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Reforming internal medicine residency training

A report from the society of general internal medicine’s task force for residency reform

  • Internal Medicine Residency Reform: Task Force Report
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References

  1. Schroeder SA, Showstack JA, Gerbert B. Residency training in internal medicine: time for change? Ann Intern Med. 1986;104:554–61.

    PubMed  CAS  Google Scholar 

  2. Greganti MA, Fletcher SW. Residency training in the inpatient setting: a new dilemma for internal medicine. J Gen Intern Med. 1989;4:136–8.

    Article  PubMed  CAS  Google Scholar 

  3. Fallon HJ. Residency reform: a perspective from the Association of Professors in Medicine. Ann Intern Med. 1992;116:1041.

    PubMed  CAS  Google Scholar 

  4. Nolan JP, Inui TS. Tinkering or real reform? The choice is ours. Ann Intern Med. 1992;116:1042–5.

    PubMed  CAS  Google Scholar 

  5. Cantor JC, Baker LC, Hughes RG. Preparedness for practice: young physicians’ views of their professional education. JAMA. 1993;270:1035–40.

    Article  PubMed  CAS  Google Scholar 

  6. Cohen JJ. Honoring the “E” in GME. Acad Med. 1999;74:108–13.

    Article  PubMed  CAS  Google Scholar 

  7. Task Force on Academic Health Centers. Training tomorrow’s doctors: the medical education mission of academic health centers. Commonwealth Fund. April 2002.

  8. Whitcomb ME. Putting patients first: the need to reform graduate medical education. Acad Med. 2003;78:851–2.

    Article  PubMed  Google Scholar 

  9. Donabedian A. The Definition of Quality and to its Assessment. Ann Arbor, Mich: Health Administration Press; 1980.

    Google Scholar 

  10. Accreditation Council for Graduate Medical Education. ACGME Outcome Project: The General Competencies. Accessed at www.acgme.org on April 24, 2004.

  11. American Board of Internal Medicine. Portfolio for Internal Medicine Residency Programs. Philadelphia: American Board of Internal Medicine; 2001.

    Google Scholar 

  12. Ben-david MF. AMEE guide no. 14: outcome-based education: part 3—assessment in outcome-based education. Med Teach. 1999;21:23–5.

    Article  Google Scholar 

  13. Harden RM. AMEE guide no. 14: outcome-based education: part 1: an introduction to outcome-based education. Med Teach. 1999;21:7–14.

    Article  Google Scholar 

  14. Institute of Medicine. Health Professions Education: A Bridge to Quality. Washington: National Academy Press; 2003.

    Google Scholar 

  15. Ende J, Atkins E. Conceptualizing curriculum for graduate medical education. Acad Med. 1992;67:528–34.

    Article  PubMed  CAS  Google Scholar 

  16. Choudhry NK, Fletcher RH, Soumerai SB. Systematic review: the relationship between clinical experience and quality of health care. Ann Intern Med. 2005;142:260–73.

    PubMed  Google Scholar 

  17. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington: National Academy Press; 2001.

    Google Scholar 

  18. Institute of Medicine. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington: National Academy Press; 2002.

    Google Scholar 

  19. Institute for the Future. Health and Healthcare 2010: The Forecast, the Challenge. San Francisco: Jossey-Bass; 2003.

    Google Scholar 

  20. Stillman PL, Regan MB, Swanson DB, et al. An assessment of the clinical skills of fourth year students at four New England medical schools. Acad Med. 1990;65:320–6.

    Article  PubMed  CAS  Google Scholar 

  21. Pfeiffer C, Madray H, Ardolino A, Willms J. The rise and fall of students’ skill in obtaining a medical history. Med Educ. 1998;32:283–8.

    Article  PubMed  CAS  Google Scholar 

  22. Mangione S, Nieman LZ. Cardiac auscultatory skills of Internal Medicine and Family Practice trainees: a comparison of diagnostic proficiency. JAMA. 1997;278:717–22.

    Article  PubMed  CAS  Google Scholar 

  23. Newton DA, Grayson MS. Trends in career choice by US medical school graduates. JAMA. 2003;290:1179–82.

    Article  PubMed  CAS  Google Scholar 

  24. Dorsey ER, Jarjoura D, Rutecki GW. Influence of controllable lifestyle on recent trends in specialty choice by US medical students. JAMA. 2003;290:1173–8.

    Article  PubMed  CAS  Google Scholar 

  25. Jolly P. Medical school tuition and young physician indebtedness. American Association of Medical Colleges, 2004. Accessed at www.aamc.org August 10, 2004.

  26. Petersdorf RG, Goitein L. The future of internal medicine. Ann Intern Med. 1993;119:1130–7.

    PubMed  CAS  Google Scholar 

  27. Perkoff GT. Teaching medicine in the ambulatory setting: an idea whose time may finally have come. N Engl J Med. 1986;314:27–31.

    Article  PubMed  CAS  Google Scholar 

  28. Walter D, Whitcomb ME. Venues for clinical education in Internal Medicine residency programs and their implications for future training. Am J Med. 1998;105:262–5.

    PubMed  CAS  Google Scholar 

  29. Wiest FC, Ferris TG, Gokhale M, Campbell EG, Weissman JS, Blumenthal D. Preparedness of internal medicine and family practice residents for treating common conditions. JAMA. 2002;288:2609–14.

    Article  PubMed  Google Scholar 

  30. Spickard A III, Ryan SP, Muldowney JA III, Farnham L. Outpatient morning report: a new conference for internal medicine residency programs. J Gen Intern Med. 2000;15:822–4.

    Article  PubMed  Google Scholar 

  31. Wenderoth S, Pelzman F, Demopoulos B. Ambulatory morning report: can it prepare residents for the American Board of Internal Medicine examination? J Gen Intern Med. 2002;17:207–9.

    Article  PubMed  Google Scholar 

  32. Randall DC, Strong J, Gibbons R. A longitudinal subspecialty experience for internal medicine residents. Mil Med. 2001;166:40–3.

    PubMed  CAS  Google Scholar 

  33. Hellmann DB, Flynn JA. Development and evaluation of a coordinated, ambulatory rheumatology experience for internal medicine residents. Arthr Care Res. 1999;12:325–30.

    Article  CAS  Google Scholar 

  34. Bharel M, Jain S, Hollander H. Comprehensive ambulatory medicine training for categorical internal medicine residents. J Gen Intern Med. 2003;18:288–93.

    Article  PubMed  Google Scholar 

  35. Bowen JL, Irby DM. Assessing quality and costs of education in the ambulatory setting: a review of the literature. Acad Med. 2002;77:621–80.

    Article  PubMed  Google Scholar 

  36. Blumenthal D, Gokhale M, Campbell EG, Weissman JS. Preparedness for clinical practice: reports of graduating residents at academic health centers. JAMA. 2001;286:1027–34.

    Article  PubMed  CAS  Google Scholar 

  37. Wickstrom GC, Kelley DK, Keyserling TC, et al. Confidence of graduating internal medicine residents to perform ambulatory procedures. J Gen Intern Med. 2000;15:353–60.

    Article  PubMed  CAS  Google Scholar 

  38. Bernard AM, Anderson L, Cook CB, Phillips LS. What do internal medicine residents need to enhance their diabetes care? Diabetes Care. 1999;22:661–6.

    Article  PubMed  CAS  Google Scholar 

  39. Boutin-Foster C, Charlson ME. Problematic resident-patient relationships: the patient’s perspective. J Gen Intern Med. 2001;16:750–4.

    Article  PubMed  CAS  Google Scholar 

  40. Nelson EC, Batalden PB, Huber TP, et al. Microsystems in health care: part 1. Learning from high performing front line units. Jt Comm J Qual Safety. 2002;28:472–93.

    Google Scholar 

  41. Godfrey MM, Nelson EC, Wasson JH, Mohr JJ, Batalden PB. Microsystems in health care: part 3. Planning patient centered services. Jt Comm J Qual Safety. 2003;29:159–70.

    Google Scholar 

  42. Wasson JH, Godfrey MM, Nelson EC, Mohr JJ, Batalden PB. Microsystems in health care: part 4. Planning patient-centered care. Jt Comm J Qual Safety. 2003;29:227–37.

    Google Scholar 

  43. Von Korff M, Gruman J, Schaefer J, Curry SJ, Wagner EH. Collaborative management of chronic illness. Ann Intern Med. 1997;127:1097–102.

    Google Scholar 

  44. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff. 2001;20:64–78.

    Article  CAS  Google Scholar 

  45. Wagner EH. The role of patient care teams in chronic disease management. BMJ. 2000;320:569–72.

    Article  PubMed  CAS  Google Scholar 

  46. Hall P, Weaver L. Interdisciplinary education and teamwork: a long and winding road. Med Educ. 2001;35:867–75.

    Article  PubMed  CAS  Google Scholar 

  47. Ludmerer KM. Time to Heal: American Education from the Turn of the Century to the Era of Managed Care. Oxford: Oxford University Press; 1999.

    Google Scholar 

  48. Morelock JA, Stern DT. Shifting patients: how residency programs respond to Residency Review Committee requirements. Acad Med. 2003;115:48–54.

    Google Scholar 

  49. Wenger NS, Shpiner RB. An analysis of morning report: implications for internal medicine education. Ann Intern Med. 1993;119:395–9.

    PubMed  CAS  Google Scholar 

  50. Matter CA, Speice JA, McCann R, et al. Hospital to home: improving internal medicine residents’ understanding of the needs of older persons after a hospital stay. Acad Med. 2003;78:793–7.

    Article  PubMed  Google Scholar 

  51. Wright SM, Durbin P, Barker LR. When should learning about hospitalized patients end? Providing housestaff with post-discharge follow-up information. Acad Med. 2000;75:380–3.

    Article  PubMed  CAS  Google Scholar 

  52. Diem SJ, Prochazka AV, Meyer TJ, Fryer GE. Effects of a postdischarge clinic on housestaff satisfaction and utilization of hospital services. J Gen Intern Med. 1996;11:179–81.

    Article  PubMed  CAS  Google Scholar 

  53. Dresselhaus TR, Luck J, Wright BC, Spragg RG, Lee ML, Bozzette SA. Analyzing the time and value of housestaff inpatient work. J Gen Intern Med. 1998;13:534–40.

    Article  PubMed  CAS  Google Scholar 

  54. Nerenz D, Rosman H, Newcomb C, et al. The on-call experience of interns in internal medicine. Medical education task force of the Henry Ford Hospital. Arch Intern Med. 1990;150:2294–7.

    Article  PubMed  CAS  Google Scholar 

  55. Cooper H, Carlisle C, Gibbs T, Watkins C. Developing an evidence base for interdisciplinary learning: a systematic review. J Adv Nurs. 2001;35:228–37.

    Article  PubMed  CAS  Google Scholar 

  56. Moore SM, Alemi F, Headrick LA, et al. Interdisciplinary learning in continuous improvement of healthcare: four perspectives. Jt Comm J Qual Improvement. 1996;22:165–87.

    CAS  Google Scholar 

  57. Accreditation Council for Graduate Medical Education. General program requirements; Residency Review Committee. Accessed at www.acgme.org on April 24, 2004.

  58. Schroeder SA. How many hours is enough? An old profession meets a new generation. Ann Intern Med. 2004;140:838–9.

    PubMed  Google Scholar 

  59. Skeff KM, Ezeji-Okoye S, Pompei P, Rockson S. Benefits of resident work hours regulation. Ann Intern Med. 2004;140:816–7.

    PubMed  Google Scholar 

  60. Charap M. Reducing resident work hours: unproven assumptions and unforeseen outcomes. Ann Intern Med. 2004;140:814–5.

    PubMed  Google Scholar 

  61. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med. 2002;136:358–67.

    PubMed  Google Scholar 

  62. Lockley SW, Cronin JW, Evans EE, et al. Effects of reducing interns’ weekly work hours on sleep and attentional failures. N Engl J Med. 2004;351:1829–37.

    Article  PubMed  CAS  Google Scholar 

  63. Landrigan CP, Rothschild JM, Cronin JW, et al. Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med. 2004;351:1838–48.

    Article  PubMed  CAS  Google Scholar 

  64. Barger LK, Cade BE, Ayas NT, et al. N Engl J Med. 2005;352:125–34.

    Article  PubMed  CAS  Google Scholar 

  65. Petersen LA, Brennan TA, O’Neil AC, Cook EF, Lee TH. Does housestaff discontinuity of care increase the risk for preventable adverse events? Ann Intern Med. 1994;121:866–72.

    PubMed  CAS  Google Scholar 

  66. Patterson ES, Roth EM, Woods DD, Chow R, Gomes JO. Handoff strategies in settings with high consequences for failure: lessons for healthcare operations. Int J Qual Healthcare. 2004;16:125–32.

    Article  Google Scholar 

  67. Wong J, Holmboe ES, Huot S. A novel dayfloat rotation to address the 80 hour work restriction. J Gen Intern Med. 2004;19(part 2):519–23.

    Article  PubMed  Google Scholar 

  68. Kripalani S, pope AC, Rask K, et al. Hospitalists as teachers: how do they compare to subspecialty and general medicine faculty? J Gen Intern Med. 2004;19:8–15.

    Article  PubMed  Google Scholar 

  69. Kulaga ME, Charney P, O’Mahony SP, et al. The positive impact of initiation of hospitalist clinician educators. J Gen Intern Med. 2004;19:293–301.

    Article  PubMed  Google Scholar 

  70. Landrigan CP, Muret-Wagstaff S, Chiang VW, Nigrin DJ, Goldmann DA, Finkelstein JA. Effect of a pediatric hospitalist system on housestaff education and experience. Archiv Pediatr Adolescent Med. 2002;156:877–83.

    Google Scholar 

  71. Nishimura RA, Linderbaum JA, Naessens JM, Spurrier B, Koch MB, Gaines KA. A nonresident cardiovascular inpatient service improves residents’ experience in an academic medical center: a new model to meet the challenges of the new millennium. Acad Med. 2004;79:426–31.

    Article  PubMed  Google Scholar 

  72. Griffith CH III, Rich EC, Hillson SD, Wilson JF. Internal medicine residency training and outcomes. J Gen Intern Med. 1997;12:390–6.

    Article  PubMed  Google Scholar 

  73. Tenner PA, Dibrell H, Taylor RP. Improved survival with hospitalists in a pediatric intensive care unit. Crit Care Med. 2003;31:847–52.

    Article  PubMed  Google Scholar 

  74. Chung P, Morrison J, Jin L, Levinson W, Humphrey H, Meltzer D. Resident satisfaction on an academic hospitalist service: time to teach. Am J Med. 2002;112:597–601.

    Article  PubMed  Google Scholar 

  75. Chaudhry SI, Olofinboda KA, Krumholz HM. Detection of errors by attending physicians on a general medicine service. J Gen Intern Med. 2003;18:595–600.

    Article  PubMed  Google Scholar 

  76. Fox RA, Clark CLI, Scotland AD, Dacre JE. A study of pre-registration house officers’ clinical skills. Med Educ. 2000;34:1007–12.

    Article  PubMed  CAS  Google Scholar 

  77. Weiner S, Nathanson M. Physical examination. Frequently observed errors. JAMA. 1976;236:852–5.

    Article  Google Scholar 

  78. Wray NP, Friedland JA. Detection and correction of house staff error in physical diagnosis. JAMA. 1983;249:1035–7.

    Article  PubMed  CAS  Google Scholar 

  79. Mangione S, Burdick WP, Peitzman SJ. Physical diagnosis skills of physicians in training: a focused assessment. Acad Emerg Med. 1995;2:622–9.

    Article  PubMed  CAS  Google Scholar 

  80. Li JTC. Assessment of basic examination skills of internal medicine residents. Acad Med. 1994;69:296–9.

    Article  PubMed  CAS  Google Scholar 

  81. Johnson JE, Carpenter JL. Medical house staff performance in physical examination. Arch Intern Med. 1986;146:937–41.

    Article  PubMed  CAS  Google Scholar 

  82. Battles JB, Shea CE. A system of analyzing medical errors to improve GME curricula and programs. Acad Med. 2001;76:125–33.

    Article  PubMed  CAS  Google Scholar 

  83. Reilly BM. Physical examination in the care of medical inpatients: an observational study. Lancet. 2003;362:1100–5.

    Article  PubMed  Google Scholar 

  84. Holliman CJ, Wuerz RC, Kimak MJ, et al. Attending supervision of nonemergency medicine residents in a university hospital ED. Am J Emerg Med. 1995;13:259–61.

    Article  PubMed  CAS  Google Scholar 

  85. Gennis VM, Gennis MA. Supervision in the outpatient clinic: effects on teaching and patient care. J Gen Intern Med. 1993;9:116–20.

    Google Scholar 

  86. Kilminster SM, Jolly BC. Effective supervision in clinical practice settings: a literature review. Med Educ. 2000;34:827–40.

    Article  PubMed  CAS  Google Scholar 

  87. Phy MP, Offord KP, Manning DM, Bundrick JB, Huddleston JM. Increased faculty presence on inpatient teaching services. Mayo Clin Proceed. 2004;79:332–6.

    Article  Google Scholar 

  88. Norcini JJ, Blank LL, Arnold GK, Kimball HR. The mini-CEX (clinical evaluation exercise): a preliminary investigation. Ann Intern Med. 1995;123:795–9.

    PubMed  CAS  Google Scholar 

  89. Norcini JJ, Blank LL, Duffy FD, Fortna GS. The mini-CEX: a method for assessing clinical skills. Ann Intern Med. 2003;138:476–81.

    PubMed  Google Scholar 

  90. Irby DM. Three exemplary models of case-based teaching. Acad Med. 1994;69:947–52.

    Article  PubMed  CAS  Google Scholar 

  91. Grant J, Kilminster S, Jolly B, Cottrell D. Clinical supervision of SpRs: where does it happen, when does it happen and is it effective? Specialist registrars. Med Educ. 2003;37:140–8.

    Article  PubMed  Google Scholar 

  92. Lehmann LS, Brancati FL, Chen M-C, Roter D, Dobs AS. The effect of bedside case presentations on patients’ perceptions of their medical care. N Engl J Med. 1997;336:1150–6.

    Article  PubMed  CAS  Google Scholar 

  93. Wright SM, Kern DE, Kolodner K, Howard DM, Brancati FL. Attributes of excellent attending-physician role models. N Engl J Med. 1998;339:1986–93.

    Article  PubMed  CAS  Google Scholar 

  94. Federated Council of Internal Medicine. Curriculum for Internal Medicine. Accessed at acponline.org on April 24, 2004.

  95. Hripcsak G, Stetson PD, Gordon PG. Using the Federated Council of Internal Medicine curricular guide and administrative codes to assess IM residents’ breadth of experience. Acad Med. 2004;79:557–63.

    Article  PubMed  Google Scholar 

  96. Dreyfus HL. On the Internet: Thinking in Action. New York: Routledge; 2001.

    Google Scholar 

  97. Batalden P, Leach D, Swing S, Dreyfus H, Dreyfus S. General competencies and accreditation in graduate medical education. Health Aff. 2002;21:103–11.

    Article  Google Scholar 

  98. Ogrinc G, Headrick LA, Mutha S, Coleman MT, O’Donnell J, Miles PV. A framework for teaching medical students and residents about practice-based learning and improvement, synthesized from a literature review. Acad Med. 2003;78:748–56.

    Article  PubMed  Google Scholar 

  99. Mallett S, Clarke M. How many reviews are needed to cover existing evidence on the effects of health care interventions? ACP J Club. 2003;139:A11.

  100. Institute of Medicine. Improving Medical Education: Enhancing the Behavioral and Social Science Content of Medical School Curricula. Washington: National Academy Press; 2004.

    Google Scholar 

  101. Council on Graduate Medical Education (COGME). Proceedings of the GME Financing Stakeholders Meeting. Public Response to COG-ME’s Fifteenth Report. Department of Health and Human Services, Rockville, Md, September, 2001.

    Google Scholar 

  102. Institute of Medicine. Academic Health Centers. Leading Change in the 21st Century. Washington: National Academy Press; 2004.

    Google Scholar 

  103. Price EG, Beach MC, Gary T, et al. Quality of educational literature on cultural competence training of health professionals. J Gen Intern Med Vol. 2004; 19(suppl 1):200.

    Google Scholar 

  104. Beach MC, Price EG, Gary TL, et al. Cultural competence. A systematic review of health care provider educational interventions. Med Care. 2005;43:356–73.

    Article  PubMed  Google Scholar 

  105. Wardlow H. Giving birth to Gonolia: “culture” and sexually transmitted disease among the Huli of Papua New Guinea. Medl Anthropol Quart. 2002;16:151–75.

    Article  Google Scholar 

  106. Lypson ML, Gruppen L, Stern DT. Warning signs of declining faculty diversity. Acad Med. 2002;77:S10–2.

    Article  PubMed  Google Scholar 

  107. Covell DG, Uman GC, Manning PR. Information needs in office practice: are they being met? Ann Intern Med. 1985;103:596–9.

    PubMed  CAS  Google Scholar 

  108. Ramsey PG, Carline JD, Inui TS, et al. Changes over time in the knowledge base of practicing internists. JAMA. 1991;266:1103–7.

    Article  PubMed  CAS  Google Scholar 

  109. McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348:2635–45.

    Article  PubMed  Google Scholar 

  110. Brockett RG, Hiemstra R. Self-Direction in Learning: Perspectives in Theory, Research, and Practice. London: Routledge; 1991.

    Google Scholar 

  111. Garrison DR. Self-directed learning: toward a comprehensive model. Adult Educ Quart. 1997;48:18–33.

    Article  Google Scholar 

  112. Candy PC. Self-Directed Lifelong Learning: A Comprehensive Guide to Theory and Practice. San Francisco: Jossey & Bass; 1991.

    Google Scholar 

  113. Slotnick HB. How doctors learn: physicians’ self-directed learning episodes. Acad Med. 1999;74:1106–17.

    Article  PubMed  CAS  Google Scholar 

  114. Coomarasamy A, Taylor R, Khan KS. A systematic review of postgraduate teaching in evidence-based medicine and critical appraisal. Med Teach. 2003;25:77–81.

    Article  PubMed  Google Scholar 

  115. Alguire PC. A review of journal clubs in postgraduate medical education. J Gen Intern Med. 1998;13:347–53.

    Article  PubMed  CAS  Google Scholar 

  116. Green ML. Graduate medical education training in clinical epidemiology, critical appraisal, and evidence-based medicine: a critical review of curricula. Acad Med. 1999;74:686–94.

    Article  PubMed  CAS  Google Scholar 

  117. Ozuah PO, Stein RE. More on problem-based learning and self-directed learning [comment]. Arch Pediatr Adolesc Med. 2001;155:1278.

    PubMed  CAS  Google Scholar 

  118. Itani KM, Miller CC, Church HM, McCollum CH. Impact of a problem-based learning conference on surgery residents’ in training exam (AB-SITE) scores. American Board of Surgery in Training Exam. J Surg Res. 1997;70:66–8.

    Article  PubMed  CAS  Google Scholar 

  119. FitzGerald JD, Wenger NS. Didactic teaching conferences for IM resident: who attends, and is attendance related to medical certifying examination scores? Acad Med. 2003;78:84–9.

    Article  PubMed  Google Scholar 

  120. Green ML. Evidence-based medicine training in internal medicine residency programs a national survey. J Gen Intern Med. 2000;15:129–33.

    Article  PubMed  CAS  Google Scholar 

  121. Dellavalle RP, Stegner DL, Deas AM, et al. Assessing evidence-based dermatology and evidence-based internal medicine curricula in US residency training programs: a national survey. Arch Dermatol. 2003;139:369–72; discussion 372.

    Article  PubMed  Google Scholar 

  122. Green ML, Ellis PJ. Impact of an evidence-based medicine curriculum based on adult learning theory. J Gen Intern Med. 1997;12:742–50.

    Article  PubMed  CAS  Google Scholar 

  123. Smith CA, Ganschow PS, Reilly BM, et al. Teaching residents evidence-based medicine skills: a controlled trial of effectiveness and assessment of durability. J Gen Intern Med. 2000;15:710–5.

    Article  PubMed  CAS  Google Scholar 

  124. Ross R, Verdieck A. Introducing an evidence-based medicine curriculum into a family practice residency—is it effective? Acad Med. 2003;78:412–7.

    Article  PubMed  Google Scholar 

  125. Green ML. Evidence-based medicine training in graduate medical education: past, present and future. J Eval Clin Pract. 2000;6:121–38.

    Article  PubMed  CAS  Google Scholar 

  126. Richardson WS. One slice or the whole pie? Evidence-Based Health Care Newslett. 2001;21:17–18.

    Google Scholar 

  127. Bradley DR, Rana GK, Martin PW, Schumacher RE. Real-time, evidence-based medicine instruction: a randomized controlled trial in a neonatal intensive care unit. J Med Library Assoc. 2002;90:194–201.

    Google Scholar 

  128. Green ML, Ciampi MA, Ellis PJ. Residents’ medical information needs in clinic: are they being met? Am J Med. 2000;109:218–23.

    Article  PubMed  CAS  Google Scholar 

  129. Dinkevich E, Ozuah PO. Self-directed learning activities of paediatric residents. Med Educ. 2003;37:388–9.

    Article  PubMed  Google Scholar 

  130. Council on Graduate Medical Education (COGME). Fifteenth Report: Financing Graduate Medical Education in a Changing Health Care Environment, Department of Health and Human Services, Rockville, Md, December 2000.

    Google Scholar 

  131. American College of Physicians. The physician workforce and financing graduate medical education. Ann Intern Med. 1998;128:142–8.

    Google Scholar 

  132. Sundwall DN. Another alternative for financing graduate medical education. A proposal from the Council on Graduate Medical Education. Health Aff. 2001;20:156–8.

    Article  CAS  Google Scholar 

  133. Fryer GE, Green LA, Dovey S, Phillips RL. Direct graduate medical education payments to teaching hospitals by Medicare: unexplained variation and public policy contradictions. Acad Med. 2001;76:439–45.

    Article  PubMed  Google Scholar 

  134. Covey AS, Freidlaender GE. Financing graduate medical education: sorting out the confusion. J Bone Jt Surg. 2003;85:1594–1604.

    Google Scholar 

  135. Rich EC, Liebow M, Srinivasan M, et al. Medicare financing of graduate medical education. Intractable problems, elusive solutions. J Gen Intern Med. 2002;17:283–92.

    Article  PubMed  Google Scholar 

  136. Gusmano M, Schlesinger M. The social roles of Medicare: assessing Medicare collateral benefits. J Health Politics, Policy, Law. 2001;26:37–79.

    Article  CAS  Google Scholar 

  137. Council on Graduate Medical Education (COGME). Collaborative Education to Ensure Patient Safety, Department of Health and Human Services, Rockville, Md, 2000.

    Google Scholar 

  138. Liaison Committee on Medical Education. Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Programs Leading to the MD Degree, Washington, DC, September 2003.

  139. Gorroll AH, Sirio C, Duffy FD, et al. A new model for accreditation of residency programs in internal medicine. Ann Intern Med. 2004;140:902–9.

    Google Scholar 

  140. Duffy FD, Zipes DP. The future of certification and recertification. Am J Med. 2004;117:140–4.

    Article  Google Scholar 

  141. Bowen JL. Adapting residency training. Training adaptable residents. West J Med. 1998;168:371–7.

    PubMed  CAS  Google Scholar 

  142. Cleghorn CD, Headrick LA. The PDSA cycle at the core of learning in health professions education. Jt Comm J Qual Improv. 1996;22:206–12.

    PubMed  CAS  Google Scholar 

  143. Humphries HJ. Customizing residency education. Ann Intern Med. 2004;140:663–4.

    Google Scholar 

  144. Goldman L. Modernizing the paths to certification in Internal Medicine and its subspecialties. Am J Med. 2004;117:133–6.

    Article  PubMed  Google Scholar 

  145. Miller G. The assessment of clinical skills/competence/performance. Acad Med. 1990;65:S63–7.

    Article  PubMed  CAS  Google Scholar 

  146. Holmboe ES. The importance of faculty observation of trainees’ clinical skills. Acad Med. 2004;79:16–22.

    Article  PubMed  Google Scholar 

  147. Long DM. Competency-based residency training: the next advance in graduate medical education. Acad Med. 2000;75:1178–83.

    Article  PubMed  CAS  Google Scholar 

  148. Lypson ML, Frohna JG, Gruppen LD, Wolliscroft JO. Assessing residents’ competencies at baseline: identifying the gaps. Acad Med. 2004;79:564–70.

    Article  PubMed  Google Scholar 

  149. Silber CG, Nasca TJ, Paskin DL, Eiger G, Robeson M, Veloski JJ. Do global rating forms enable program directors to assess the ACGME competencies? Acad Med. 2004;79:549–56.

    Article  PubMed  Google Scholar 

  150. Ramos KD, Schafer S, Tracz SM. Validation of the Fresno test of competence in evidence based medicine. BMJ. 2003;326:319–21.

    Article  PubMed  Google Scholar 

  151. Fung MF, Walker M, Fung KF, et al. An internet-based learning portfolio in resident education: the KOALA multicentre programme. Med Educ. 2000;34:474–9.

    Article  PubMed  CAS  Google Scholar 

  152. Guglielmino LM. Development of the self-directed learning readiness scale (doctoral dissertation, University of Georgia). Dissertation Abstracts International. 1997;38:6467A.

  153. Shea JA, Arnold L, Mann KV. A RIME perspective on the quality and relevance of current and future medical education research. Acad Med. 2004;79:931–8.

    Article  PubMed  Google Scholar 

  154. Dauphinee WD, Wood-Dauphinee S. The need for evidence in medical education: the development of best evidence medical education as an opportunity to inform, guide, and sustain medical education research. Acad Med. 2004;79:925–30.

    Article  PubMed  Google Scholar 

  155. Chen FM, Baucher H, Burstin H. A call for outcomes research in medical education. Acad Med. 2004;79:955–60.

    Article  PubMed  Google Scholar 

  156. Wartman SA. Revisiting the idea of a national center for health professions education research. Acad Med. 2004;79:910–7.

    Article  PubMed  Google Scholar 

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Correspondence to Eric S. Holmboe MD.

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See editorial by Holly Humphrey, P. 1189

The opinions reflected within this manuscript are solely those of the authors and do not represent the views of the Department of Defense, Department of the Army, the American Board of Internal Medicine, or the American College of Physicians. Portions of this work were supported by the Society of General Internal Medicine.

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Holmboe, E.S., Bowen, J.L., Green, M. et al. Reforming internal medicine residency training. J GEN INTERN MED 20, 1165–1172 (2005). https://doi.org/10.1111/j.1525-1497.2005.0249.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2005.0249.x

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