Article Text

  1. S. F. Green,
  2. P. B. Seals,
  3. J. F. Wilson,
  4. M. B. Duke,
  5. C. A. Feddock,
  6. T. S. Caudill
  1. University of Kentucky, Lexington, KY


Purpose Internal medicine residency training programs must provide a diverse set of knowledge and skills for graduates to effectively enter general internal medicine practice. We surveyed graduates from the last 10 years of our internal medicine and medicine-pediatrics residency programs to characterize current practices and to evaluate their preparedness for general medicine practice.

Methods We mailed paper surveys to all residents who completed our program from 1995-2005. Graduates were asked to rate on a 5-point Likert scale preparedness (1 = poorly prepared, 5 = very prepared) and frequency of performance (1 = never, 5 = very often) of managing common chronic adult diseases and 15 procedures traditionally performed general internists and are required training by the ABIM. "Well prepared " and "very often " were identified as a rating of 4 or 5 while "poorly prepared " and infrequent were identified as a rating of 1 or 2. Graduates were also asked to list any skills for which they had received additional training after residency.

Results Of 217 surveys received, 112 were returned (52%). Of these, 78 graduates were general internists. Graduates felt well prepared for managing common medical diagnoses such as heart failure, diabetes mellitus, and COPD and also reported managing them frequently. However, they reported managing behavioral conditions, such as depression, obesity, and pain, frequently, but did not feel well prepared by their residency training. Seven of the 15 procedures in question were performed infrequently by more than 70% of internists. Only 3 of the 15 procedures were performed frequently by more than 50% of respondents. Graduates reported seeking additional training most frequently for performing office orthopedic procedures, such as joint aspirations (18%) and dermatologic procedures (9%).

Conclusions Graduates of our program felt well prepared to care for common chronic medical conditions seen in general internists' practices. However, they felt ill-prepared for common behavioral diagnoses they frequently manage in their practices. A number of ABIM-required procedures are not frequently performed by our graduates. These findings support the need for further curricular interventions designed to improve resident preparedness in behavioral medicine and raise questions regarding the efficiency of training all residents in procedures infrequently performed by general internists.

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