Date of Award

January 2014

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Stephen Huot

Subject Area(s)

Medicine

Abstract

The combination of a rapidly aging US population with the recent implementation of the Affordable Care Act has prompted a dramatic rise in health care demand for primary care services, most notably for general internal medicine physicians. This demand, however, coincides with a progressive decline in interest toward general internal medicine (GIM) careers with a notable disinterest among Primary Care Internal Medicine (PCIM) residents, whose selection of the PCIM residency is seemingly suggestive of a strong interest in GIM. The reasons for this discrepancy have been examined in prior surveys, citing perceptions of diminished lifestyle control, low prestige, and of frustrated general internists in practice. However, more in-depth study is warranted, particularly among PCIM residents who appear to be dissuaded from GIM careers, likely at some point during their residency. By gaining a more in-depth understanding of PCIM resident training experiences, the investigators aim to elucidate what program factors have the potential to encourage or discourage PCIM residents from GIM careers. The investigators in this study completed structured interviews with second and third year PCIM residents, analyzed the qualitative data obtained using grounded theory methods, and identified emergent themes from the interview transcripts. Among the seven study participants' responses, the investigators identified six program factor themes with a potential to encourage or discourage residents from GIM. Three potentially encouraging themes were: a culture of like-mindedness among colleagues, including comfort with change; positive reflections on the outpatient curriculum; and an appreciation of exposure to various models of primary care. Three potentially discouraging themes were: a mismatch between trainee expectations and the actual experience with the practice of primary care; challenges with disjointed care, including interruption of continuity by inpatient rotations; and inadequate communication between practice teams and subspecialist physicians. Improving resident training experience by bolstering potentially encouraging program factors while addressing potentially discouraging program factors may influence a greater number of PCIM residents to enter GIM care.

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