The impact of early specialization on the clinical competence of residents.

To study the relation between first-year postgraduate training and performance on a test of general clinical competence, we analyzed results on the Part III National Board Examination according to the type of residency chosen by 1514 graduates of Jefferson Medical College between 1970 and 1979. The results show that physicians in family medicine, internal medicine, or flexible programs score higher on Part III than do those in surgery, pediatrics, obstetrics/gynecology, psychiatry, or pathology, even after correction for their performance on Part II of the boards. Although these differences could be due to other factors, we suggest that in the first year of some residency programs, knowledge and skills in broad areas of medicine are not being sufficiently emphasized, and that changes are needed to strengthen the residents' general capabilities.