title: Differences in preventive health quality by residency year. Is seniority better?
abstract: 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.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Alabama, Birmingham, Alabama 35294-0012, USA. lwillett@uabmc.edu
authors.forename: Lisa L
authors.initials: LL
authors.lastname: Willett
authors.forename: Katri
authors.initials: K
authors.lastname: Palonen
authors.forename: Jeroan J
authors.initials: JJ
authors.lastname: Allison
authors.forename: Gustavo R
authors.initials: GR
authors.lastname: Heudebert
authors.forename: Catarina I
authors.initials: CI
authors.lastname: Kiefe
authors.forename: F Stanford
authors.initials: FS
authors.lastname: Massie
authors.forename: Terry C
authors.initials: TC
authors.lastname: Wall
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Houston
mesh_terms: 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