Using an organizational development strategy to improve residency training

Medical students' preferences for residencies in internal medicine are in decline. To attract outstanding students, departments of medicine must strive to improve the quality of their training programs. In the setting of a university-affiliated residency program, the authors employed a strategy based on organization development principles to identify remediable educational problems and to facilitate the process of solving these problems. Residents, attending physicians, and administrators used a consensus-building method, the nominal group technique, to develop problem lists ranked by two criteria--relative importance and potential for solution. Problems of high importance and high potential for solution were identified and assigned to committees of housestaff and faculty for action. Management plans consisting of short-term and long-term interventions were created to solve each problem. These plans were widely accepted and short-term interventions were successfully implemented. This strategy represents a pragmatic approach to improving internal medicine residency programs because it focuses limited institutional resources on problems that are both important and amenable to change.