New doctors poorly trained in outpatient care

In a recent study, Steven Sisson, an associate professor of medicine at Hopkins, discovered that students training in internal residency programs are not being taught suitable ambulatory and outpatient care. As a result, new doctors who take up positions that include outpatient care components do not have the knowledge to treat their patients.

“When I graduated from residency [at Hopkins],” Sisson said in an interview with www.futurity.org. “I knew much more about how to ventilate a patient on a machine than how to control somebody’s blood sugar, and that’s a problem.”

Most people in America visit the doctor for chronic diseases such as diabetes, anemia or back pain, or for diseases that can be remedied via outpatient care. Sisson’s results are alarming since they imply that many doctors emerging from American residency programs do not have the adequate knowledge necessary to meet the country’s growing needs.

“We need to change the way we teach residents,” Sisson said. “If the mission of internal medicine residency programs is to meet society’s health care needs, then our results suggest that these training programs are failing.”

In his study, Sisson monitored the performance of internal medicine residents at both university and community based hospitals through the Johns Hopkins Internet Learning Center. This website provides ambulatory care training modules chosen via a national survey of the most common visits to internal medicine clinics. The results showed that both types of residents scored very poorly on these tests in their first year of residency, and that community hospital based residents scored higher than university based ones in their second and third year. In all, both types of residents scored 50% or less on ambulatory care and outpatient diagnosis topics.

“The average resident doesn’t know what the goal for normal fasting blood sugar should be,” Sisson said. “If you don’t know what it has to be, how are you going to guide your diabetes management with patients?”

Sisson suggests that one of the reasons why university residents are not receiving adequate education in outpatient care is because universities exhibit a bias towards specialized and inpatient care.

Specialists often take leadership roles in universities and therefore the environment favors specialized tracts. Another concern is that medical residents in both types of hospitals are just not interested in generalist tracts, and therefore do not choose to pursue them.

Sisson’s study calls for a redesign of internal residency medical training programs to include more education on ambulatory health care topics. To do this he suggests an in-depth evaluation of which topics are the most important as well as which ones are least studied. The goal is to encourage more medical residents to become involved in the outpatient care system.