Using the Federated Council for Internal Medicine curricular guide and administrative codes to assess IM residents' breadth of experience.

PURPOSE: To estimate internal medicine residents' breadth of experience using a published curricular guide and an electronic medical record.
METHOD: A cohort of 41 internal medicine residents at Columbia University Medical Center, a large, inner-city, primary and tertiary care center, were followed over their three years of training in the late 1990s. Residents were mapped to the patients they cared for, the diagnoses those patients were assigned, and the Federated Council for Internal Medicine (FCIM) competencies covered. The proportion and distribution of competencies covered (potential to achieve a competency) were measured.
RESULTS: Residents covered 76% of priority 1 competencies (those identified by FCIM as optimally learned through direct responsibility for patients) and 67% of all competencies. Although the number of patients cared for was correlated with breadth of experience, the effect was small. Rare diagnoses appear to have been distributed well.
CONCLUSION: Internal medicine residents had the potential to achieve the majority of competencies via direct patient care, but no residents achieved full coverage. The electronic medical record may provide a mechanism to track residents and study training programs.