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Background: Although program evaluation is a core requirement of Internal Medicine residencies, little is reported in the literature regarding resident satisfaction with training. Most program evaluation consists of numerical rating scales from which it is often difficult to pinpoint exact sources of dissatisfaction., Methods: Our goal in this work is to evaluate the utility of focus group methodology to uncover in detail the reasons for residents' deteriorating morale in an IM residency program, as well as to solicit suggestions for correction. This study employed focus groups (FG) in a qualitative research design, in which descriptive statistics from a resident program evaluation survey served to guide an intensive focus group process. Participants were 40 of 45 2nd and 3rd year internal medicine residents enrolled in the IM residency training program. Five chief residents were trained to conduct 5 focus groups with 8 residents in each group. The focus groups examined possible issues contributing to the deterioration of morale noted in the quantitative survey., Results: Many unexpected themes were uncovered by the FGs. Residents identified the following factors as the major contributors to deteriorating morale: 1) Pace of change 2) Process of change 3) The role of chief residents in change 4) Fear of intimidation and retaliation. Groups also suggested practical recommendations for improving the culture of the residency., Conclusion: Introducing change in residency training is a challenging process. Respectful attention to resident frustrations and solution-focused discussions are necessary to understand and improve morale. Focus groups proved to be a useful tool in revealing the precise source of pervasive resident concerns as well as providing potential solutions. In addition, FGs methodology can be adapted in a practical manner to residency evaluation.

Many opinion leaders of the academic internal medicine community have expressed concern about the adequacy of internal medicine (IM) residency training to prepare residents for their careers and to attract medical students to IM residency programs. In response to those concerns, several core organizations have prepared reports and issued significant recommendations suggesting comprehensive reform and restructuring of IM training programs.The authors discuss their approach, strategy, and efforts to restructure the first year in the IM residency training program at the University of California, Irvine. They point out that educators have often viewed the internship as a rite of passage, heavy with inpatient service commitment. However, in the authors' view, the current trend to residents' early subspecialty commitment has made it imperative that the first year of IM residency be more focused, standardized, meaningful, and effective in order to achieve core educational goals before each resident's career focus has become too narrowed and while the big picture is more apparent. The authors describe in detail their review of their first-year curriculum based on consensus goals and objectives. This process led to a restructuring of the first year that places emphasis on a defined educational model and a central core curriculum. The authors conclude that residency program leaders can restructure the first year to provide a model of education that includes appropriate educational experiences as well as meaningful time for reflection and professional growth.

Medical educators have only limited understanding of how integrating humanities-based components into standard curricula contributes to the medical students' professionalism. This study qualitatively analyzed how students used a creative-project assignment during their third-year internal medicine clerkships to explore various aspects of their professional development.A total of 277 students from three consecutive classes (1999-2002) at the University of California, Irvine, College of Medicine each completed a creative project reflecting on a particularly problematic or meaningful illness-related incident. Process and content analyses of the 221 projects submitted for analysis were performed.Students' projects employed a wide range of formats, tones, and styles to examine the process of socialization into medicine. Within this framework, their work tended to explore issues such as the proper relationship of medical students to patients, coming to terms with death and dying, understanding the patient's experience of illness, and coping with professional and personal stress.A creative-projects course component can be a valuable adjunct to traditional clerkship activities in helping students to reflect on the process of becoming a physician.

Objective: To determine whether there are differences in the methods and criteria used by primary care and traditional internal medicine programs to select first-year residents.Design: A questionnaire was sent to primary care and traditional internal medicine program directors, who were asked to rank in importance ten documents of an applicant's file and to score the relative importance, on a scale of -5 to +5, of 21 candidate traits of four types: academic, demographic, personal, and career goal.Setting: Programs at institutions (n = 54) that have categorical residency programs in both traditional and primary care internal medicine.Participants: Of 108 questionnaires, the overall response rate was 81%, with 40 pairs (74%) of matched respondents. Seventy-two percent of the responding institutions were university-administered.Results: Primary care and traditional programs use similar methods to process applicants, rank similarly ten documents in an applicant's file, and value academic success during the clinical years as the most important candidate trait. Compared with traditional tracks, primary care tracks place greater emphasis on a candidate's career goals and select for candidates planning to pursue primary care careers (3.9 +/- 1.4 vs 0.9 +/- 1.5, p < 0.001), enter practice (1.4 +/- 1.5 vs 0.1 +/- 1.2, p < 0.001), or serve medically indigent populations (2.7 +/- 1.5 vs 1.2 +/- 1.2, p < 0.001). Primary care programs rate negatively candidates who intend to subspecialize, whereas traditional programs view them almost neutrally (-1.8 +/- 2.2 vs 0.5 +/- 1.5, p < 0.001).Conclusion: Primary care and traditional track internal medicine programs use similar methods to select residents and both rank academic achievement during the clinical years as a candidate's most important attribute. However, only primary care programs strongly select for candidates on the basis of their career plans and in particular prefer candidates who are committed to pursuing primary care careers and serving the medically indigent. [ABSTRACT FROM AUTHOR]

Compares the academic performance of internal medicine residents with their specific teaching behaviors in Irvine, California. Utilization of baseline teaching videotapes; Correlation between the academic performance and teaching behavior of internal medicine residents; Evaluation of medical students' global ratings of residents' teaching skills.