title: Quantifying internal medicine resident clinical experience using resident-selected primary diagnosis codes.
abstract: BACKGROUND
  While experiential learning is a desirable goal of residency education, little is known regarding the actual clinical experience of internal medicine residents during their training.
  
  
  METHODS
  We modified an electronic patient handoff tool to include a system for resident entry of a primary diagnosis for each of their patients. Using the International Classification of Diseases, Ninth Revision (ICD-9) system, we created two methods to select the code: 1) an organ system-based dropdown list containing frequently used codes; and 2) a search option for the complete ICD-9 database. The codes were then grouped using ICD-9 categorization.
  
  
  RESULTS
  A total of 7562 resident-patient diagnostic encounters were studied. A wide spectrum of clinical conditions was observed, with symptoms and ill-defined conditions, circulatory disorders, respiratory disorders, neoplasms, genitourinary disorders, digestive disorders, diseases of the blood/blood forming organs, endocrinologic/nutritional/metabolic/immune disorders, and disorders of the skin and subcutaneous tissue accounting for about 86% of resident clinical experience. Symptoms and ill-defined conditions were noted to represent a sizable portion of resident clinical experience. Within this category, the most common conditions were fever; abdominal pain; and chest pain, unspecified.
  
  
  CONCLUSIONS
  Analysis of resident-selected ICD-9 codes might serve as a method to attempt to define resident clinical experience, and may be useful in the development of innovative experiential learning-based residency curricula. This might also be used to assess gaps in experiential learning at the program or resident level, and may serve to identify topics that require additional teaching supplementation.
authors.affiliation: Department of Medicine, Long Island Jewish Medical Center, North Shore-Long Island Jewish Health System, Great Neck, New York, USA. mattana@lij.edu
authors.forename: Joseph
authors.initials: J
authors.lastname: Mattana
authors.forename: Howard
authors.initials: H
authors.lastname: Kerpen
authors.forename: Clifton
authors.initials: C
authors.lastname: Lee
authors.forename: Alan
authors.initials: A
authors.lastname: Multz
authors.forename: Renee
authors.initials: R
authors.lastname: Pekmezaris
authors.forename: Barbara
authors.initials: B
authors.lastname: Napolitano
authors.forename: Rajni
authors.initials: R
authors.lastname: Walia
authors.forename: Harry
authors.initials: H
authors.lastname: Steinberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059019:Clinical Coding / Q000379:methods / Q000592:standards*; D002983:Clinical Competence / Q000592:standards*; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000379:methods / Q000592:standards*; D038801:International Classification of Diseases / Q000592:standards*; D007396:Internship and Residency / Q000379:methods / Q000592:standards*; D008297:Male; D008875:Middle Aged; D018794:Problem-Based Learning / Q000592:standards; D055815:Young Adult