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Changing habits of practice

Transforming internal medicine residency education in ambulatory settings

  • Internal Medicine Residency Reform: Task Force Report
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

PURPOSE: The majority of health care, both for acute and chronic conditions, is delivered in the ambulatory setting. Despite repeated proposals for change, the majority of internal medicine residency training still occurs in the inpatient setting. Substantial changes in ambulatory education are needed to correct the current imbalance. To assist educators and policy makers in this process, this paper reviews the literature on ambulatory education and makes recommendations for change.

METHODS: The authors searched the Medline, Psychlit, and ERIC databases from 2000 to 2004 for studies that focused specifically on curriculum, teaching, and evaluation of internal medicine residents in the ambulatory setting to update previous reviews. Studies had to contain primary data and were reviewed for methodological rigor and relevance.

RESULTS: Fifty-five studies met criteria for review. Thirty-five of the studies focused on specific curricular areas and 11 on ambulatory teaching methods. Five involved evaluating performance and 4 focused on structural issues. No study evaluated the overall effectiveness of ambulatory training or investigated the effects of current resident continuity clinic microsystems on education.

CONCLUSION: This updated review continues to identify key deficiencies in ambulatory training curriculum and faculty skills. The authors make several recommendations: (1) Make training in the ambulatory setting a priority. (2) Address systems problems in practice environments. (3) Create learning experiences appropriate to the resident’s level of development. (4) Teach and evaluate in the examination room. (5) Expand subspecialty-based training to the ambulatory setting. (6) Make faculty development a priority. (7) Create and fund multiinstitutional educational research consortia.

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Authors and Affiliations

  1. USUHS, Tripler Army Medical Center, Honolulu, HI, USA

    Stephen M. Salerno MD, MPH

  2. Internal Medicine Residency, Tripler Army Medical Center, Honolulu, HI, USA

    Stephen M. Salerno MD, MPH

  3. Department of Medicine and Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA

    John K. Chamberlain MD

  4. Department of Internal Medicine, Legacy Health System, Portland, OR, USA

    Elizabeth Eckstrom MD, MPH

  5. Department of Medicine, Oregon Health & Science University, Portland, OR, USA

    Elizabeth Eckstrom MD, MPH

  6. University of California, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA

    Helen L. Chen MD

  7. Division of General Internal Medicine, University of Colorado Health Sciences Center, Denver, CO, USA

    Suzanne Brandenburg MD

  8. Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, L-475, 97239-3098, Portland, OR

    Judith L. Bowen MD

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  1. Judith L. Bowen MD
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  2. Stephen M. Salerno MD, MPH
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  3. John K. Chamberlain MD
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  4. Elizabeth Eckstrom MD, MPH
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  5. Helen L. Chen MD
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Corresponding author

Correspondence to Judith L. Bowen MD.

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The authors have no conflicts of interest to report.

See editorial by Holly Humphrey, p. 1189

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Bowen, J.L., Salerno, S.M., Chamberlain, J.K. et al. Changing habits of practice. J GEN INTERN MED 20, 1181–1187 (2005). https://doi.org/10.1111/j.1525-1497.2005.0248.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2005.0248.x

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