Internal medicine residency programs aren't doing enough to teach quality treatment for diabetes, concluded a study, which doesn't bode well for doctors who will eventually care for one of the most common diseases in the United States.
Researchers at the American Board of Internal Medicine compared the quality of diabetes care provided in residency clinics with that of practicing physicians, using the Diabetes Practice Improvement Modules of the American Board of Internal Medicine (ABIM) as an assessment tool.
The research was done by staff at the American Board of Internal Medicine and appears in the January issue of Health Affairs.
Sixty-seven clinic sites from 37 residency programs completed baseline data collection for the Diabetes Practice Improvement Module from 2005 to 2010, and were compared to a geographically matched sample of 703 practicing general internists who completed the module in the same period.
Practicing physicians performed three of four process measures more frequently: retinal exam, foot exam, and addressing smoking cessation. (The fourth was urine testing). Patients of practicing physicians had better blood pressure and blood glucose control, but there was no difference in control of LDL cholesterol. Residency clinics received lower ratings on patient-experience measures (P values less than 0.001).
The residency clinics performed substantially lower on the composite measure (mean: 61.8) than did the practicing physicians (mean: 71.4) (P less than 0.001).
The authors wrote, "Our results clearly signal a problem: Residency clinics are not providing high-quality care for one of the most common chronic conditions in the United States."
Even practicing physicians have room for improvement, the authors noted from their results.
"Habits are formed during residency training," the authors wrote. "When residents work in clinics that deliver high-quality care, there is a greater likelihood that they will deliver high-quality care after completing their residencies. But the fact is that residents' ambulatory training does not often occur in high performance settings."