Adult inpatient training for a family practice residency: a university-versus community-based setting

Some educators have expressed concern about the quality of inpatient training received by family practice residents in community-based residency programs because of insufficient patient numbers and resources in those programs. This study compared the number, diagnoses, and lengths of stay of patients seen by first-year family practice residents in a large inner-city, university-based medical center's internal medicine service versus those in a family practice teaching service in a smaller, community-based suburban regional hospital.

The adult inpatient training services of the two training sites were compared for 6 months to determine if any differences existed between the sites in patients'age, gender, primary and secondary diagnoses, average length of hospital stay, or in the number of monthly admissions.

A total of 247 patients were admitted to the teaching service of the suburban community hospital, while 317 patients were admitted to the teaching service at the university hospital. The average length of stay for the suburban hospital was 6.1 days and 5.7 days at the university hospital. A total of 107 different diagnoses were made on admission at Kenner Regional Medical Center, while 90 were made at University Hospital. Chest pain/angina was the most frequent diagnosis encountered at admission at both hospitals.

Based on the two inpatient services studied, a broad variety of diagnoses and patient demographics are encountered at community-based hospitals, with similar numbers of patients, lengths of stay, and variation in diagnoses in comparison to an urban-based university hospital. The results indicate that there can be adequate numbers of patients and diagnostic variability to permit effective inpatient teaching at community-based hospitals.