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

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

Research output: Contribution to journalArticle

18 Scopus citations

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 - Aug 2009

Keywords

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

ASJC Scopus subject areas

  • Internal Medicine

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    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