Differences in preventive health quality by residency year. Is seniority better?
BACKGROUND
It is assumed that the performance of more senior residents is superior to that of interns, but this has not been assessed objectively.


OBJECTIVE
To determine whether adherence to national guidelines for outpatient preventive health services differs by year of residency training.


METHODS
Cross-sectional study.


METHODS
One hundred twenty Internal Medicine residents, postgraduate year (PGY)- 1 and PGY -2, attending a University Internal Medicine teaching clinic between June 2000 and May 2003.


METHODS
We studied 6 preventive health care services offered or received by patients by abstracting data from 1,017 patient records. We examined the differences in performance between PGY-1 and PGY-2 residents.


RESULTS
Postgraduate year-2 residents did not statistically outperform PGY-1 residents on any measure. The overall proportion of patients receiving appropriate preventive health services for pneumococcal vaccination, advising tobacco cessation, breast and colon cancer screening, and lipid screening was similar across levels of training. PGY-1s outperformed PGY-2s for tobacco use screening (58%, 51%, P = .03). These results were consistent after accounting for clustering of patients within provider and adjusting for patient age, gender, race and insurance, resident gender, and number of visits during the measurement year.


CONCLUSIONS
Overall, patients cared for by PGY-2 residents did not receive more outpatient preventive health services than those cared for by PGY-1 residents. Efforts should be made to ensure quality patient care in the outpatient setting for all levels of training.
Willett
Lisa L
LL
Division of General Internal Medicine, Department of Medicine, University of Alabama, Birmingham, Alabama 35294-0012, USA. lwillett@uabmc.edu
Palonen
Katri
K
Allison
Jeroan J
JJ
Heudebert
Gustavo R
GR
Kiefe
Catarina I
CI
Massie
F Stanford
FS
Wall
Terry C
TC
Houston
Thomas K
TK
D000328:Adult; D015179:Colorectal Neoplasms / Q000517:prevention & control; D003376:Counseling / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D010372:Pediatrics / Q000193:education; D011315:Preventive Medicine; D011787:Quality of Health Care; D014481:United States