The association between residency training and internists' ability to practice conservatively.

Area of Science:

• Medical Education
• Health Services Research
• Clinical Practice Patterns

Background:

• Rising healthcare costs and potential harms necessitate minimizing unnecessary medical care.
• Assessing physicians' ability to manage care conservatively is of growing importance.

Purpose of the Study:

• To evaluate if residency programs with low-intensity practice patterns produce graduates skilled in conservative patient care.
• To determine if these graduates are less capable of providing appropriately aggressive care when needed.

Main Methods:

• Cross-sectional analysis of 6,639 first-time test-takers of the 2007 American Board of Internal Medicine certifying examination.
• Practice intensity measured by the End-of-Life Visit Index in residency program hospital referral regions.
• Appropriately Conservative Management (ACM) and Appropriately Aggressive Management (AAM) scores analyzed via linear regression, stratified by knowledge tier.

Main Results:

• Graduates from low-intensity practice regions scored significantly better on the Appropriately Conservative Management (ACM) subscale across all knowledge tiers.
• Within the lowest knowledge tier, ACM scores for graduates from low-intensity regions were higher (38th percentile) compared to high-intensity regions (22nd percentile).
• Graduates from low-intensity regions showed a weaker tendency towards better Appropriately Aggressive Management (AAM) scores in three of four knowledge tiers.

Conclusions:

• Internists trained in lower-intensity practice regions are more adept at identifying appropriate conservative management strategies.
• Training in low-intensity practice settings does not impair physicians' ability to provide aggressive care when indicated.
• These findings suggest practice patterns in residency training influence physician decision-making regarding care intensity.