The authors conducted a two-year prospective study (1988-1990) to determine whether internal medicine residents at a multi-facility teaching hospital in New York State could meet the expectations of a formal credentialing protocol and receive independent privileges in a timely manner. The study group consisted of 38 first-year residents separated into two subgroups. Subgroup I, seven categorical and 11 preliminary residents, entered the residency program July 1, 1988; subgroup II, seven categorical and 13 preliminary residents, joined the residency July 1, 1989. During the first three months of the 1988-89 academic year, subgroup I showed minimal compliance, obtaining only 11% of the total privileges available. However, subgroup II, working under a protocol that underwent major revisions related to monitoring the credentialing process, showed significant improvement, with 90% of all required privileges credentialed within the first quarter of 1989-90. The findings suggest that a minimal rate of residents' compliance can be improved dramatically by the development of a structured protocol that includes stringent monitoring of the entire credentialing process and formal, regular feedback to the housestaff regarding their progress.
