What do senior internal medicine residents do in their continuity clinics?

Abstract

Objective: To describe the activities of second- and third-year internal medicine residents during their outpatient continuity clinics.

Design: Descriptive observational study.

Setting: Medical school-affiliated community hospital primary care clinic.

Patients/participants: All second-year (n=15) and third-year (n=14) residents enrolled in the internal medicine training program were observed at one-minute intervals during their routine half-day continuity clinics.

Measurements and main results: An average of 203 observations were recorded for each resident. The distribution of resident activities was as follows: 1) direct interaction with patients (29.5%); 2) charting or writing prescriptions (24.0%); 3) social interactions with staff (13.7%); 4) attending conferences or reviewing medical literature (9.4%); 5) waiting or transiting (8.2%); 6) ward responsibilities (4.9%); 7) reviewing cases with attending physician (4.4%); and 8) miscellaneous activities (4.9%). Analysis of variance procedures revealed that the following variables significantly (p<0.05) affected the residents’ activities: 1) the actual number of patients seen produced predictable increases in direct and indirect patient care activities; and 2) the year of training had an impact on the mean number of observations of interactions with the supervising attending physician (PGY-2=11.4, PGY-3=3.8).

Conclusions: These results suggest that this senior resident continuity experience is clinically intensive, yet provides surprisingly infrequent direct resident supervision. Further analysis of the educational activities occurring on these half-days is necessary to judge whether they are quantitatively and qualitatively adequate.