Referral rates of senior family practice residents in an ambulatory care clinic.

Discretion regarding the need for and appropriateness of consultations and referrals is an important dimension of clinical competence. However, the process of consultation by medical residents has not been well studied. In the study reported here, a review was made of office-based referrals requested by second- and third-year family practice residents over a three-year period. Significantly lower referral rates were found for the second-year residents than the third-year residents. Possible explanations for this finding included: differences in approach to case management, lack of referral experience by second-year residents, and differences in case mix. Although no explicit protocol existed for the distribution of patients to the residents, differences in case mix and patient age between the patients seen by the two groups of residents accounted for the difference in referral rates. This difference implies that patient distribution in graduate training programs may not be random as commonly thought.