INTERNAL-MEDICINE RESIDENCY TRAINING AND OUTCOMES

OBJECTIVE: To review the impact of the clinical education of internal medicine residents on patients' outcomes. DATA SOURCES AND STUDY SELEC TION English-language studies of the relation between internal medicin e housestaff training and patients' outcomes were systematically ident ified by a MEDLINE search and from bibliographies and reference lists of recently published articles. MAIN RESULTS: We hypothesized that the primary impact of internal medicine residency training on patients' o utcomes would be the result of: (1) the inexperience of the residents; (2) the heavy workload these inexperienced residents are expected to manage; or (3) some structural feature of the internal medicine teachi ng services, such as the discontinuity of patient care inherent in nig ht neat systems and the fact that residents rotate to different servic es each month, We also hypothesized that residents may in many ways pr ovide superior care, and may actually improve certain patient outcomes . Housestaff inexperience, workload, and structural features that prom ote discontinuity have been shown to affect especially outcomes of res ource utilization, length of stay, and patient satisfaction. No study has demonstrated that internal medicine residents contribute to excess patient morbidity or mortality. However, the published studies in thi s area are for the most part retrospective and were conducted 10 to 15 years ago, The full extent of the untoward (or the beneficial) effect s of internal medicine residency training on patients' outcomes is unk nown. CONCLUSIONS: Multisite, prospective studies would remedy the def iciencies in the published research in this area and would yield the m ost valid insight into the range and extent of the effects of housesta ff training on patients' outcomes, In the absence of such studies and in a rapidly changing managed care environment, academic medical cente rs and departments of medicine need to be aware of those aspects of th e clinical education of residents that are most likely to affect patie nts' outcomes.