Variation in Case Exposure During Internal Medicine Residency

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.