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.
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References
Bodenheimer T, Pham HH. Primary care: Current problems and proposed solutions. Health Aff (Millwood). 2010;29(5):799–805.
Schwartz MD. Health care reform and the primary care workforce bottleneck. J Gen Intern Med. 2012;27(4):469–72.
Salsberg E, Rockey PH, Rivers KL, Brotherton SE, Jackson GR. US residency training before and after the 1997 balanced budget act. JAMA. 2008;300(10):1174–80.
Garibaldi RA, Popkave C, Bylsma W. Career plans for trainees in internal medicine residency programs. Acad Med. 2005;80(5):507–12.
Jeffe DB, Whelan AJ, Andriole DA. Primary care specialty choices of United States medical graduates, 1997–2006. Acad Med. 2010;85(6):947–58.
Schwartz MD, Linzer M, Babbott D, Divine GW, Broadhead E. 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. 1991;114(1):6–15.
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. Perspective: The unintended consequences of training residents in dysfunctional outpatient settings. Acad Med. 2008;83(5):498–502.
Nadkarni M, Reddy S, Bates CK, Fosburgh B, Babbott S, Holmboe E. 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. 2011;26(1):16–20.
Hauer KE, Durning SJ, Kernan WN, Fagan MJ, Mintz M, O’Sullivan PS, et al. Factors associated with medical students’ career choices regarding internal medicine. JAMA. 2008;300(10):1154–64.
Laponis R, O’Sullivan PS, Hollander H, Cornett P, Julian K. Educating generalists: factors of resident continuity clinic associated with perceived impact on choosing a generalist career. J Grad Med Educ. 2011;3(4):469–474.
Weinberger SE, Smith LG, Collier VU. Education committee of the American college of physicians. Redesigning training for internal medicine. Ann Intern Med. 2006;144(12):927–32.
Holmboe ES, Bowen JL, Green M, Gregg J, DiFrancesco L, Reynolds E, et al. Reforming internal medicine residency training. A report from the Society of General Internal Medicine’s task force for residency reform. J Gen Intern Med. 2005;20(12):1165–72.
Meyers FJ, Weinberger SE, Fitzgibbons JP, Glassroth J, Duffy FD, Clayton CP, et al. Redesigning residency training in internal medicine: The consensus report of the Alliance for Academic Internal Medicine Education redesign task force. Acad Med. 2007;82(12):1211–9.
Keitz SA, Holland GJ, Melander EH, Bosworth HB, Pincus SH. VA learners’ perceptions working group. The veterans affairs learners’ perceptions survey: The foundation for educational quality improvement. Acad Med. 2003;78(9):910–7.
Cannon GW, Keitz SA, Holland GJ, Chang BK, Byrne JM, Tomolo A, et al. Factors determining medical students‘and residents’ satisfaction during VA-based training: Findings from the VA learners’ perceptions survey. Acad Med. 2008;83(6):611–20.
Warm EJ. Interval examination: The ambulatory long block. J Gen Intern Med. 2010;25(7):750–2.
Warm EJ, Schauer DP, Diers T, Mathis BR, Neirouz Y, Boex JR, et al. The ambulatory long-block: An Accreditation Council for Graduate Medical Education (ACGME) educational innovations project (EIP). J Gen Intern Med. 2008;23(7):921–6.
Sisson SD, Boonyasai R, Baker-Genaw K, Silverstein J. Continuity clinic satisfaction and valuation in residency training. J Gen Intern Med. 2007;22(12):1704–10.
Henderson MC, Hunt DK, Williams JW Jr. General internists influence students to choose primary care careers: The power of role modeling. Am J Med. 1996;101(6):648–53.
DeWitt DE, Curtis JR, Burke W. What influences career choices among graduates of a primary care training program? J Gen Intern Med. 1998;13(4):257–61.
DeZee KJ, Maurer DDO, Colt R, Shimeall W, Mallory R, Powers JMSS, et al. Effect of financial remuneration on specialty choice of fourth-year US medical students. Acad Med. 2011;86(2):187–93.
Gazewood JD, Owen J, Rollins LK. Effect of generalist preceptor specialty in a third-year clerkship on career choice. Fam Med. 2002;34(9):673–7.
Wright S, Wong A, Newill C. The impact of role models on medical students. J Gen Intern Med. 1997;12(1):53–6.
Fitzmaurice GM, Laird NM, Ware JH. Applied longitudinal analysis. Hoboken, NJ: Wiley; 2004.
Wisnivesky JP, Leventhal H, Halm EA. Predictors of asthma-related health care utilization and quality of life among inner-city patients with asthma. J Allergy Clin Immunol. 2005;116(3):636–42.
Wiest FC, Ferris TG, Gokhale M, Campbell EG, Weissman JS, Blumenthal D. Preparedness of internal medicine and family practice residents for treating common conditions. JAMA. 2002;288(20):2609–14.
Blumenthal D, Gokhale M, Campbell EG, Weissman JS. Preparedness for clinical practice: Reports of graduating residents at academic health centers. JAMA. 2001;286(9):1027–34.
Kassler WJ, Wartman SA, Silliman RA. Why medical students choose primary care careers. Acad Med. 1991;66(1):41–3.
Mariotti JL, Shalaby M, Fitzgibbons JP. The 4ratio1 schedule: A novel template for internal medicine residencies. J Grad Med Educ. 2010;2(4):541–7.
Connelly MT, Sullivan AM, Peters AS, Clark-Chiarelli N, Zotov N, Martin N, et al. Variation in predictors of primary care career choice by year and stage of training. J Gen Intern Med. 2003;18(3):159–69.
Compton MT, Frank E, Elon L, Carrera J. Changes in US medical students’ specialty interests over the course of medical school. J Gen Intern Med. 2008;23(7):1095–100.
Markert RJ. Original contributions. Why medical students change to and from primary care as a career choice. Fam Med. 1991;23(5):347–50.
McMurray JE, Schwartz MD, Genero NP, Linzer M. The attractiveness of internal medicine: A qualitative analysis of the experiences of female and male medical students. Ann Intern Med. 1993;119(8):812–8.
Norris TE, Schaad DC, DeWitt D, Ogur B, Hunt DD. 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. 2009;84(7):902–7.
Colgan R, Iafolla CE, Rooks Y, Stewart DL. Increasing student interest in family medicine and urban health care: The family care tract. Md Med. 2009;10(1):21. 3, 30.
Mennin SP, Kalishman S, Friedman M, Pathak D, Snyder J. A survey of graduates in practice from the University of New Mexico’s conventional and community-oriented, problem-based tracks. Acad Med. 1996;71(10):1079–89.
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 Jr, Owen JA, Hayden GF. Effect of a second-year primary care preceptorship on medical students’ career plans. South Med J. 2002;95(7):691–4.
Contributors
Deborah Korenstein, M.D.
Funding
There were no sources of funding for this study.
Prior Presentations
This work was presented as oral presentations at the National SGIM meetings in May 2011 and May 2012 as well as poster presentations at Regional SGIM in March 2011 and Mount Sinai Educational Research Day in April 2011.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
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Peccoralo, L.A., Tackett, S., Ward, L. et al. Resident Satisfaction with Continuity Clinic and Career Choice in General Internal Medicine. J GEN INTERN MED 28, 1020–1027 (2013). https://doi.org/10.1007/s11606-012-2280-5
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DOI: https://doi.org/10.1007/s11606-012-2280-5