Alternative approaches to ambulatory training: Internal medicine residents' and program directors' perspectives

Kris G. Thomas, Colin Patrick West, Carol Popkave, Lisa M. Bellini, Steven E. Weinberger, Joseph C. Kolars, Jennifer R. Kogan

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

BACKGROUND: Internal medicine ambulatory training redesign, including recommendations to increase ambulatory training, is a focus of national discussion. Residents' and program directors' perceptions about ambulatory training models are unknown. OBJECTIVE: To describe internal medicine residents' and program directors' perceptions regarding ambulatory training duration, alternative ambulatory training models, and factors important for ambulatory education. DESIGN: National cohort study. PARTICIPANTS: Internal medicine residents (N= 14,941) and program directors (N=222) who completed the 2007 Internal Medicine In-Training Examination (IM-ITE) Residents Questionnaire or Program Directors Survey, representing 389 US residency programs. RESULTS: A total of 58.4% of program directors and 43.7% of residents preferred one-third or more training time in outpatient settings. Resident preferences for one-third or more outpatient training increased with higher levels of training (48.3% PGY3), female sex (52.7%), primary care program enrollment (64.8%), and anticipated outpatient-focused career, such as geriatrics. Most program directors (77.3%) and residents (58.4%) preferred training models containing weekly clinic. Although residents and program directors reported problems with competing inpatient-outpatient responsibilities (74.9% and 88.1%, respectively) and felt that absence of conflict with inpatient responsibilities is important for good outpatient training (69.4% and 74.2%, respectively), only 41.6% of residents and 22.7% of program directors supported models eliminating ambulatory sessions during inpatient rotations. CONCLUSIONS: Residents' and program directors' preferences for outpatient training differ from recommendations for increased ambulatory training. Discordance was observed between reported problems with conflicting inpatient-outpatient responsibilities and preferences for models maintaining longitudinal clinic during inpatient rotations. Further study regarding benefits and barriers of ambulatory redesign is needed.

Original languageEnglish (US)
Pages (from-to)904-910
Number of pages7
JournalJournal of General Internal Medicine
Volume24
Issue number8
DOIs
StatePublished - 2009

Fingerprint

Internal Medicine
Outpatients
Inpatients
Internship and Residency
Geriatrics
Primary Health Care
Cohort Studies
Education

Keywords

  • Ambulatory care
  • Curriculum/program evaluation
  • Medical education-graduate
  • Medical student and residency education

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Thomas, K. G., West, C. P., Popkave, C., Bellini, L. M., Weinberger, S. E., Kolars, J. C., & Kogan, J. R. (2009). Alternative approaches to ambulatory training: Internal medicine residents' and program directors' perspectives. Journal of General Internal Medicine, 24(8), 904-910. https://doi.org/10.1007/s11606-009-1015-8

Alternative approaches to ambulatory training : Internal medicine residents' and program directors' perspectives. / Thomas, Kris G.; West, Colin Patrick; Popkave, Carol; Bellini, Lisa M.; Weinberger, Steven E.; Kolars, Joseph C.; Kogan, Jennifer R.

In: Journal of General Internal Medicine, Vol. 24, No. 8, 2009, p. 904-910.

Research output: Contribution to journalArticle

Thomas, KG, West, CP, Popkave, C, Bellini, LM, Weinberger, SE, Kolars, JC & Kogan, JR 2009, 'Alternative approaches to ambulatory training: Internal medicine residents' and program directors' perspectives', Journal of General Internal Medicine, vol. 24, no. 8, pp. 904-910. https://doi.org/10.1007/s11606-009-1015-8
Thomas, Kris G. ; West, Colin Patrick ; Popkave, Carol ; Bellini, Lisa M. ; Weinberger, Steven E. ; Kolars, Joseph C. ; Kogan, Jennifer R. / Alternative approaches to ambulatory training : Internal medicine residents' and program directors' perspectives. In: Journal of General Internal Medicine. 2009 ; Vol. 24, No. 8. pp. 904-910.
@article{394ce6adfef345a28d1ff4ee0b45a76e,
title = "Alternative approaches to ambulatory training: Internal medicine residents' and program directors' perspectives",
abstract = "BACKGROUND: Internal medicine ambulatory training redesign, including recommendations to increase ambulatory training, is a focus of national discussion. Residents' and program directors' perceptions about ambulatory training models are unknown. OBJECTIVE: To describe internal medicine residents' and program directors' perceptions regarding ambulatory training duration, alternative ambulatory training models, and factors important for ambulatory education. DESIGN: National cohort study. PARTICIPANTS: Internal medicine residents (N= 14,941) and program directors (N=222) who completed the 2007 Internal Medicine In-Training Examination (IM-ITE) Residents Questionnaire or Program Directors Survey, representing 389 US residency programs. RESULTS: A total of 58.4{\%} of program directors and 43.7{\%} of residents preferred one-third or more training time in outpatient settings. Resident preferences for one-third or more outpatient training increased with higher levels of training (48.3{\%} PGY3), female sex (52.7{\%}), primary care program enrollment (64.8{\%}), and anticipated outpatient-focused career, such as geriatrics. Most program directors (77.3{\%}) and residents (58.4{\%}) preferred training models containing weekly clinic. Although residents and program directors reported problems with competing inpatient-outpatient responsibilities (74.9{\%} and 88.1{\%}, respectively) and felt that absence of conflict with inpatient responsibilities is important for good outpatient training (69.4{\%} and 74.2{\%}, respectively), only 41.6{\%} of residents and 22.7{\%} of program directors supported models eliminating ambulatory sessions during inpatient rotations. CONCLUSIONS: Residents' and program directors' preferences for outpatient training differ from recommendations for increased ambulatory training. Discordance was observed between reported problems with conflicting inpatient-outpatient responsibilities and preferences for models maintaining longitudinal clinic during inpatient rotations. Further study regarding benefits and barriers of ambulatory redesign is needed.",
keywords = "Ambulatory care, Curriculum/program evaluation, Medical education-graduate, Medical student and residency education",
author = "Thomas, {Kris G.} and West, {Colin Patrick} and Carol Popkave and Bellini, {Lisa M.} and Weinberger, {Steven E.} and Kolars, {Joseph C.} and Kogan, {Jennifer R.}",
year = "2009",
doi = "10.1007/s11606-009-1015-8",
language = "English (US)",
volume = "24",
pages = "904--910",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",
number = "8",

}

TY - JOUR

T1 - Alternative approaches to ambulatory training

T2 - Internal medicine residents' and program directors' perspectives

AU - Thomas, Kris G.

AU - West, Colin Patrick

AU - Popkave, Carol

AU - Bellini, Lisa M.

AU - Weinberger, Steven E.

AU - Kolars, Joseph C.

AU - Kogan, Jennifer R.

PY - 2009

Y1 - 2009

N2 - BACKGROUND: Internal medicine ambulatory training redesign, including recommendations to increase ambulatory training, is a focus of national discussion. Residents' and program directors' perceptions about ambulatory training models are unknown. OBJECTIVE: To describe internal medicine residents' and program directors' perceptions regarding ambulatory training duration, alternative ambulatory training models, and factors important for ambulatory education. DESIGN: National cohort study. PARTICIPANTS: Internal medicine residents (N= 14,941) and program directors (N=222) who completed the 2007 Internal Medicine In-Training Examination (IM-ITE) Residents Questionnaire or Program Directors Survey, representing 389 US residency programs. RESULTS: A total of 58.4% of program directors and 43.7% of residents preferred one-third or more training time in outpatient settings. Resident preferences for one-third or more outpatient training increased with higher levels of training (48.3% PGY3), female sex (52.7%), primary care program enrollment (64.8%), and anticipated outpatient-focused career, such as geriatrics. Most program directors (77.3%) and residents (58.4%) preferred training models containing weekly clinic. Although residents and program directors reported problems with competing inpatient-outpatient responsibilities (74.9% and 88.1%, respectively) and felt that absence of conflict with inpatient responsibilities is important for good outpatient training (69.4% and 74.2%, respectively), only 41.6% of residents and 22.7% of program directors supported models eliminating ambulatory sessions during inpatient rotations. CONCLUSIONS: Residents' and program directors' preferences for outpatient training differ from recommendations for increased ambulatory training. Discordance was observed between reported problems with conflicting inpatient-outpatient responsibilities and preferences for models maintaining longitudinal clinic during inpatient rotations. Further study regarding benefits and barriers of ambulatory redesign is needed.

AB - BACKGROUND: Internal medicine ambulatory training redesign, including recommendations to increase ambulatory training, is a focus of national discussion. Residents' and program directors' perceptions about ambulatory training models are unknown. OBJECTIVE: To describe internal medicine residents' and program directors' perceptions regarding ambulatory training duration, alternative ambulatory training models, and factors important for ambulatory education. DESIGN: National cohort study. PARTICIPANTS: Internal medicine residents (N= 14,941) and program directors (N=222) who completed the 2007 Internal Medicine In-Training Examination (IM-ITE) Residents Questionnaire or Program Directors Survey, representing 389 US residency programs. RESULTS: A total of 58.4% of program directors and 43.7% of residents preferred one-third or more training time in outpatient settings. Resident preferences for one-third or more outpatient training increased with higher levels of training (48.3% PGY3), female sex (52.7%), primary care program enrollment (64.8%), and anticipated outpatient-focused career, such as geriatrics. Most program directors (77.3%) and residents (58.4%) preferred training models containing weekly clinic. Although residents and program directors reported problems with competing inpatient-outpatient responsibilities (74.9% and 88.1%, respectively) and felt that absence of conflict with inpatient responsibilities is important for good outpatient training (69.4% and 74.2%, respectively), only 41.6% of residents and 22.7% of program directors supported models eliminating ambulatory sessions during inpatient rotations. CONCLUSIONS: Residents' and program directors' preferences for outpatient training differ from recommendations for increased ambulatory training. Discordance was observed between reported problems with conflicting inpatient-outpatient responsibilities and preferences for models maintaining longitudinal clinic during inpatient rotations. Further study regarding benefits and barriers of ambulatory redesign is needed.

KW - Ambulatory care

KW - Curriculum/program evaluation

KW - Medical education-graduate

KW - Medical student and residency education

UR - http://www.scopus.com/inward/record.url?scp=77950353660&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77950353660&partnerID=8YFLogxK

U2 - 10.1007/s11606-009-1015-8

DO - 10.1007/s11606-009-1015-8

M3 - Article

C2 - 19475458

AN - SCOPUS:77950353660

VL - 24

SP - 904

EP - 910

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

IS - 8

ER -