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The development of a quality assurance program as part of residency training in internal medicine is described. In addition to ensuring quality, the program allows both the faculty and the resident to assess individual performance more precisely than previously possible. The residents become increasingly thorough and improve problem-solving skills over the three-year program. They are provided the tools to manage quality in their own practice.

The audit of behaviors of health care providers is a valuable tool for learning the essentials of primary care and health care delivery. At the University of Vermont a dynamic curriculum has evolved from the student audits of the practice sites where the training takes place. Evaluation studies to date indicate a positive effect on career goals leading to primary care specialties and a desire to practice in rural settings in underserved areas. This approach to teaching primary care has proven to be effective and has gained high acceptance with the students. They learn that audit is a valuable means of self-education as well as method for providing quality assurance to the patient.