Evaluation of general and traditional internal medicine residencies utilizing a medical records audit based on educational objectives.

Residency programs in general internal medicine must ensure that skills relevant to the care of both ambulatory and hospitalized patients are taught effectively. The authors evaluated both a general and a traditional internal medicine training program at the same institution. They employed a medical records audit technique based on educational objectives that assessed the approach of residents in each program in dealing with five inpatient and five outpatient problems. Inpatient performance also was assessed by subjective faculty evaluations. Resident physicians in the general program more closely reflected the educational objectives in two of five outpatient audits. There were no differences between the programs for inpatient audits or subjective evaluations. These findings support the argument that the emphasis on teaching ambulatory medicine need not jeopardize inpatient training, and they demonstrate the feasibility of a medical records audit based on educational objectives for program evaluation.