title: Alternative approaches to ambulatory training: internal medicine residents' and program directors' perspectives.
abstract: BACKGROUND
  Internal medicine ambulatory training redesign, including recommendations to increase ambulatory training, is a focus of national discussion. Residents' and program directors' perceptions about ambulatory training models are unknown.
  
  
  OBJECTIVE
  To describe internal medicine residents' and program directors' perceptions regarding ambulatory training duration, alternative ambulatory training models, and factors important for ambulatory education.
  
  
  METHODS
  National cohort study.
  
  
  METHODS
  Internal medicine residents (N = 14,941) and program directors (N = 222) who completed the 2007 Internal Medicine In-Training Examination (IM-ITE) Residents Questionnaire or Program Directors Survey, representing 389 US residency programs.
  
  
  RESULTS
  A total of 58.4% of program directors and 43.7% of residents preferred one-third or more training time in outpatient settings. Resident preferences for one-third or more outpatient training increased with higher levels of training (48.3% PGY3), female sex (52.7%), primary care program enrollment (64.8%), and anticipated outpatient-focused career, such as geriatrics. Most program directors (77.3%) and residents (58.4%) preferred training models containing weekly clinic. Although residents and program directors reported problems with competing inpatient-outpatient responsibilities (74.9% and 88.1%, respectively) and felt that absence of conflict with inpatient responsibilities is important for good outpatient training (69.4% and 74.2%, respectively), only 41.6% of residents and 22.7% of program directors supported models eliminating ambulatory sessions during inpatient rotations.
  
  
  CONCLUSIONS
  Residents' and program directors' preferences for outpatient training differ from recommendations for increased ambulatory training. Discordance was observed between reported problems with conflicting inpatient-outpatient responsibilities and preferences for models maintaining longitudinal clinic during inpatient rotations. Further study regarding benefits and barriers of ambulatory redesign is needed.
authors.affiliation: Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Kris G
authors.initials: KG
authors.lastname: Thomas
authors.forename: Colin P
authors.initials: CP
authors.lastname: West
authors.forename: Carol
authors.initials: C
authors.lastname: Popkave
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Bellini
authors.forename: Steven E
authors.initials: SE
authors.lastname: Weinberger
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Kolars
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Kogan
mesh_terms: D000553:Ambulatory Care / Q000379:methods* / Q000592:standards; D000554:Ambulatory Care Facilities / Q000592:standards; D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D015331:Cohort Studies; D003625:Data Collection / Q000379:methods; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education* / Q000379:methods* / Q000639:trends; D007396:Internship and Residency / Q000379:methods* / Q000639:trends; D008297:Male; D008486:Physician Executives / Q000592:standards; D015397:Program Evaluation / Q000379:methods / Q000592:standards