The lasting value of clinical skills

To assess the lasting value of clinical skills learned by residents in a subspecialty-oriented training program in internal medicine, we surveyed recent graduates. Graduates received a questionnaire contrasting separate ratings of the amount of training (preparation) they received during residency with the importance of this training in subsequent career activities. Topics included 12 traditional medical disciplines, 15 areas related to the practice of medicine, 15 allied medical disciplines, ten basic skill and knowledge areas, and 28 technical procedures. Response rate was 91.8% (56/61). Ninety-five percent of respondents had certification from the American Board of Internal Medicine, 80% had subspecialty training, and 89% rendered direct patient care. Fifty-six topics showed disparity between preparation and importance scores (45 with P less than .0001). For 14 categories, mainly technical procedures, disparate ratings suggested excessive programmatic emphasis, while for 42 categories, including history taking and physical examination, there may have been inadequate emphasis. These data suggest that basic clinical skills may require greater emphasis, even in traditional programs. The opinion of program graduates is an important resource in designing training programs in internal medicine.