September 7, 2001

More than one in ten medical residents say they feel unprepared to handle certain treatments and procedures relative to their specialties, despite years of solid training, according to an MGH study published this week in the Journal of the American Medical Association.

While residents in all eight specialties represented in the study felt prepared to handle most of the common conditions they would encounter in their clinical careers, a surprising one-tenth said they felt unprepared to deal with such tasks as the treatment of HIV/AIDS, substance abuse, nursing home patients, management of chronic pain, counseling patients about domestic violence and depression, and certain procedures, such as spinal or cancer-related surgery.

The study, from the MGH/Partners Institute for Health Policy, is the first comprehensive analysis of resident preparedness in more than a decade. The findings suggest that gaps exist in the preparedness of physicians to manage the full range of patients, procedures and problems they may encounter.

Residents reported a very positive view of their training to handle most common clinical problems, but they expressed concern regarding the adequacy of their training for dealing with nontraditional patient populations, such as patients with substance abuse problems or patients in settings like nursing homes.

"This survey tells us that residency programs may not be changing quickly enough to keep up with the reality of medical practice today. We may be seeing a residency-practice mismatch," says David Blumenthal, MD, MPP, lead study author and director of the MGH/Partners Institute for Health Policy. "Teaching hospitals and medical schools need to provide residents with quality training that reflects the diversity of the patients they will one day treat."

The study was conducted by Blumenthal, Manjusha Gokhale, Eric G. Campbell, PhD, and Joel S. Weissman, PhD, all of the MGH/Partners Institute for Health Policy.