Alternative Approaches to Ambulatory Training: Internal Medicine Residents’ and Program Directors’ Perspectives

ABSTRACT Background Combined internal medicine and pediatrics (medicine-pediatrics) residencies were Accreditation Council for Graduate Medical Education (ACGME) accredited separately from their corresponding categorical residencies in June 2006. Objective We investigated how ACGME accreditation of medicine-pediatrics programs has affected the levels of support (both financial and personnel), the National Resident Matching Program (NRMP) match rate, performance on the board examination, and other graduate outcomes. Methods From 2009 through 2013 we sent an annual SurveyMonkey online survey to members of the Medicine-Pediatrics Program Directors Association. Questions pertained to program characteristics, program director support, recruitment, ambulatory training, and graduate data. More than 79% of responders completed the entire survey for each year (sample size was 60 program directors). Results Compared to the time prior to accreditation of the specialty, there was an increase in program directors who are dually trained (89% versus 93%), an increase in program director salary ($134,000 before accreditation versus $185,000 in 2013, P < .05), and an increase in the average full-time equivalent support (0.32 before accreditation versus 0.42 in 2013, P < .05). There was also an increase in programs with associate program directors (35% versus 78%), programs with chief residents (71% versus 91%), and an increase in program budgets controlled by program directors (52% versus 69%). The 2013 NRMP match rates increased compared to those of 2005 (99% versus 49%). Performance on the American Board of Pediatrics examination was comparable to that for pediatrics residents. Since accreditation, a larger number of residents are choosing careers in hospital medicine. Conclusions Our data show widespread improved support for medicine-pediatrics programs since the 2006 start of ACGME accreditation.

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Palliative Care Exposure in Internal Medicine Residency Education: A Survey of ACGME Internal Medicine Program Directors

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909116687986 ◽

2017 ◽

Vol 35 (1) ◽

pp. 41-44 ◽

Cited By ~ 8

Author(s):

Asher Edwards ◽

Samuel Nam

Keyword(s):

Internal Medicine ◽

Palliative Care ◽

Supply And Demand ◽

Program Directors ◽

Care Needs ◽

Baby Boomer Generation ◽

Palliative Care Education ◽

Internal Medicine Residents ◽

Palliative Care Services ◽

Care Training

As the baby boomer generation ages, the need for palliative care services will be paramount and yet training for palliative care physicians is currently inadequate to meet the current palliative care needs. Nonspecialty-trained physicians will need to supplement the gap between supply and demand. Yet, no uniform guidelines exist for the training of internal medicine residents in palliative care. To our knowledge, no systematic study has been performed to evaluate how internal medicine residencies currently integrate palliative care into their training. In this study, we surveyed 338 Accreditation Council for Graduate Medical Education–accredited internal medicine program directors. We queried how palliative care was integrated into their training programs. The vast majority of respondents felt that palliative care training was “very important” (87.5%) and 75.9% of respondents offered some kind of palliative care rotation, often with a multidisciplinary approach. Moving forward, we are hopeful that the data provided from our survey will act as a launching point for more formal investigations into palliative care education for internal medicine residents. Concurrently, policy makers should aid in palliative care instruction by formalizing required palliative care training for internal medicine residents.

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The Neighborhood Health Exchange: Developing a Community Partnership in Residency

Journal of Graduate Medical Education ◽

10.4300/jgme-d-10-00067.1 ◽

2010 ◽

Vol 2 (3) ◽

pp. 456-461 ◽

Cited By ~ 1

Author(s):

Kimberly M. Tartaglia ◽

Valerie G. Press ◽

Benjamin H. Freed ◽

Timothy Baker ◽

Joyce W. Tang ◽

...

Keyword(s):

Internal Medicine ◽

Residency Training ◽

Current System ◽

Hospital Setting ◽

Community Outreach ◽

Community Partnership ◽

Community Members ◽

Training Experience ◽

Ambulatory Training ◽

Internal Medicine Residents

Abstract Background The current system of residency training focuses on the hospital setting, and resident exposure to the surrounding community is often limited. However, community interaction can play an important role in ambulatory training and in learning systems-based practice, a residency core competency. The goal of the Neighborhood Health Exchange was to develop a community partnership to provide internal medicine residents with an opportunity to interface with community members through a mutually beneficial educational experience. Methods Internal medicine residents received training during their ambulatory block and participated in a voluntary field practicum designed to engage community members in discussions about their health. Community members participated in education sessions led by resident volunteers. Results Resident volunteers completed a survey on their experiences. All residents stated that the opportunity to lead an exchange was very useful to their overall residency training. Eight exchanges were held with a total of 61 community participants, who completed a 3-question survey following the session. This survey asked about the level of material, the helpfulness of the exchanges, and opportunities for improvement. We received 46 completed surveys from community members: 91% stated that the material was presented “at the right level” and 93% stated that the presentations were somewhat or very helpful. Eighty percent gave positive and encouraging comments about the exchange. Conclusion Effective community partnerships involve assessing needs of the stakeholders, anticipating leadership turnover, and adapting the Neighborhood Health Exchange model to different groups. Community outreach can also enhance internal medicine ambulatory training experience, provide residents with patient counseling opportunities, and offer a novel method to enhance resident understanding of systems-based practice, especially within the larger community in which their patients live.

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Training Internal Medicine Residents in Outpatient HIV Care: A Survey of Program Directors

Journal of General Internal Medicine ◽

10.1007/s11606-010-1398-6 ◽

2010 ◽

Vol 25 (9) ◽

pp. 977-981 ◽

Cited By ~ 15

Author(s):

Jennifer Adams ◽

Karen Chacko ◽

Gretchen Guiton ◽

Eva Aagaard

Keyword(s):

Internal Medicine ◽

Program Directors ◽

Hiv Care ◽

Internal Medicine Residents

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Defining Content for a Competency-based (CanMEDS) Postgraduate Curriculum in Ambulatory Care: A Delphi Study

Canadian Medical Education Journal ◽

10.36834/cmej.36570 ◽

2012 ◽

Vol 3 (1) ◽

pp. e21-e32

Author(s):

René Wong

Keyword(s):

Internal Medicine ◽

Ambulatory Care ◽

Delphi Study ◽

Delphi Process ◽

Ambulatory Training ◽

Societal Needs ◽

Internal Medicine Residents ◽

Recent Graduates ◽

Health Advocate ◽

Competency Based

Background: Ambulatory training in internal medicine has been noted to be dysfunctional and inadequate. In this study, we developed a set of competency-based outcomes specific to ambulatory care to guide the design, implementation and evaluation of instructional events to ensure that societal needs are addressed. Methods: In 2007 a Delphi technique was used to reach consensus and define the priorities for competency-based training in ambulatory care for internal medicine residents. Four groups of stakeholders in Canada participated: program directors, members of the Canadian Society of Internal Medicine, recent graduates, and residents. Results: Two rounds of the Delphi process were required to reach consensus on a set of sixty competency-based educational objectives in ambulatory care that were classified under the CanMEDS roles. The inclusion of recent graduates in this study resulted in the addition of non-clinical topics that would have otherwise been missed, falling under roles historically viewed as being challenging to teach and evaluate (Manager, Health Advocate). Conclusion: This study is the first time a Delphi-process has been used to define the priorities for ambulatory care training in internal medicine under a competency-based framework. The resulting compendium of competency-based objectives provides a foundation from which educators can design, evaluate and modify existing training experiences.

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