Differences in curriculum emphasis in US undergraduate and generalist residency education programmes

Objectives Little attention has been paid to the differential emphasis unde rgraduate and graduate medical education programmes place on the broad comp etencies that will be needed for practice in an increasingly managed health care environment. The purpose of this study was to determine differences i n emphasis that undergraduate and primary care graduate medical education p rogrammes are currently placing on 33 broad practice competencies, compared with the emphasis they ideally would like to give them, and the barriers t hey perceive to curriculum change. Design Subjects were surveyed by mailed questionnaire. A reminder postcard and follow-up mailing were sent to non-respondents. Setting US allopathic medical schools. Subjects Academic deans identified by the Association of American Medical C olleges (AAMC) and generalist (family medicine, internal medicine, paediatr ics and obstetrics-gynaecology) residency programme directors identified by the American Council on Graduate Medical Education (ACGME). Results Findings revealed that residency programmes placed greater emphasis on the study's broad curriculum topics than did undergraduate medical educ ation programmes. Statistically significant differences were found in curre nt emphasis for 12 topics and ideal emphasis for six topics. Both groups id entified an already crowded curriculum and inadequate funding as the top tw o barriers to curriculum change. Conclusions The differences in curriculum emphases and perceived barriers t o curriculum change most probably reflect the different realities of underg raduate and graduate medical education programmes, i.e. academics vs. a foc us on immediate practice realities.