Title

Resident Ambulatory Experience in Primary Care Clinic: Mixed Methods Approach

Authors

Preetha Hebbar, MD MPH - Yale New Haven Hospital, Yale Primary Care Chief Resident Delaney Marguerite W. Rawson, MD, MPH - UCLA Health Sheba Ebhote, MD- Yale New Haven Hospital, Yale Primary Care Chief Resident Sneha Modi, MD- Temple Health Christine Krueger, MD- Yale New Haven Hospital

Introduction

The US healthcare system faces a critical shortage of primary care physicians (1) yet 80% of internal medicine residents do not plan to pursue a career in general internal medicine (2). Resident satisfaction with various aspects of their primary care experience increases the likelihood of residents choosing to pursue a career in general internal medicine (3).

Methods

All residents in an internal medicine primary care program from July 2023 - June 2024 were eligible to participate. The primary care clinic is located in an FQHC clinic in New Haven, Connecticut. Electronic surveys assessing satisfaction with the primary care clinic experience as well as prior and current interest in pursuing a career in primary care were distributed via email listserv. In-person focus groups were conducted in small groups led by two researchers. The content of these focus groups was de-identified and qualitatively analyzed to identify themes. Changes were made to the clinic including hiring more support staff, shifting some logistical work from residents to support staff, halting the addition of new patients to resident patient panels, and the introduction of resident training in optimization of the electronic medical record. After these changes were enacted, another electronic survey was distributed which additionally assessed satisfaction with the various interventions.

Results

Initial electronic survey data had a sample response of 44 demonstrated mean resident satisfaction in clinic at 2.56 on a 1 to 5 Likert scale. At the time of initial survey completion, 53% of residents said they were interested in pursuing primary care compared to 93% reporting they were interested in primary care before starting residency. The qualitative analysis of the small-group interviews included 44 participants and highlighted themes of faculty interactions, scheduling and logistics, and continuity with patients. In the follow-up survey, 22 responses demonstrated a mean resident satisfaction was 3.09 on the same Likert scale and 63% of residents were interested in pursuing primary care at the time of survey completion. On average, residents were satisfied with the multiple interventions but satisfaction levels varied per intervention.

Conclusion

Resident satisfaction with the clinic and interest in pursuing a career in primary care was increased after targeted interventions to improve the resident experience in the clinic. Next steps include additional interventions targeting themes elucidated in the small group interviews and investigating whether satisfaction in clinic impacts actual career choice at the time of graduation. 

References

Schwartz MD. Health care reform and the primary care workforce bottleneck. J Gen Intern Med. 2012;27(4):469–72. doi: 10.1007/s11606-011-1921-4. West CP, Dupras DM. General medicine vs. subspecialty career plans among internal medicine residents. JAMA : J Am Med Assoc. 2012;308(21):2241–2247. doi: 10.1001/jama.2012.47535. Peccoralo LA, Tackett S, Ward L, et al. Resident satisfaction with continuity clinic and career choice in general internal medicine. J Gen Intern Med. 2013;28(8):1020-1027. doi:10.1007/s11606-012-2280-5