Comparing practice differences of residency graduates: implications for curricular change

To document and assess differences in the practice experiences and practice patterns of graduates from two similar sized but regionally separated community-based internal medicine residency programs.

Sixty percent responded to the survey. Responses from graduates practicing general internal medicine were used in the analyses (Wichita n = 20; Baystate n = 23). Only graduates from Wichita were in solo practice (15%). Baystate graduates had a significantly higher percentage of HMO patients (32% vs. 17%, p < .05). A higher percentage of Kansas respondents worked in a community with a population of less than 50,000 (55% vs. 26%, p = .052). Of 28 components of a residency curriculum, 7 were considered significantly more important to daily practice by Kansas respondents than by Baystate respondents: Critical Care, Dermatology, Gastroenterology, Nephrology, Neurology, Occupational Medicine, and Rheumatology. Kansas respondents performed on average significantly more procedures than Massachusetts respondents in the last year in 6 of 16 procedures: bone marrow biopsy, exercise stress tests, flexible sigmoidoscopy, liquid nitrogen, skin biopsy, and thoracentesis. The procedures of skin biopsy, stress testing, and the curricula of dermatology, nephrology, neurology and rheumatology remained significantly different when controlled for the size of the community population (<50,000). Wichita graduates scored higher on the practice intensity measure than Baystate graduates.

We have documented differences in the importance of particular curricula, procedures, and practice intensity likely related to the community population in which residency graduates practice. Understanding the needs of graduates and incorporating this information into existing rotations or new initiatives is integral to the ongoing development of residency curricula.