Abstract
Objective: To describe consultation practice patterns of graduates of an internal medicine residency program and to determine whether they consider themselves to be adequately trained to practice in the area of internal medicine consultations.
Design: The authors surveyed graduates of the internal medicine residency program at the University of California, San Diego, School of Medicine from 1980 to 1989. Respondents described their practice types and the mechanics of consultations they currently perform, as well as the adequacy of their training in and frequency of encountering 74 clinical problems in the area of internal medicine consultation. Topics were categorized as Group I: excessive training; Group II: adequate training, frequently encountered; Group III: adequate training, infrequently encountered; Group IV: inadequate training, frequently encountered; and Group V: inadequate training, infrequently encountered.
Setting: University teaching hospital.
Participants: Of 214 graduates, 91 returned surveys adequate for analysis.
Results: Internists prefer verbal communication with their colleagues and seeing surgical patients in the office prior to admission. Residents perceive that they have been excessively trained in preoperative evaluations of the asymptomatic and chronically ill adult and in several postoperative complications. Topics seen frequently in clinical practice but inadequately taught include: issues in convalescence and rehabilitation from surgical procedures, use of psychotropic medications, and management of eating disorders.
Conclusions: To prepare residents for practice, program directors in consultation medicine might consider incorporating outpatient preoperative evaluation assessments, encouraging a liaison between surgeons and internists, and modeling verbal communication among colleagues. Consideration should be given for more didactic training for Group IV topics.
Similar content being viewed by others
References
Phelps LA, Rentier JH. The development of a “statement of policy regarding consultations.” J Fam Pract. 1977;5:979–81.
Saunders TC. Consultation-referral among physicians: practice and process. J Fam Pract. 1978;6:123–8.
Burnum JF. What one internist does in his practice: implications for the internist’s disputed role and education. Ann Intern Med. 1973;78:437–44.
Petersdorf RG. Health manpower: numbers, distribution, quality. Ann Intern Med. 1975;82:694–701.
Kupfer S. The art and science of consultation in medicine. Mt Sinai J Med. 1991;58(1):1.
Rudd P, Siegler M, Byyny RL. Perioperative diabetic consultation: a plea for improved training. J Med Educ. 1978;53:590–6.
Aloia JF. The flexible medical residency. Arch Intern Med. 1977;137:121–3.
Bomalaski JS, Martin GJ, Webster JR. General internal medicine consultation: the last bridge. Arch Intern Med. 1983;143:875–6.
Rosansky SJ. The medical consultation: a neglected science. Milit Med. 1981;146:181–3.
Aiken LH, Lewis CE, Craig J, et al. The contribution of specialists to the delivery of primary care: a new perspective. N Engl J Med. 1979;300:1363–70.
Eisenberg, JM. The internist as gatekeeper: preparing the general internist for a new role. Ann Intern Med. 1985;102:537–43.
Nuckolls JG. Internal medicine practice in transition: implications for curriculum changes. Ann Intern Med. 1992;116(12,pt 2):1051–4.
Schroeder SA, Showstack JA, Gerbert B. Residency training in internal medicine: time for a change? Ann Intern Med. 1986;104:554–61.
Cole Jr, Lipton JA. The reputations of American medical schools. Soc Forces. 1977;55(3):662–84.
Ferguson RP, Rubinstein E. Preoperative medical consultations in a community hospital. J Gen Intern Med. 1987;2:89–92.
Lee T, Pappus EM, Goldman L. Impact of inter-physician communication on the effectiveness of medical consultations. Am J Med. 1983;74:106–12.
Sears C, Charlson M. The effectiveness of a consultation; compliance with initial recommendations. Am J Med. 1983;74:870–6.
Klein LE, Levine DM, Moore RD, Kirby SM. The preoperative consultation. Arch Intern Med. 1983;143:743.
Popkin MK, Mackenzie TB, Callies AL. Consultation-liaison outcome evaluation system. Arch Gen Psychiatry. 1983;40:215–9.
Klein LE, Moore RD, Levine DM, Kirby S. Effectiveness of medical consultations. J Med Educ. 1983;58:149–151.
Goldman L, Lee T, Rudd P. Ten commandments for effective consultations. Arch Intern Med. 1983;143:1753–5.
Dillman DA. The design and administration of mail surveys. Annu Rev Sociol. 1991;17:225–49.
Author information
Authors and Affiliations
Additional information
Received from the Department of Medicine, Division of General Internal Medicine/Geriatrics, University of California, San Diego School of Medicine, Lajolla, California.
Rights and permissions
About this article
Cite this article
Devor, M., Renvall, M. & Ramsdell, J. Practice patterns and the adequacy of residency training in consultation medicine. J Gen Intern Med 8, 554–560 (1993). https://doi.org/10.1007/BF02599639
Issue Date:
DOI: https://doi.org/10.1007/BF02599639