title: Resident satisfaction with continuity clinic and career choice in general internal medicine.
abstract: BACKGROUND
  The quality of the continuity clinic experience for internal medicine (IM) residents may influence their choice to enter general internal medicine (GIM), yet few data exist to support this hypothesis.
  
  
  OBJECTIVE
  To assess the relationship between IM residents' satisfaction with continuity clinic and interest in GIM careers.
  
  
  METHODS
  Cross-sectional survey assessing satisfaction with elements of continuity clinic and residents' likelihood of career choice in GIM.
  
  
  METHODS
  IM residents at three urban medical centers.
  
  
  METHODS
  Bivariate and multivariate associations between satisfaction with 32 elements of outpatient clinic in 6 domains (clinical preceptors, educational environment, ancillary staff, time management, administrative, personal experience) and likelihood of considering a GIM career.
  
  
  RESULTS
  Of the 225 (90 %) residents who completed surveys, 48 % planned to enter GIM before beginning their continuity clinic, whereas only 38 % did as a result of continuity clinic. Comparing residents' likelihood to enter GIM as a result of clinic to likelihood to enter a career in GIM before clinic showed that 59 % of residents had no difference in likelihood, 28 % reported a lower likelihood as a result of clinic, and 11 % reported higher likelihood as a result of clinic. Most residents were very satisfied or satisfied with all clinic elements. Significantly more residents (p ≤ 0.002) were likely vs. unlikely to enter GIM if they were very satisfied with faculty mentorship (76 % vs. 53 %), time for appointments (28 % vs. 11 %), number of patients seen (33 % vs. 15 %), personal reward from work (51 % vs. 23 %), relationship with patients (64 % vs. 42 %), and continuity with patients (57 % vs. 33 %). In the multivariate analysis, being likely to enter GIM before clinic (OR 29.0, 95 % CI 24.0-34.8) and being very satisfied with the continuity of relationships with patients (OR 4.08, 95 % CI 2.50-6.64) were the strongest independent predictors of likelihood to enter GIM as a result of clinic.
  
  
  CONCLUSIONS
  Resident satisfaction with most aspects of continuity clinic was high; yet, continuity clinic had an overall negative influence on residents' attitudes toward GIM careers. Targeting resources toward improving ambulatory patient continuity, workflow efficiency and increasing pre-residency interest in primary care may help build the primary care workforce.
authors.affiliation: Division of General Internal Medicine, Samuel M. Bronfman Department of Internal Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1087, New York, NY 10029, USA. Lauren.peccoralo@mountsinai.org
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Peccoralo
authors.forename: Sean
authors.initials: S
authors.lastname: Tackett
authors.forename: Lawrence
authors.initials: L
authors.lastname: Ward
authors.forename: Alex
authors.initials: A
authors.lastname: Federman
authors.forename: Ira
authors.initials: I
authors.lastname: Helenius
authors.forename: Colleen
authors.initials: C
authors.lastname: Christmas
authors.forename: David C
authors.initials: DC
authors.lastname: Thomas
mesh_terms: D001291:Attitude of Health Personnel; D002321:Career Choice; D003266:Continuity of Patient Care / Q000639:trends; D003430:Cross-Sectional Studies / Q000379:methods; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000379:methods* / Q000639:trends; D007396:Internship and Residency / Q000379:methods* / Q000639:trends; D007588:Job Satisfaction; D008297:Male; D010044:Outpatient Clinics, Hospital / Q000639:trends