A 1998 national survey of 4,832 residents completing their training in 8 specialties (internal medicine, pediatrics, family practice, obstetrics/gynecology, general surgery, orthopedic surgery, psychiatry, and anesthesiology) at academic health centers in the United States has just been published in the Journal Of The American Medical Association. The study indicates that residents in all specialties rated themselves as prepared to manage most of the common conditions they would encounter in their clinical career. However, more than 10 percent of residents in each specialty reported that they felt unprepared to undertake one or more tasks relevant to their disciplines.

In particular, some family practice residents felt unprepared to care for patients who are HIV-positive or have AIDS, or patients with substance abuse problems. Some internal medicine residents felt unprepared to care for nursing home patients. Some residents in orthopedic surgery felt unprepared to perform spinal surgery. Some residents in general surgery felt unprepared for abdominal aortic aneurysm repair. Finally, some anesthesiology residents felt unprepared to deal with management of chronic pain.

The authors point out that “focused short-term training can remedy some gaps in physicians' skills.” They consider such approaches inherently less desirable than providing adequate preparation as a part of routine training. Nonetheless, there may be a role for CME in this kind of remedial work.

The survey was conducted by researchers with The Institute for Health Policy at Massachusetts General Hospital and Partners Health Care System and with the Departments of Medicine and Health Care Policy at Harvard Medical School; both institutions are based in Boston.

For a limited time, the complete text of the JAMA article is available for viewing at the journal’s web site. Click here to see it.