Resident education in free clinics: an internal medicine continuity clinic experience

Abstract

Background: Most internal medicine (IM) residency programs provide ambulatory training in academic medical centers. Community-based ambulatory training has been suggested to improve ambulatory and primary care education. Free clinics offer another potential training setting, but there have been few reports about the experience of IM residents in free clinics.

Objective: We assessed the feasibility and acceptability of inclusion of an ambulatory rotation in a free clinic and IM residency curriculum and the advantages of the free clinic setting over the traditional ambulatory clinic model.

Methods: In 2010, the University of Chicago Internal Medicine Residency Program partnered with a free clinic in order to establish a community-based continuity clinic experience. To assess the feasibility of this innovation, 16 residents were surveyed 9 months after implementation of the clinic to determine satisfaction, perceived preparation to address common medical conditions, and attitudes toward the underserved care population. A subset of these responses was compared to responses from residents in the traditional clinic model.

Results: Residents in the free clinic rotation were more satisfied and perceived they were more prepared to work in low-resource settings and reported similar levels of preparation regarding common outpatient conditions than residents in a traditional continuity clinic format. They reported increased future likelihood of working in an underserved clinic.

Conclusions: Our exploratory study suggests free clinics may be an effective platform for community-based continuity clinic training.

FIGURE 1

Residents' Self-Reports of Being Prepared to Treat Common Outpatient Conditions Percentages of CommunityHealth (CH) residents (n  =  15) and non-CH residents (n  =  78), respectively, who reported being prepared to treat diabetes (93% [14 of 15] vs. 92% [72 of 78]; P  =  .89), hyperlipidemia (93% [14 of 15] vs. 94% [73 of 78]), hypertension (93% [14 of 15] vs. 95% [74 of 78]; P  =  .81), depression (73% [11 of 15] vs. 67% [52 of 78]; P  =  .61), and vaginitis (67% [10 of 15] vs. 54% [42 of 78]; P  =  .36) were similar.