Quantifying internal medicine resident clinical experience using resident-selected primary diagnosis codes

Area of Science:

• Medical Education
• Internal Medicine
• Clinical Informatics

Background:

• Experiential learning is crucial in residency education.
• Actual clinical experiences of internal medicine residents are not well-defined.
• Understanding resident clinical exposure is key to improving training.

Purpose of the Study:

• To define the clinical experience of internal medicine residents.
• To explore the utility of resident-entered diagnostic codes for curriculum development.
• To identify potential gaps in resident learning.

Main Methods:

• Modified an electronic handoff tool for resident entry of primary diagnoses.
• Utilized the International Classification of Diseases, Ninth Revision (ICD-9) system for coding.
• Employed organ system-based dropdowns and a complete database search for ICD-9 code selection.

Main Results:

• Analyzed 7562 resident-patient diagnostic encounters.
• Observed a broad spectrum of clinical conditions, with 86% in specific categories like circulatory and respiratory disorders.
• Symptoms and ill-defined conditions (fever, abdominal/chest pain) constituted a significant portion of experience.

Conclusions:

• Resident-selected ICD-9 codes can define clinical experience.
• This data can guide the development of experiential learning curricula.
• Analysis can identify learning gaps and areas needing supplemental teaching.