The Residency-Practice Training Mismatch: A Primary Care Education Dilemma

doi:10.1001/archinte.1988.00380040154022

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Vol. 148 No. 4, April 1988

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The Residency-Practice Training Mismatch

A Primary Care Education Dilemma

David B. Reuben, MD; Jack D. McCue, MD; Barbara Gerbert, PhD

Arch Intern Med. 1988;148(4):914-919.

Abstract

• Primary care practice requires clinical skills and knowledgeedge that differ greatly from those required for successfulcompletion of residency training. Discrepant clinical settingsand physician responsibilities have thus created a mismatchbetween the educational content of residency training and thecontent of clinical practice, which may result in suboptimalpreparation of internists, family practitioners, and pediatriciansfor patient care. Of equal concern, the psychosocial environmentof residency does not prepare physicians for their future communityand personal adult roles. Barriers to correcting this worseningmismatch include the following: (1) economic pressures to usehouse staff to meet service needs of hospitals, (2) changesin patient demographics and the focus of hospital-based medicinethat are making hospitals progressively more unsuitable as theprincipal training site for primary care physicians, (3) thedeemphasis of practicing physicians as role models and teachersin postgraduate training, and (4) the often heated disagreementamong medical educators regarding the purpose and content ofresidency training. Efforts to resolve this mismatch shouldinclude the following: reexamining the educational objectivesof the current system of postgraduate training, better counselingof physicians in training regarding career goals, and emphasizingthe primary care physician as role models and faculty.

(Arch Intern Med 1988;148:914-919)

Author Affiliations

From the Department of Community Health, Brown University Program in Medicine, Providence, RI (Dr Reuben); Department of Medicine, Bay-state Medical Center, Tufts University Medical School, Boston (Dr McCue); and Department of Dental, Public Health and Hygiene, University of California, San Francisco (Dr Gerbert).

Footnotes

Accepted for publication Dec 21, 1987.

Reprint requests to Division of General Internal Medicine, RhodeIsland Hospital, 593 Eddy St, Providence, RI 02903 (Dr Reuben).

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