Internal Medicine Residents May Benefit Most From Time In Clinic

Eric Warm, MD, associate professor of medicine and lead investigator of the study, says research showed residents who spent increased time in outpatient settings as opposed to the hospital delivered a higher quality of care and had more satisfaction in their duties.

Results of this study are published in the July edition of the Journal of General Internal Medicine.

“We essentially redesigned how the internal medicine residency runs,” says Warm. “With this new system, residents complete one year in an outpatient clinic actually doing the things patients expect from their primary care doctors. In the past, residents were based mainly in the hospital, and their delivery of care to outpatients suffered.”

Warm says in restructuring the program, he and colleagues hoped to reduce conflict between inpatient and outpatient care, provide enough time for hands-on learning and enhance the feeling of reward for residents, in addition to raising patient satisfaction and improving physician continuity.

He says there are two overall problems with current residency programs that are primarily focused on inpatient care: not enough time spent in the clinics and no tool to assess the quality of work in the clinic or ways to make it better.

“By placing our residents in the clinic, it allows them to focus on patient care,” he says. “Within the first year, both the patients’ and the residents’ satisfaction had increased.

“We utilized the chronic care model—a tool that helps improve patient care—as our central operating force.”

Instead of allowing residents to engage in “sporadic” interactions with patients for three years, this new model placed them face-to-face with the same patients for one year. During this time, they developed more intimate relationships with patients and learned how to assess and improve the quality of care they delivered.

Overall, residents reported an improvement in their ability to focus in the clinic without being distracted, an increase in personal reward and a greater sense of relationship with their patients.

Patients were also more satisfied with their care, according to Press-Ganey survey data.

Warm says there are several other legs of this study to be completed in the future, including research on the long-term impact on chronic disease.

“We hope research such as this will lead to the most optimal training for our doctors, which will benefit patients in the future,” he says.

The study is part of the Educational Innovations Project (EIP), sponsored through the Accreditation Council for Graduate Medical Education, to facilitate competency-based education and outcomes assessment in programs needing innovation.