EXPERT RATINGS OF PRIMARY-CARE GOALS AND OBJECTIVES

OBJECTIVE: To develop consensus on proficiencies internal medicine res idents should master in the area of primary and managed care. DESIGN: A draft compendium of primary care educational objectives including im portant clinical topics was developed at the Sepulveda Veterans Health Administration Medical Center Pitot Ambulatory Care and Education (PA CE) Program as part of a local and regional primary care curricular re view. Fifty-one experts, including leaders in the Society of General I nternal Medicine, the Association of Program Directors in Internal Med icine, the American College of Physicians, general internal medicine d ivision chiefs, and Veterans Affairs (VA) associate chiefs of staff fo r ambulatory care rated the compendium. MEASUREMENTS AND MAIN RESULTS: Eleven objectives and nine clinical topics were rated ''critically im portant'' (4.7 or above on a five-point scale). General internal medic ine chiefs and associate chiefs of staff for ambulatory care judged th em to be covered adequately in fewer than half of the 17 VA Western Re gion-affiliated internal medicine programs. Forty-five objectives and 77 clinical topics were considered at least somewhat important to the education of general internal medicine residents in primary care, The VA raters reported that in the prior academic year, their housestaffs had spent between 21% (postgraduate year I) and 33% (postgraduate year III) of their time in ambulatory care settings. CONCLUSION: With the emphasis on primary and managed care, there is a need for national con sensus on educational objectives in primary care general internal medi cine, This review provides educators with a benchmark to test the adeq uacy of their institutions' curricula in primary care internal medicin e.