The Outpatient Training Gap: A Pilot Study

Abstract

Background and Objectives: Most family medicine residency training takes place in hospitals, which is not reflective of the outpatient care practiced by most primary care clinicians. This pilot study is an initial exploration of family medicine residency directors’ opinions regarding this outpatient training gap. Methods: The authors surveyed 11 California family medicine residency program directors in 2017-2018 about factors that influence decisions regarding allocation of residents’ inpatient and outpatient time. Nine of the 11 program directors agreed to be interviewed. We analyzed the interviews for common themes. Results: The participating program directors were generally satisfied with inpatient and outpatient balance in their residents’ schedules. Factors identified as promoting inpatient training included the need for resident staffing of hospital services, the educational value of inpatient rotations, and a lack of capacity in continuity clinics. From the program directors’ perspective, residency funding played no direct role in curriculum planning. Program directors also felt that the ACGME requirements prescribing 1,650 continuity clinic visits throughout residency inhibited the development of creative outpatient training opportunities. Conclusions: Family medicine residency program directors participating in this exploratory study did not feel that their programs overly emphasized inpatient care and training.