How Are Residency Programs Preparing Our 21st Century Internists?

A Review of Internal Medicine Residency Programs' Teaching on Selected Topics

by Kristina M. Cordasco, Mariana Horta, Nicole Lurie, Chloe E. Bird, Barbara O. Wynn

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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.

Table of Contents

  • Chapter One


  • Chapter Two


  • Chapter Three

    Sample and Interview Characteristics

  • Chapter Four


  • Chapter Five

    Summary and Discussion

  • Appendix

    Medical School Training in selected Topics: A Review of Written Currricula

  • Appendix

    Interview Protocol

The research in this report was prepared for the Medicare Payment Advisory Commission and conducted by RAND Health.

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