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Internal medicine residents experience significant variation in patient case exposure, impacting learning and readiness. An integrated database revealed disparities between residents, hospitals, and over time, highlighting the need for equitable training.

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Area of Science:

  • Medical Education
  • Health Informatics
  • Internal Medicine Training

Background:

  • Resident case exposure variability impacts learning and future practice readiness.
  • Accurate reporting of case exposure is hindered by a lack of reliable patient-resident linkage methods.

Purpose of the Study:

  • To develop an integrated educational-clinical database for characterizing and measuring case exposure variability among internal medicine residents.

Main Methods:

  • A cohort study linked patients admitted during overnight internal medicine call shifts to senior residents across 5 Canadian teaching hospitals.
  • Data from 143,632 admissions linked to 793 residents (2010-2019) were analyzed.
  • Case exposure was defined by patient demographics, diagnoses, acuity, complexity (Charlson Comorbidity Index), and social determinants of health.

Main Results:

  • Substantial variation in case exposure was observed at resident, hospital, and temporal levels.
  • Residents in the highest quartile had nearly 4 times more admissions requiring critical care transfer compared to the lowest quartile.
  • Over time, residents experienced an increase in admissions per shift and patient complexity, despite similar working hours.

Conclusions:

  • Significant variation in case exposure exists among internal medicine residents, across different hospital sites, and over time.
  • The developed integrated database effectively characterized these variations.
  • Addressing this variability is crucial for ensuring equitable resident education and preparedness.