How Are Residency Programs Preparing Our 21st Century Internists?

Over the past 50 years, the practice of medicine in the United States has changed dramatically. RAND was asked to conduct an exploratory study of how residency programs are adapting their teaching to prepare physicians to practice within the current health care delivery system, based on interviews with internal medicine program directors. Topics included practice-based learning and improvement; systems-based care; and interpersonal and communication skills. Researchers also assessed the care settings through which the residents rotate and the information technology being used in these settings. They found that programs are teaching their residents to use evidence-based medicine. Most programs are also teaching quality improvement methods, but the curriculum varies widely. Although residency programs are adapting their curricula to prepare physicians-in-training to practice in a demographically shifting patient population and evolving health care system, there is substantial variation in programs’ approaches to instruction in the topics of interest. For many topics, informal teaching through faculty role-modeling and patient-focused feedback and discussions is predominant.