I recently read an interesting article published out of the Johns Hopkins University School of Medicine.
Dr. Stephen D. Sisson and Dr. Deepan Dalal analyzed data from 4,724 residents (at 67 residency programs) who participated in the Johns Hopkins Internet Learning Center, an online training program that offers 38 educational modules in ambulatory care and an evaluation tool to assess knowledge.
The gist of their findings was that internal medicine residents trained in academic centers are not as well prepared as those trained in community-based programs.
There is no doubt that ambulatory care training is key. The majority of patient contact for practicing internists is in an outpatient office setting.
But every residency program – academic- or community-based – is different in its ability to provide that training. And even among program directors, there can be differences in the emphasis given to developing ambulatory care knowledge.
Coming from my own experience in an academic medical center, I feel that my program does a great job of preparing us for this aspect of our careers. We have our weekly longitudinal clinic, a primary care clinic month, elective time to pursue ambulatory knowledge as seniors, as well as multiple seminars dealing strictly with issues such as chronic disease, preventive health, women’s health, and mental health.
There are many factors contributing to the primary care crisis; inadequate training in ambulatory care is just one factor. Still, recognizing that there are inadequacies is paramount to finding solutions. Several factors contribute to the training that internists receive including the costs of medical school, reimbursement structures, and the role of nurse practitioners and physician assistants. Even the advent of Minute Clinics has an impact on the needs of society and the training that internal medicine residency programs aim to provide in ambulatory care.