Time for Clinic: Fourth-Year Primary Care Exposure and Clinic Preparedness Among Internal Medicine Interns

J Gen Intern Med. 2021 Oct;36(10):2929-2934. doi: 10.1007/s11606-020-06562-y. Epub 2021 Feb 5.


Background: Internal medicine (IM) residency graduates consistently report being less prepared for outpatient practice than inpatient medicine. Although an initial study suggested interns arriving for IM residency reported low levels of preparedness for continuity clinic, the impact of education and experience during the undergraduate medical education to graduate medical education transition on ambulatory training is unclear.

Objective: To describe end of medical school primary care exposure among entering IM interns and its association with self-assessed preparedness for residency continuity clinic.

Design: Cross-sectional survey of 161 entering IM interns in 2019.

Participants: Entering interns at four geographically diverse IM residency programs (University of Chicago, University of North Carolina, University of Pennsylvania, and University of Washington), representing 81 US medical schools.

Results: A total of 139 interns (86%) responded to the survey. Surveyed interns reported a median of zero days of general internal medicine (GIM) clinic (interquartile range [IQR]: 0-20 days) and 2.5 days of multispecialty adult primary care (IQR: 0-26.5 days) during fourth year of medical school. The median last exposure to primary care was 13 months prior to internship (IQR: 7-18 months). Interns who rated themselves as prepared for primary care clinic reported a median of twenty more multispecialty adult primary care days (20 vs. 0 days; p < 0.01) and fourteen more GIM clinic days (14 vs. 0 days; p < 0.01) than their unprepared counterparts. The experiences were also more recent, with six fewer months between their last multispecialty adult primary care exposure and the start of internship (9 vs. 15 months; p < 0.01).

Conclusions: The majority of incoming IM interns had no primary care training during the fourth year of medical school. At the start of residency, IM interns who felt more prepared for their primary care clinic reported more recent and more numerous primary care experiences.

Keywords: fourth-year medical school; intern year; medical education; primary care; resident continuity clinic.

MeSH terms

  • Adult
  • Ambulatory Care Facilities
  • Clinical Competence
  • Cross-Sectional Studies
  • Education, Medical, Graduate
  • Humans
  • Internship and Residency*
  • Primary Health Care