Purpose: To establish a benchmark for ambulatory educational practice in internal medicine in the mid-1990s using descriptive data from a representative sample of residency programs.
Method: Data were obtained from the program directors and residents of 103 internal medicine residencies in 1994 and 1995. The program directors supplied information about general medicine, subspecialty, and non-internal medicine ambulatory experiences; the types of settings where the experiences occurred; the duration of the experiences; the number of residents, patients, and attending physicians in the settings; and demographic characteristics of the patients. The 2,598 residents provided responses to 39 questionnaire items about continuity-of-care experience, educational environment, and services. In addition, the residents rated the quality of facilities, services, and supervision in the ambulatory settings.
Results: The program directors' reports showed that the median program provided the opportunity for training in general medicine continuity and non-continuity settings in seven subspecialties and five to six non-internal medicine specialties. The majority of the programs provided the opportunity for ambulatory experiences in hospital clinics, freestanding clinics (non-health maintenance organizations), and private offices. The residents strongly affirmed the existence of continuity experiences that provided first-contact, comprehensive and continuing care, and the availability of consultations. The residents responded that they were supervised in their continuity experiences by physicians experienced in general internal medicine. Most of the residents thought that facilities were more than adequate. Services provided by some non-medical personnel were among the lowest-rated aspects of the ambulatory experience.
Conclusion: This study suggests that the overall ambulatory experience of internal medicine residents appears to be good. Continuity experiences are clearly in place, faculty and consultants are available, and facilities are adequate. Some aspects of ambulatory education have improved since the middle-to-late 1980s, when an earlier series of studies of the general characteristics of ambulatory education was conducted.