Resident Satisfaction with Continuity Clinic and Career Choice in General Internal Medicine
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The quality of the continuity clinic experience for internal medicine (IM) residents may influence their choice to enter general internal medicine (GIM), yet few data exist to support this hypothesis.
To assess the relationship between IM residents’ satisfaction with continuity clinic and interest in GIM careers.
Cross-sectional survey assessing satisfaction with elements of continuity clinic and residents' likelihood of career choice in GIM.
IM residents at three urban medical centers.
Bivariate and multivariate associations between satisfaction with 32 elements of outpatient clinic in 6 domains (clinical preceptors, educational environment, ancillary staff, time management, administrative, personal experience) and likelihood of considering a GIM career.
Of the 225 (90 %) residents who completed surveys, 48 % planned to enter GIM before beginning their continuity clinic, whereas only 38 % did as a result of continuity clinic. Comparing residents’ likelihood to enter GIM as a result of clinic to likelihood to enter a career in GIM before clinic showed that 59 % of residents had no difference in likelihood, 28 % reported a lower likelihood as a result of clinic, and 11 % reported higher likelihood as a result of clinic. Most residents were very satisfied or satisfied with all clinic elements. Significantly more residents (p ≤ 0.002) were likely vs. unlikely to enter GIM if they were very satisfied with faculty mentorship (76 % vs. 53 %), time for appointments (28 % vs. 11 %), number of patients seen (33 % vs. 15 %), personal reward from work (51 % vs. 23 %), relationship with patients (64 % vs. 42 %), and continuity with patients (57 % vs. 33 %). In the multivariate analysis, being likely to enter GIM before clinic (OR 29.0, 95 % CI 24.0–34.8) and being very satisfied with the continuity of relationships with patients (OR 4.08, 95 % CI 2.50–6.64) were the strongest independent predictors of likelihood to enter GIM as a result of clinic.
Resident satisfaction with most aspects of continuity clinic was high; yet, continuity clinic had an overall negative influence on residents’ attitudes toward GIM careers. Targeting resources toward improving ambulatory patient continuity, workflow efficiency and increasing pre-residency interest in primary care may help build the primary care workforce.
- Bodenheimer, T, Pham, HH (2010) Primary care: Current problems and proposed solutions. Health Aff (Millwood) 29: pp. 799-805 CrossRef
- Schwartz, MD (2012) Health care reform and the primary care workforce bottleneck. J Gen Intern Med. 27: pp. 469-72 CrossRef
- Salsberg, E, Rockey, PH, Rivers, KL, Brotherton, SE, Jackson, GR (2008) US residency training before and after the 1997 balanced budget act. JAMA. 300: pp. 1174-80 CrossRef
- Garibaldi, RA, Popkave, C, Bylsma, W (2005) Career plans for trainees in internal medicine residency programs. Acad Med. 80: pp. 507-12 CrossRef
- Jeffe, DB, Whelan, AJ, Andriole, DA (2010) Primary care specialty choices of United States medical graduates, 1997–2006. Acad Med 85: pp. 947-58 CrossRef
- Schwartz, MD, Linzer, M, Babbott, D, Divine, GW, Broadhead, E (1991) Medical student interest in internal medicine. Initial report of the society of general internal medicine interest group survey on factors influencing career choice in internal medicine. Ann Intern Med 114: pp. 6-15 CrossRef
- Accreditation Council for Graduate Medical Education data resource book [Internet].; 2011. Available from: http://www.acgme.org/acgmeweb/Portals/0/PFAssets/PublicationsBooks/2011-2012_ACGME_DATABOOK_DOCUMENT_Final.pdf. Accessed October 15, 2012.
- Keirns, CC, Bosk, CL (2008) Perspective: The unintended consequences of training residents in dysfunctional outpatient settings. Acad Med 83: pp. 498-502 CrossRef
- Nadkarni, M, Reddy, S, Bates, CK, Fosburgh, B, Babbott, S, Holmboe, E (2011) Ambulatory-based education in internal medicine: Current organization and implications for transformation. Results of a national survey of resident continuity clinic directors. J Gen Intern Med 26: pp. 16-20 CrossRef
- Hauer, KE, Durning, SJ, Kernan, WN, Fagan, MJ, Mintz, M, O’Sullivan, PS (2008) Factors associated with medical students’ career choices regarding internal medicine. JAMA 300: pp. 1154-64 CrossRef
- Laponis, R, O’Sullivan, PS, Hollander, H, Cornett, P, Julian, K (2011) Educating generalists: factors of resident continuity clinic associated with perceived impact on choosing a generalist career. J Grad Med Educ 3: pp. 469-474 CrossRef
- Weinberger, SE, Smith, LG, Collier, VU (2006) Education committee of the American college of physicians. Redesigning training for internal medicine. Ann Intern Med 144: pp. 927-32 CrossRef
- Holmboe, ES, Bowen, JL, Green, M, Gregg, J, DiFrancesco, L, Reynolds, E (2005) Reforming internal medicine residency training. A report from the Society of General Internal Medicine’s task force for residency reform. J Gen Intern Med 20: pp. 1165-72 CrossRef
- Meyers, FJ, Weinberger, SE, Fitzgibbons, JP, Glassroth, J, Duffy, FD, Clayton, CP (2007) Redesigning residency training in internal medicine: The consensus report of the Alliance for Academic Internal Medicine Education redesign task force. Acad Med. 82: pp. 1211-9 CrossRef
- Keitz, SA, Holland, GJ, Melander, EH, Bosworth, HB, Pincus, SH (2003) VA learners’ perceptions working group. The veterans affairs learners’ perceptions survey: The foundation for educational quality improvement. Acad Med 78: pp. 910-7 CrossRef
- Cannon, GW, Keitz, SA, Holland, GJ, Chang, BK, Byrne, JM, Tomolo, A (2008) Factors determining medical students‘and residents’ satisfaction during VA-based training: Findings from the VA learners’ perceptions survey. Acad Med. 83: pp. 611-20 CrossRef
- Warm, EJ (2010) Interval examination: The ambulatory long block. J Gen Intern Med. 25: pp. 750-2 CrossRef
- Warm, EJ, Schauer, DP, Diers, T, Mathis, BR, Neirouz, Y, Boex, JR (2008) The ambulatory long-block: An Accreditation Council for Graduate Medical Education (ACGME) educational innovations project (EIP). J Gen Intern Med. 23: pp. 921-6 CrossRef
- Sisson, SD, Boonyasai, R, Baker-Genaw, K, Silverstein, J (2007) Continuity clinic satisfaction and valuation in residency training. J Gen Intern Med. 22: pp. 1704-10 CrossRef
- Henderson, MC, Hunt, DK, Williams, JW (1996) General internists influence students to choose primary care careers: The power of role modeling. Am J Med. 101: pp. 648-53 CrossRef
- DeWitt, DE, Curtis, JR, Burke, W (1998) What influences career choices among graduates of a primary care training program?. J Gen Intern Med 13: pp. 257-61 CrossRef
- DeZee, KJ, Maurer, DDO, Colt, R, Shimeall, W, Mallory, R, Powers, JMSS (2011) Effect of financial remuneration on specialty choice of fourth-year US medical students. Acad Med. 86: pp. 187-93 CrossRef
- Gazewood, JD, Owen, J, Rollins, LK (2002) Effect of generalist preceptor specialty in a third-year clerkship on career choice. Fam Med 34: pp. 673-7
- Wright, S, Wong, A, Newill, C (1997) The impact of role models on medical students. J Gen Intern Med. 12: pp. 53-6 CrossRef
- Fitzmaurice, GM, Laird, NM, Ware, JH (2004) Applied longitudinal analysis. Wiley, Hoboken, NJ
- Wisnivesky, JP, Leventhal, H, Halm, EA (2005) Predictors of asthma-related health care utilization and quality of life among inner-city patients with asthma. J Allergy Clin Immunol 116: pp. 636-42 CrossRef
- Wiest, FC, Ferris, TG, Gokhale, M, Campbell, EG, Weissman, JS, Blumenthal, D (2002) Preparedness of internal medicine and family practice residents for treating common conditions. JAMA. 288: pp. 2609-14 CrossRef
- Blumenthal, D, Gokhale, M, Campbell, EG, Weissman, JS (2001) Preparedness for clinical practice: Reports of graduating residents at academic health centers. JAMA. 286: pp. 1027-34 CrossRef
- Kassler, WJ, Wartman, SA, Silliman, RA (1991) Why medical students choose primary care careers. Acad Med. 66: pp. 41-3 CrossRef
- Mariotti, JL, Shalaby, M, Fitzgibbons, JP (2010) The 4ratio1 schedule: A novel template for internal medicine residencies. J Grad Med Educ. 2: pp. 541-7 CrossRef
- Connelly, MT, Sullivan, AM, Peters, AS, Clark-Chiarelli, N, Zotov, N, Martin, N (2003) Variation in predictors of primary care career choice by year and stage of training. J Gen Intern Med. 18: pp. 159-69 CrossRef
- Compton, MT, Frank, E, Elon, L, Carrera, J (2008) Changes in US medical students’ specialty interests over the course of medical school. J Gen Intern Med 23: pp. 1095-100 CrossRef
- Markert, RJ (1991) Original contributions. Why medical students change to and from primary care as a career choice. Fam Med 23: pp. 347-50
- McMurray, JE, Schwartz, MD, Genero, NP, Linzer, M (1993) The attractiveness of internal medicine: A qualitative analysis of the experiences of female and male medical students. Ann Intern Med. 119: pp. 812-8 CrossRef
- Norris, TE, Schaad, DC, DeWitt, D, Ogur, B, Hunt, DD (2009) Consortium of Longitudinal Integrated Clerkships. Longitudinal integrated clerkships for medical students: An innovation adopted by medical schools in Australia, Canada, South Africa, and the United States. Acad Med. 84: pp. 902-7 CrossRef
- Colgan, R, Iafolla, CE, Rooks, Y, Stewart, DL (2009) Increasing student interest in family medicine and urban health care: The family care tract. Md Med 10: pp. 21
- Mennin, SP, Kalishman, S, Friedman, M, Pathak, D, Snyder, J (1996) A survey of graduates in practice from the University of New Mexico’s conventional and community-oriented, problem-based tracks. Acad Med. 71: pp. 1079-89 CrossRef
- Medical schools invest in primay care [Internet].; March 22, 2011. Available from: http://www.usnews.com/education/best-graduate-schools/articles/2011/03/22/medical-schools-invest-in-primary-care. Accessed October 15, 2012.
- Corbett, EC, Owen, JA, Hayden, GF (2002) Effect of a second-year primary care preceptorship on medical students’ career plans. South Med J 95: pp. 691-4
- Resident Satisfaction with Continuity Clinic and Career Choice in General Internal Medicine
Journal of General Internal Medicine
Volume 28, Issue 8 , pp 1020-1027
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- medical education—career choice
- medical education—graduate
- primary care
- ambulatory medicine
- Industry Sectors
- Author Affiliations
- 1. Division of General Internal Medicine, Samuel M. Bronfman Department of Internal Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1087, New York, NY, 10029, USA
- 3. Department of Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
- 2. Division of Internal Medicine, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, USA
- 4. Division of General Internal Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA