Primary Care Residency Graduates' Reported Training Needs

Abstract

Primary care residency graduates were surveyed about their satisfaction with their training. The respondents desired more training in outpatient knowledge and procedures, psychosocial skills, and business skills.

METHOD

We surveyed 92 physicians who completed their primary care residencies between 1979 and 1993 about what they wished they had learned during residency and what skills they had acquired after residency. They were also asked to rate their competency with procedures using a five-point Likert scale (1 = very competent, 3 = neutral, 5 = not at all). Study methods and influences for remaining generalists or becoming subspecialists have been reported.¹ A total of 88 completed the survey and a semi-structured telephone interview.

RESULTS

Of all respondents, 68% were generalists, 32% were specialists, and 40% were academic physicians. Self-assessed competency for all procedures was 2.62 ± 1.24 for generalists and 2.09 ± 1.01 for specialists (p = 0.05). Table 1 shows the percentages of graduates responding to the survey about more training desired and skills acquired since graduation. Respondents who had fellowship training accounted for 32% of the 34% reporting attainment of specialist knowledge. Of the respondents, 25% reported acquiring research and training skills, but 40% were academic physicians.

Table 1: Graduates' Responses

DISCUSSION

Residency programs should ask their graduates what skills are most important and modify programs accordingly.² Incorporating our graduates' comments, the residency implemented joint-injection workshops, an ambulatory curriculum, and evidence-based medicine seminars during clinic blocks.

Improving business and patient—physician/psychiatry skills has proved more difficult. For residents, business and psychosocial skills pale next to the urgency of mastering inpatient skills. The respondents indicated that the relevancy of these skills increased during practice. In our experience, community-based and rural rotations allow residents to `discover' these training needs and focus their learning efforts. Also, a continuous quality improvement process may decrease the mismatch between training experience and practice needs.