Training and Performance Differences in US Internal Medicine Residents Trained in Community- and University-Based Programs -- A Systematic Review

Introduction: Residents' learning and performance depends on program structures, clinical setting and faculty mentors; however, performance differences between and community based vs. university based residents have not been explored systematically. Objectives: To systematically review the performance differences between internal medicine residents trained in community-based programs [CBPs] versus university-based programs [UBPs] in the US. Methods: Eligible studies were identified in Medline and Embase databases from 1990- June 2018. Eligible studies compared learning and performance differences between UBP and CBP internal medicine residency programs aligned with ACGME recommendations. Results: Out of 4916 titles, 14 cross-sectional studies were included in the analysis. Diverse reporting among the included studies precluded meta-analysis. Significant differences were found in specific practice areas, such as knowledge about HIV, nutrition training, and program accreditation cycle. Residents in UBPs participated more often in hypothesis driven research and had higher publication rates than residents in CBPs. Residents trained in CBPs experienced more burnt out than those in UBPs and had higher prevalence of residents with problematic behaviors and deficiencies. Nonsignificant differences were found among residents regarding ABIM pass rate, medical procedures, and public health training. Conclusion: Our review reports inconsistent trends in residents' learning and performances following RRC-IM and ACGME recommendations. Significant differences were noted in areas that required more practice and system based learning, non-procedural skills and patient care. Future studies with larger sample sizes and adjusted analyses are needed to evaluate the difference between residents' performance and learning in UBPs versus CBPs.