Journal of General Internal Medicine

, Volume 28, Issue 8, pp 1020–1027 | Cite as

Resident Satisfaction with Continuity Clinic and Career Choice in General Internal Medicine

  • Lauren A. Peccoralo
  • Sean Tackett
  • Lawrence Ward
  • Alex Federman
  • Ira Helenius
  • Colleen Christmas
  • David C. Thomas
Original Research

Abstract

Background

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.

Objective

To assess the relationship between IM residents’ satisfaction with continuity clinic and interest in GIM careers.

Design

Cross-sectional survey assessing satisfaction with elements of continuity clinic and residents' likelihood of career choice in GIM.

Participants

IM residents at three urban medical centers.

Main Measures

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.

Key Results

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.

Conclusions

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.

Key Words

medical education—career choice medical education—graduate primary care ambulatory medicine 

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Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • Lauren A. Peccoralo
    • 1
  • Sean Tackett
    • 3
  • Lawrence Ward
    • 2
  • Alex Federman
    • 1
  • Ira Helenius
    • 4
  • Colleen Christmas
    • 3
  • David C. Thomas
    • 1
  1. 1.Division of General Internal Medicine, Samuel M. Bronfman Department of Internal MedicineMount Sinai School of MedicineNew YorkUSA
  2. 2.Division of Internal Medicine, Department of Internal MedicineThomas Jefferson UniversityPhiladelphiaUSA
  3. 3.Department of Internal MedicineJohns Hopkins Bayview Medical CenterBaltimoreUSA
  4. 4.Division of General Internal MedicineUniversity of Virginia School of MedicineCharlottesvilleUSA

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