0
May 18, 1994, Vol 271, No. 19 >
ARTICLE | May 18, 1994

Defining the Generalist Physician's Training FREE

Marc L. Rivo, MD, MPH; John W. Saultz, MD; Steven A. Wartman, MD, PhD; Thomas G. DeWitt, MD
[+] Author Affiliations

Reprint requests to Council on Graduate Medical Education, Parklawn Bldg, 5600 Fishers Lane, Room 9A27, Rockville, MD 20857 (Dr Rivo).


JAMA. 1994;271(19):1499-1504. doi:10.1001/jama.1994.03510430053034
Text Size: A A A
Published online
Article
References

Objective.  —To determine the extent to which various specialties prepare residents in the broad competencies required for primary care practice and to propose guidelines for improving generalist physician training.

Data Sources.  —Leading causes of morbidity and mortality, 1991 National Ambulatory Medical Care Survey data, expert reports, and the special requirements for residency training.

Design.  —From the data sources we identified the common presenting conditions and diagnoses that broadly trained generalist physicians could be expected to manage in primary care practice. We then compiled a list of 60 requisite residency training components grouped according to seven practice criteria for generalist physicians. Using the special requirements for residency training for family practice, internal medicine, pediatrics, obstetrics and gynecology, and emergency medicine, we determined the extent to which the requirements addressed the 60 components and continuity-of-care training.

Results.  —Almost all of the 60 generalist training components were required by family practice (95%), internal medicine (91%), and pediatrics (91%), compared with emergency medicine (42%) and obstetrics and gynecology (47%). Family practice, internal medicine, and pediatric residencies also require lengthy, well-defined continuity-of-care experiences.

Conclusion.  —Family practice, internal medicine, and pediatric programs prepare residents in the broad competencies necessary for primary care practice. To train competent generalist physicians, we recommend that residency programs require training in 90% or more of the 60 components, 50% or more of the components in each of the seven categories, and a continuity-of-care experience for a panel of patients during at least 10% of the entire residency training period.(JAMA. 1994;271:1499-1504)

REFERENCES

1 +
Mullan F, Rivo ML, Politzer RM.  Doctors, dollars and determination: making physician workforce policy work. Health Aff (Millwood) . 1993;;12 ( (suppl) ):138-151.
2 +
Kindig DA, Cultice JM, Mullan F.  The elusive generalist physician. JAMA . 1993;;270:1069-1073.
3 +
Cohen JJ.  Transforming the size and composition of the physician workforce to meet the demands of health care reform. N Engl J Med . 1993;; 329:3136-3139.
4 +
Starfield B, Simpson L.  Primary care as part of US health services reform. JAMA . 1993;;269:3136-3139.
5 +
Lundberg GD.  The American health care system and the 1992 election. JAMA . 1992;;268:2082.
6 +
Rivo ML, Satcher D.  Improving access to health care through physician workforce reform: directions for the 21st century: third report of the Council on Graduate Medical Education. JAMA . 1993;; 270:1074-1078.
7 +
 Association of American Medical Colleges. AAMC policy on the generalist physician. Acad Med . 1993;; 68:1-6.
8 +
Rivo ML, Jackson DM, Clare FL.  Comparing physician workforce reform recommendations. JAMA . 1993;;270:1083-1084.
9 +
Pruessner HT, Hensel WA, Rasco TL.  The scientific basis of generalist medicine. Acad Med . 1992;; 67:232-235.
10 +
Geyman JP.  Training primary care physicians for the 21st century. JAMA . 1986;;255:2631-2635.
11 +
Nutting P, Clancy CM, Franks P.  Gatekeeping revisited: protecting patients from overtreatment. N Engl J Med . 1992;;327:424-429.
12 +
Greenfield S, Nelson EC, Zubkoff M, et al.  Variations in resource utilization among medical specialties and systems of care: results from the Medical Outcomes Study. JAMA . 1992;;267:1624-1630.
13 +
Rosenblatt RA.  Specialists or generalists: on whom shall we base the American health care system? JAMA . 1992;;267:1665-1666.
14 +
Council on Graduate Medical Education. Fourth Report: Recommendations to Improve Access to Health Care Through Physician Workforce Reform . Rockville, Md: US Public Health Service, Health Resources and Services Administration, Bureau of Health Professions; 1993;.
15 +
Accreditation Council for Graduate Medical Education. Essentials and Information Items: 1993-1994 . Chicago, Ill: Accreditation Council for Graduate Medical Education; 1993;.
16 +
US Public Health Service. Healthy People 2000 . Washington, DC: US Dept of Health and Human Services; 1990;.
17 +
McGinnis JM, Foege WH.  Actual causes of death in the United States. JAMA . 1993;;270:2207-2212.
18 +
Schappert SM. National Ambulatory Medical Care Survey: 1991 Summary . Hyattsville, Md: National Center for Health Statistics; 1992;.
19 +
Alpert JJ, Chaney E. The Education of Physicians for Primary Care . Washington, DC: US Dept of Health, Education and Welfare, US Public Health Service, Health Resources and Services Adminstration; 1973;.
20 +
Institute of Medicine. A Manpower Policy for Primary Health Care . Washington, DC: National Academy of Sciences; 1978;.
21 +
ShugarsDA, O'NeilEH,Bader JD,eds. Healthy America: Practitioners for 2005 . San Francisco, Calif: Pew Health Professions Commission; 1991;.
22 +
Wartman SA, O'Sullivan PS, Cyr MG.  Ambulatory-based residency education: improving the congruence of teaching, learning, and patients care. Ann Intern Med . 1992;;116:1071-1075.
23 +
Sargent JR, Osborn LM, Roberts KB, DeWitt TG.  Establishment of primary care continuity experiences in community pediatricians' offices: nuts and bolts. Pediatrics . 1993;;91:1185-1189.
24 +
Rivo ML.  Internal medicine and the journey to medical generalism. Ann Intern Med . 1993;;119:146-152.
25 +
Dunn LJ.  Not to decide is to decide. Am J Obstet Gynecol . 1993;;168:1053-1062.
26 +
Anderson GV.  Where we've been, where we are, and where we're going: emergency medicine— past, present, and future. Ann Emerg Med . 1988;; 17:982-989.
27 +
Moore GT. The impact of managed care on the medical education environment: a report to the Council on Graduate Medical Education . Rockville, Md: US Public Health Service, Health Resources and Services Administration, Bureau of Health Professions; 1993;.
28 +
Group Health Association of America. Policy Paper on Primary Care Physicians: Recommendations to Reform Medical Education to Increase the Supply of Physicians Trained to Practice in Managed Care . Washington, DC: Group Health Association of America; 1993;.
29 +
Corrigan JM, Thompson LM.  Contractual arrangements between residency programs and HMOs. J Fam Pract . 1992;;35:543-547.
30 +
Lundberg GD, Lamm RD.  Solving our primary care crisis by retraining specialists to gain specific primary care competencies. JAMA . 1993;;270:380-381.
31 +
Group Health Association of America. The recruitment experience of HMOs for primary care physicians: report for the Health Resources and Services Administration . Rockville, Md: US Public Health Service; 1993;.
32 +
Cantor JC, Baker LC, Hughes RG.  Preparedness for practice: young physicians' views of their professional education. JAMA . 1993;;270:1035-1040.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Mullan F, Rivo ML, Politzer RM.  Doctors, dollars and determination: making physician workforce policy work. Health Aff (Millwood) . 1993;;12 ( (suppl) ):138-151.
2 +
Kindig DA, Cultice JM, Mullan F.  The elusive generalist physician. JAMA . 1993;;270:1069-1073.
3 +
Cohen JJ.  Transforming the size and composition of the physician workforce to meet the demands of health care reform. N Engl J Med . 1993;; 329:3136-3139.
4 +
Starfield B, Simpson L.  Primary care as part of US health services reform. JAMA . 1993;;269:3136-3139.
5 +
Lundberg GD.  The American health care system and the 1992 election. JAMA . 1992;;268:2082.
6 +
Rivo ML, Satcher D.  Improving access to health care through physician workforce reform: directions for the 21st century: third report of the Council on Graduate Medical Education. JAMA . 1993;; 270:1074-1078.
7 +
 Association of American Medical Colleges. AAMC policy on the generalist physician. Acad Med . 1993;; 68:1-6.
8 +
Rivo ML, Jackson DM, Clare FL.  Comparing physician workforce reform recommendations. JAMA . 1993;;270:1083-1084.
9 +
Pruessner HT, Hensel WA, Rasco TL.  The scientific basis of generalist medicine. Acad Med . 1992;; 67:232-235.
10 +
Geyman JP.  Training primary care physicians for the 21st century. JAMA . 1986;;255:2631-2635.
11 +
Nutting P, Clancy CM, Franks P.  Gatekeeping revisited: protecting patients from overtreatment. N Engl J Med . 1992;;327:424-429.
12 +
Greenfield S, Nelson EC, Zubkoff M, et al.  Variations in resource utilization among medical specialties and systems of care: results from the Medical Outcomes Study. JAMA . 1992;;267:1624-1630.
13 +
Rosenblatt RA.  Specialists or generalists: on whom shall we base the American health care system? JAMA . 1992;;267:1665-1666.
14 +
Council on Graduate Medical Education. Fourth Report: Recommendations to Improve Access to Health Care Through Physician Workforce Reform . Rockville, Md: US Public Health Service, Health Resources and Services Administration, Bureau of Health Professions; 1993;.
15 +
Accreditation Council for Graduate Medical Education. Essentials and Information Items: 1993-1994 . Chicago, Ill: Accreditation Council for Graduate Medical Education; 1993;.
16 +
US Public Health Service. Healthy People 2000 . Washington, DC: US Dept of Health and Human Services; 1990;.
17 +
McGinnis JM, Foege WH.  Actual causes of death in the United States. JAMA . 1993;;270:2207-2212.
18 +
Schappert SM. National Ambulatory Medical Care Survey: 1991 Summary . Hyattsville, Md: National Center for Health Statistics; 1992;.
19 +
Alpert JJ, Chaney E. The Education of Physicians for Primary Care . Washington, DC: US Dept of Health, Education and Welfare, US Public Health Service, Health Resources and Services Adminstration; 1973;.
20 +
Institute of Medicine. A Manpower Policy for Primary Health Care . Washington, DC: National Academy of Sciences; 1978;.
21 +
ShugarsDA, O'NeilEH,Bader JD,eds. Healthy America: Practitioners for 2005 . San Francisco, Calif: Pew Health Professions Commission; 1991;.
22 +
Wartman SA, O'Sullivan PS, Cyr MG.  Ambulatory-based residency education: improving the congruence of teaching, learning, and patients care. Ann Intern Med . 1992;;116:1071-1075.
23 +
Sargent JR, Osborn LM, Roberts KB, DeWitt TG.  Establishment of primary care continuity experiences in community pediatricians' offices: nuts and bolts. Pediatrics . 1993;;91:1185-1189.
24 +
Rivo ML.  Internal medicine and the journey to medical generalism. Ann Intern Med . 1993;;119:146-152.
25 +
Dunn LJ.  Not to decide is to decide. Am J Obstet Gynecol . 1993;;168:1053-1062.
26 +
Anderson GV.  Where we've been, where we are, and where we're going: emergency medicine— past, present, and future. Ann Emerg Med . 1988;; 17:982-989.
27 +
Moore GT. The impact of managed care on the medical education environment: a report to the Council on Graduate Medical Education . Rockville, Md: US Public Health Service, Health Resources and Services Administration, Bureau of Health Professions; 1993;.
28 +
Group Health Association of America. Policy Paper on Primary Care Physicians: Recommendations to Reform Medical Education to Increase the Supply of Physicians Trained to Practice in Managed Care . Washington, DC: Group Health Association of America; 1993;.
29 +
Corrigan JM, Thompson LM.  Contractual arrangements between residency programs and HMOs. J Fam Pract . 1992;;35:543-547.
30 +
Lundberg GD, Lamm RD.  Solving our primary care crisis by retraining specialists to gain specific primary care competencies. JAMA . 1993;;270:380-381.
31 +
Group Health Association of America. The recruitment experience of HMOs for primary care physicians: report for the Health Resources and Services Administration . Rockville, Md: US Public Health Service; 1993;.
32 +
Cantor JC, Baker LC, Hughes RG.  Preparedness for practice: young physicians' views of their professional education. JAMA . 1993;;270:1035-1040.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems