Julia Nath1, Julie Oyler1, Amber Bird2, Maryann K Overland3, Lesley King3, Christopher J Wong3, Amy W Shaheen4, Amber T Pincavage5. 1. Internal Medicine Residency Program, University of Chicago Medicine, Chicago, IL, USA. 2. University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA. 3. Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA, USA. 4. University of North Carolina, Chapel Hill, NC, USA. 5. Pritzker School of Medicine & Department of Medicine, University of Chicago, Chicago, IL, USA. apincava@medicine.bsd.uchicago.edu.
Abstract
BACKGROUND: Internal medicine (IM) residency graduates consistently report being less prepared for outpatient practice than inpatient medicine. Although an initial study suggested interns arriving for IM residency reported low levels of preparedness for continuity clinic, the impact of education and experience during the undergraduate medical education to graduate medical education transition on ambulatory training is unclear. OBJECTIVE: To describe end of medical school primary care exposure among entering IM interns and its association with self-assessed preparedness for residency continuity clinic. DESIGN: Cross-sectional survey of 161 entering IM interns in 2019. PARTICIPANTS: Entering interns at four geographically diverse IM residency programs (University of Chicago, University of North Carolina, University of Pennsylvania, and University of Washington), representing 81 US medical schools. RESULTS: A total of 139 interns (86%) responded to the survey. Surveyed interns reported a median of zero days of general internal medicine (GIM) clinic (interquartile range [IQR]: 0-20 days) and 2.5 days of multispecialty adult primary care (IQR: 0-26.5 days) during fourth year of medical school. The median last exposure to primary care was 13 months prior to internship (IQR: 7-18 months). Interns who rated themselves as prepared for primary care clinic reported a median of twenty more multispecialty adult primary care days (20 vs. 0 days; p < 0.01) and fourteen more GIM clinic days (14 vs. 0 days; p < 0.01) than their unprepared counterparts. The experiences were also more recent, with six fewer months between their last multispecialty adult primary care exposure and the start of internship (9 vs. 15 months; p < 0.01). CONCLUSIONS: The majority of incoming IM interns had no primary care training during the fourth year of medical school. At the start of residency, IM interns who felt more prepared for their primary care clinic reported more recent and more numerous primary care experiences.
BACKGROUND: Internal medicine (IM) residency graduates consistently report being less prepared for outpatient practice than inpatient medicine. Although an initial study suggested interns arriving for IM residency reported low levels of preparedness for continuity clinic, the impact of education and experience during the undergraduate medical education to graduate medical education transition on ambulatory training is unclear. OBJECTIVE: To describe end of medical school primary care exposure among entering IM interns and its association with self-assessed preparedness for residency continuity clinic. DESIGN: Cross-sectional survey of 161 entering IM interns in 2019. PARTICIPANTS: Entering interns at four geographically diverse IM residency programs (University of Chicago, University of North Carolina, University of Pennsylvania, and University of Washington), representing 81 US medical schools. RESULTS: A total of 139 interns (86%) responded to the survey. Surveyed interns reported a median of zero days of general internal medicine (GIM) clinic (interquartile range [IQR]: 0-20 days) and 2.5 days of multispecialty adult primary care (IQR: 0-26.5 days) during fourth year of medical school. The median last exposure to primary care was 13 months prior to internship (IQR: 7-18 months). Interns who rated themselves as prepared for primary care clinic reported a median of twenty more multispecialty adult primary care days (20 vs. 0 days; p < 0.01) and fourteen more GIM clinic days (14 vs. 0 days; p < 0.01) than their unprepared counterparts. The experiences were also more recent, with six fewer months between their last multispecialty adult primary care exposure and the start of internship (9 vs. 15 months; p < 0.01). CONCLUSIONS: The majority of incoming IM interns had no primary care training during the fourth year of medical school. At the start of residency, IM interns who felt more prepared for their primary care clinic reported more recent and more numerous primary care experiences.
Authors: Amber T Pincavage; Mark J Fagan; Nora Y Osman; Debra S Leizman; Deborah DeWaay; Camilla Curren; Nadia Ismail; Karen Szauter; Michael Kisielewski; Amy W Shaheen Journal: J Gen Intern Med Date: 2019-05 Impact factor: 5.128
Authors: D Michael Elnicki; Susan Gallagher; Laura Willett; Gregory Kane; Martin Muntz; Daniel Henry; Maria Cannarozzi; Emily Stewart; Heather Harrell; Meenakshy Aiyer; Cori Salvit; Saumil Chudgar; Robert Vu Journal: Acad Med Date: 2015-10 Impact factor: 6.893
Authors: Francine C Wiest; Timothy G Ferris; Manjusha Gokhale; Eric G Campbell; Joel S Weissman; David Blumenthal Journal: JAMA Date: 2002-11-27 Impact factor: 56.272