Periodic health examination: comparison of residency programs and national recommendations

Health maintenance and disease prevention guidelines of primary care internal medicine residency (PCIM) programs were investigated and compared with recommendations of major national organizations. Preventive screening data were requested from 134 PCIM programs; 120 (90%) responded. Methods included seminars/lectures by 73 (61%), health maintenance flow sheets by 58 (48%), and a variety of other formats by 25 (21%) programs. A comparison of recommended flow sheet items (n = 33) from five major studies and 48 PCIM programs showed concordances (+/- SE) of 62% (+/- 5) with high-priority items (n = 15) and 33% (+/- 4) with low-priority items (n = 18). When an item's frequency or age range was examined, however, concordances were much lower. From our analysis, fewer than half the programs routinely used prompting systems, such as flow sheets, in their ambulatory clinics, and there was little uniformity in the frequencies and age ranges for those items employed. The data suggest that major study recommendations were underused and underemphasized.