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Does time use in outpatient residency training reflect community practice?
Edward J Callahan1, Kurt C Stange, Klea D Bertakis
1Department of Family and Community Medicine, University of California, Davis, Sacramento 95817, USA. ejcallahan@ucdavis.edu
Family Medicine
|June 24, 2003
Summary
Family medicine residents spend more time on preventive care and counseling compared to experienced physicians. This suggests practice pressures may reduce patient-centered communication over time.
Area of Science:
- Family Medicine
- Medical Education
- Health Services Research
Background:
- Residency training emphasizes certain ideals, but their persistence in community practice is unclear.
- Community practice pressures may influence physician behavior and patient interaction styles.
Purpose of the Study:
- To compare the time allocation during outpatient visits between family practice residents and experienced community family physicians.
- To investigate how practice environment and experience affect physician-patient interaction.
Main Methods:
- A comparative study analyzing outpatient visits using the Davis Observation Code (DOC).
- Observed 244 visits with residents and 277 visits with community physicians.
- The DOC categorizes visit time into 20 behavioral types reflecting physician interaction styles.
Main Results:
- Residents had longer visits with a less technical focus.
- Residents dedicated a greater percentage of visit time to health behavior change, patient activation, and preventive services.
- Residents engaged more in substance abuse discussion and counseling.
Conclusions:
- Experienced physicians offer more technical care, while residents focus more on preventive and psychosocial aspects.
- Differences may stem from patient mix, practice setting, experience, and financial pressures.
- Findings can inform residency training adjustments and future research on practice environment impacts.