Categorical medicine residents' experiential curriculum

To assess the case mix or experiential curriculum of a university-based categorical medicine residency program and compare the residents' continuity clinic case mix with the outpatients seen by practicing internists.

Descriptive study during the 1991-1992 academic year of 24,218 inpatients and outpatients from the University of California, San Francisco, Department of Medicine's three core hospitals: the University of California, San Francisco Hospital; the Department of Veterans Affairs Medical Center; and the San Francisco General Hospital. The diagnoses and ages of patients who made office visits to practicing internists from the National Ambulatory Medical Care Survey (NAMCS) were compared with corresponding data from the categorical medicine residents' continuity clinic patients.

Seventy percent of the general medicine inpatients at the three core hospitals had one of the 25 most common principal diagnoses for inpatients. Eighty-seven percent of the patients seen by the residents in their continuity clinic had one of the 20 most common diagnoses seen by practicing internists in the NAMCS. The age distribution was similar in both groups.

A systematic assessment of clinical training at one university-based hospital program shows that common internal medicine problems represent the case mix of the great majority of patients, both inpatients and outpatients, seen by categorical medicine residents. Residents' continuity clinic patients are similar to patients seen by practicing internists. The program's challenge is to ensure that residents have adequate time with general medicine experiences, both in the inpatient setting and in the ambulatory and longitudinal care settings, while balancing and integrating these activities.