Journal of General Internal Medicine

, Volume 21, Issue 5, pp 435–439

What do attending physicians contribute in a house officer-based ambulatory continuity clinic?

  • Elizabeth M. Cyran
  • Gail Albertson
  • Lisa M. Schilling
  • Chen-Tan Lin
  • Lindsay Ware
  • John F. Steiner
  • Robert J. Anderson
Original Articles

DOI: 10.1111/j.1525-1497.2006.00423.x

Cite this article as:
Cyran, E.M., Albertson, G., Schilling, L.M. et al. J GEN INTERN MED (2006) 21: 435. doi:10.1111/j.1525-1497.2006.00423.x

Abstract

OBJECTIVE: To study the educational contributions of attending physicians in an internal medicine house staff ambulatory clinic.

DESIGN: Cross-sectional, self-administered survey.

SETTING: University-affiliated general internal medicine practice.

PATIENTS/PARTICIPANTS: Internal medicine residents and attendings.

MEASUREMENTS AND MAIN RESULTS: Attending and resident perceptions of whether attendings made contributions to teaching points, diagnosis (DX), therapy (RX), and health care maintenance (HCM) were assessed in 428 patient encounters. Resident assessments significantly exceeded attending self-assessments of contributions to teaching points (82% vs 74%, P=.001), DX (44% vs 34%, P=.001), RX (61% vs 55%, P=.02), and HCM (19% vs 15%, P=.04). Both residents and attendings perceived that contributions declined progressively with increasing resident year (P<.05). Primary care and categorical residents assessed attending contributions comparably. However, attendings perceived contributing more to RX and HCM for categorical residents than primary care (P<.05). Male and female residents assessed attending contributions comparably. However, attendings perceived contributing generally more to DX in male residents than female (P=.003). In 8% of encounters, either residents or attendings felt that patient evaluation by the attending was needed. In these encounters with personal patient evaluation by attendings, both residents and attendings felt that attendings made more contributions to DX (P=.001) and teaching points than in other encounters.

CONCLUSIONS: Attending physicians consistently underestimate their perceived contributions to house officer ambulatory teaching. Their personal patient evaluation increases assistance with DX and teaching points. Given perceived declining contributions by training year, attendings may need to identify other teaching strategies for interactions with senior residents.

Key words

medical education ambulatory care internship and residency bedside training 

Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • Elizabeth M. Cyran
    • 1
  • Gail Albertson
    • 2
  • Lisa M. Schilling
    • 2
  • Chen-Tan Lin
    • 2
  • Lindsay Ware
    • 2
  • John F. Steiner
    • 2
  • Robert J. Anderson
    • 2
  1. 1.Internal Medicine Residency ProgramExempla Saint Joseph HospitalDenverUSA
  2. 2.Division of General Internal MedicineUniversity of Colorado Health Sciences CenterDenverUSA