIGN: Self-administered descriptive survey.
SETTING: Internal medicine training programs associated with 9 medical schools in the eastern United States.
PARTICIPANTS: Graduating residents (N=128); response rate, 60%.
MEASUREMENTS AND MAIN RESULTS: The total number of procedures performed during residency, importance for primary care physicians to perform these procedures, confidence to perform these procedures, and helpfulness of rotations for learning procedures were assessed. The majority of residents performed only 2 of 13 outpatient procedures 10 or more times during residency; simple spirometry and minor wound suturing. For all other procedures, the median number performed was 5 or fewer. The percentage of residents attributing high importance to a procedure was significantly greater than the percentage reporting high confidence for 8 of 13 ambulatory procedures; for all inpatient procedures, residents reported significantly higher confidence than importance. Continuity clinic and block ambulatory rotations were not considered helpful for learning ambulatory procedures.
CONCLUSIONS: Though residents in this sample considered most ambulatory procedures important for primary care physicians, they performed them infrequently, if at all, during residency and did not consider their continuity clinic experience helpful for learning these skills. Training programs need to address this deficiency by modifying the curriculum to ensure that these skills are taught to residents who anticipate a career in primary care medicine.
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References
American College of Physicians Task Force on Physician Supply. The role of the future general internist defined. Ann Intern Med. 1994;121(8):616–22.
Byyny RL. Challenges in the education of the general internist. Arch Intern Med. 1988;148:369–72.
Schroeder S, Showstack J, Gerbert B. Residency training in internal medicine: time for a change? Ann Intern Med. 1986;104:554–61.
Wigton RS. Training internists in procedural skills. Ann Intern Med. 1992;116(12 pt 2):1091–3.
American Medical Association. Graduate Medical Education Directory. Chicago, Ill: AMA; 1994–1995.
American Medical Association. Graduate Medical Education Directory. Chicago, Ill: AMA; 1998–1999.
Burke W, Baron RB, Lemon M, Losh D, Novack A. Training generalist physicians: structural elements of the curriculum. J Gen Intern Med. 1994;9(suppl 1):S23-S30.
Cohen JJ. Roles of various organizations in internal medicine curriculum reform. Ann Intern Med. 1992;116(12 pt 2):1111–5.
Federated Council of Internal Medicine Task Force. Philadelphia, PA: American College of Physicians; Graduate Education in Internal Medicine—A Resource Document. Philadelphia, PA: American College of Physicians; 1996.
Reuben DB, McCue JD, Gerbert B. The residency-practice training mismatch—a primary care education dilemma. Arch Intern Med. 1988;148:914–9.
Wigton RS, Blank LL, Nicolas JA, Tape T. Procedural skills training in internal medicine residencies. a survey of program directors. Ann Intern Med. 1989;111:932–8.
Wigton RS, Nicolas JA, Blank LL. Procedural skills of the general internist—a survey of 2500 physicians. Ann Intern Med. 1989;111(12):1023–34.
Mandel JH, Rich EC, Luxenberg MG, Spilane MT, Kern DC, Parrino TA. Preparation for practice in internal medicine—a study of ten years of residency graduates. Arch Intern Med. 1988;148:853–6.
Wigton RS, Steinmann WC. Procedural skills training in the internal medicine residency. J Med Educ. 1984;59:392–400.
Wigton RS. A method for selecting which procedural skills should be learned by internal medicine residents. J Med Educ. 1981;56:512–7.
American Board of Internal Medicine. Policies and Procedures for Certification. Philadelphia, PA: American Board of Internal Medicine; 1995.
Association of American Medical Colleges. Summary of key findings from the Internal Medicine Residency Training Survey. Washington, DC: Association of American Medical Colleges; 1996–1997.
Ende J, Davidoff F. What is a curriculum? Ann Intern Med. 1992;116(12, pt 2):1055–7.
Halperin A, Kaufman A. Ambulatory medical education: a reconsideration of sites and teachers. J Gen Intern Med. 1990;5(suppl):S35-S44.
Wickstrom GC, Kelley DK, Keyserling TC, et al. Confidence of academic general internists and family physicians to teach ambulatory procedures. J Gen Intern Med. 2000;15:353–360.
Corrigan JM, Thompson LM. Involvement of health maintenance organizations in graduate medical education. Acad Med. 1991;66(11):656–61.
American College of Physicians. Learning from Practitioners: Office-Based Teaching of Internal Medicine Residents. Philadelphia, PA: American College of Physicians; 1995.
American Board of Internal Medicine. Policies and Procedures for Certification. Philadelphia, PA: American Board of Internal Medicine; 1997.
Gabryel TF, Brierley MA, Izzo JF Jr. How completely internal medicine residents at a New York state teaching hospital met the expectations of credentialing protocol. Acad Med. 1991;66(10):613–5.
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This work was supported in part by grant 2D28PE54004 from the Bureau of Health Professions, Health Resources and Services Administration, to the Faculty Development Program for General Internal Medicine, University of North Carolina at Chapel Hill, and by grant 52285 from the Summa Health System, Akron, Ohio.
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Wickstrom, G.C., Kolar, M.M., Keyserling, T.C. et al. Confidence of graduating internal medicine residents to perform ambulatory procedures. J GEN INTERN MED 15, 361–365 (2000). https://doi.org/10.1046/j.1525-1497.2000.04118.x
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DOI: https://doi.org/10.1046/j.1525-1497.2000.04118.x