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The association between residency training and internists' ability to practice conservatively
- Source :
- JAMA internal medicine. 174(10)
- Publication Year :
- 2014
-
Abstract
- Growing concern about rising costs and potential harms of medical care has stimulated interest in assessing physicians' ability to minimize the provision of unnecessary care.To assess whether graduates of residency programs characterized by low-intensity practice patterns are more capable of managing patients' care conservatively, when appropriate, and whether graduates of these programs are less capable of providing appropriately aggressive care.Cross-sectional comparison of 6639 first-time takers of the 2007 American Board of Internal Medicine certifying examination, aggregated by residency program (n = 357).Intensity of practice, measured using the End-of-Life Visit Index, which is the mean number of physician visits within the last 6 months of life among Medicare beneficiaries 65 years and older in the residency program's hospital referral region.The mean score by program on the Appropriately Conservative Management (ACM) (and Appropriately Aggressive Management [AAM]) subscales, comprising all American Board of Internal Medicine certifying examination questions for which the correct response represented the least (or most, respectively) aggressive management strategy. Mean scores on the remainder of the examination were used to stratify programs into 4 knowledge tiers. Data were analyzed by linear regression of ACM (or AAM) scores on the End-of-Life Visit Index, stratified by knowledge tier.Within each knowledge tier, the lower the intensity of health care practice in the hospital referral region, the better residency program graduates scored on the ACM subscale (P .001 for the linear trend in each tier). In knowledge tier 4 (poorest), for example, graduates of programs in the lowest-intensity regions had a mean ACM score in the 38th percentile compared with the 22nd percentile for programs in the highest-intensity regions; in tier 2, ACM scores ranged from the 75th to the 48th percentile in regions from lowest to highest intensity. Graduates of programs in low-intensity regions tended, more weakly, to score better on the AAM subscale (in 3 of 4 knowledge tiers).Regardless of overall medical knowledge, internists trained at programs in hospital referral regions with lower-intensity medical practice are more likely to recognize when conservative management is appropriate. These internists remain capable of choosing an aggressive approach when indicated.
- Subjects :
- Adult
Male
medicine.medical_specialty
Certification
Referral
Cross-sectional study
MEDLINE
Unnecessary Procedures
Article
Health care
Internal Medicine
Medicine
Humans
Practice Patterns, Physicians'
Association (psychology)
Referral and Consultation
business.industry
Practice patterns
Internship and Residency
Health Care Costs
United States
Cross-Sectional Studies
Family medicine
Linear Models
Female
business
Residency training
Subjects
Details
- ISSN :
- 21686114
- Volume :
- 174
- Issue :
- 10
- Database :
- OpenAIRE
- Journal :
- JAMA internal medicine
- Accession number :
- edsair.doi.dedup.....ae292ff0dc7b6fd90148fbd7c23c1a63