Internal Medicine Residency Reform: Task Force Report

Journal of General Internal Medicine

, Volume 20, Issue 12, pp 1181-1187

First online:

Changing habits of practice

Transforming internal medicine residency education in ambulatory settings
  • Judith L. BowenAffiliated withDivision of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University Email author 
  • , Stephen M. SalernoAffiliated withUSUHS, Tripler Army Medical CenterInternal Medicine Residency, Tripler Army Medical Center
  • , John K. ChamberlainAffiliated withDepartment of Medicine and Pediatrics, University of Rochester School of Medicine and Dentistry
  • , Elizabeth EckstromAffiliated withDepartment of Internal Medicine, Legacy Health SystemDepartment of Medicine, Oregon Health & Science University
  • , Helen L. ChenAffiliated withUniversity of California, San Francisco Veterans Affairs Medical Center
  • , Suzanne BrandenburgAffiliated withDivision of General Internal Medicine, University of Colorado Health Sciences Center

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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.

Key Words

ambulatory graduate medical education curriculum faculty development internal medicine