Confidence of academic general internists and family physicians to teach ambulatory procedures

Abstract

OBJECTIVE:To evaluate and compare the readiness of academic general internal medicine physicians and academic family medicine physicians to perform and teach 13 common ambulatory procedures. DESIGN: Mailed survey. SETTING:Internal medicine and family medicine residency training programs associated with 35 medical schools in 9 eastern states. PARTICIPANTS:Convenience sample of full-time teaching faculty. MEASUREMENTS AND MAIN RESULTS:A total of 331 general internists and 271 family physicians returned completed questionnaires, with response rates of 57% and 65%, respectively. Academic generalists ranked most of the ambulatory procedures as important for primary care physicians to perform; however, they infrequently performed or taught many of the procedures. Overall, compared with family physicians, general internists performed and taught fewer procedures, received less training, and were less confident in their ability to teach these procedures. Physicians' confidence to teach a procedure was strongly associated with training to perform the procedure and performing or precepting a procedure at least 10 times per year. he shift in health care delivery toward the ambulatory setting has increased the need for broadly trained primary care physicians who can provide comprehensive care. 1-3 However, surveys of practicing general internists indicate deficiencies in their training for a variety of common ambulatory procedures, 4-9 raising the question whether general internists can provide common components of ambulatory care without referral. In response to this perceived need to improve ambulatory training, the Internal Medicine Residency Review Committee (RRC) guidelines, 10 effective July 1998, increased residents' training time in the ambulatory setting, and the American Board of Internal Medicine and others have published recommendations for residency training in ambulatory skills. [10][11][12][13][14][15][16][17][18] Nonetheless, a consensus regarding specific requirements for training in ambulatory procedures has not emerged, and it is not clear who should teach these procedures. CONCLUSIONS:Though academic general internists supervise the majority of resident ambulatory training, they may not be prepared to teach common ambulatory procedures. 19,20 This may be due to inadequate training and experience with these procedures, limited time spent in the ambulatory setting, or the common practice in academic settings of referring patients to readily available specialists. With this in mind, we conducted this study to assess the confidence of academic general internal medicine and aca-

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