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Francine C. Wiest, MD; Timothy G. Ferris, MD, MPH; Manjusha Gokhale, MA; Eric G. Campbell, PhD; Joel S. Weissman, PhD; David Blumenthal, MD, MPP

JAMA. 2002;288:2609-2614.

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 (P.001), while FP residents were more likely to report being very prepared for 5 of 8 outpatient conditions (P.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 office-based care for FP residents.

Author Affiliations: Robert Wood Johnson Clinical Scholars Program, Department of Veterans Affairs Puget Sound Healthcare System, and Department of Medicine, University of Washington, Seattle (Dr Wiest); Institute for Health Policy, Division of General Medicine, Massachusetts General Hospital, Partners Healthcare, and Harvard Medical School, Boston (Drs Ferris, Campbell, Weissman, and Blumenthal and Ms Gokhale).

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