Preparedness of internal medicine and family practice residents for treating common conditions

Context Although both internal medicine (IM) and family practice (FP) physicians frequently provide care for the same common adult conditions, IM. and FP residency programs differ in their training emphases. Objective To assess differences in IM and FP residents' self-perceived preparedness to diagnose and treat common adult medical conditions. Design, Setting, and Participants Cross-sectional analysis of a national survey administered in the spring of 1998 to residents in their final year of residency at US academic health centers. A total of 279 IM residents in 25 programs and 326 FP residents in 75 programs responded to the survey. Main Outcome Measures Residents' self-rated preparedness to diagnose and treat 4 inpatient conditions (acute myocardial infarction, diabetic ketoacidosis, acute asthma, and acute renal failure) and 8 outpatient conditions (diabetes, hypertension, low back pain, vaginitis, headache, depression, upper respiratory tract infection, and hyperlipidemia), controlling for resident sex, race/ethnicity, US medical school graduate status, intent to subspecialize, and estimates of exposure to patients in inpatient and outpatient settings. Results Internal medicine residents were more likely to report being very prepared for all 4 inpatient conditions (Pless than or equal to.001), while FP residents were more likely to report being very prepared for 5 of 8 outpatient conditions (Pless than or equal to.05). Differences between IM and FP residents persisted in multivariate Analyses for all inpatient conditions and some outpatient conditions. Exposure to patients in inpatient and outpatient settings varied by specialty and was significantly associated with resident self-report of preparedness for a majority of conditions investigated. Conclusions Internal medicine and FP residents report differences in preparedness to manage common adult conditions. These differences were consistent with the emphasis on an inpatient setting for IM residents and on off ice-based care for FP residents.