Thread by @samedwardsmd

Check out our new letter in @JAMAInternalMed

Quality of Care With Internal Medicine Residents vs Attending Physicians in VA Clinics

ja.ma/2VeR8Is

People worry that resident doctors don’t do as good a job as more experienced staff doctors.

This can be an issue in residency teaching clinics, where patients request not to see trainees.

nejm.org/doi/full/10.10…

People have studied this before and found that the care is very similar between IM residents and attendings. These studies are typically single site or based on self reported survey data.

ncbi.nlm.nih.gov/pmc/articles/P…

ncbi.nlm.nih.gov/pmc/articles/P…

We compared common primary care quality measures among patients cared for by internal medicine residents and attendings physicians at 10 geographically diverse @DeptVetAffairs medical centers.

We used commonly accepted measures of diabetes, HTN, overprescribing, and utilization.

RESULTS: residents care for younger patients, more non white patients, more medically complex patients, and patients under VA care for less time.

Differences in quality measures are very small.

Take home: residents provide similar quality of care, while caring for vulnerable, complex populations, and providing access to new patients.

Also system factors may be stronger drivers of performance on these measures.

Major caveat: quality measures in primary care are not that great. more sophisticated skills such as the ability to prioritize and integrate information while balancing medical needs with personal preferences and social context are unmeasured.

jabfm.org/content/30/1/1…

But overall, patients should be reassured that using the limited measures we have:

IM residents provide similar quality of care as attending physicians.

@vahsrd
@boedudley
@PDX_Tom