Characterizing the Prevalence and Types of Curricular Tracks in Internal Medicine Residency Training Programs (2024)

Associated Data

Data Availability Statement

INTRODUCTION

Internal Medicine (IM) residency programs have traditionally provided similar, generalized training for all residents. However, in recent decades, specialized training “tracks” have emerged within IM residencies. In response to national shortages and supported by funding from the Health Resources and Services Administration’s Primary Care Training and Enhancement: Residency Training in Primary Care Programs, primary care tracks (PCTs) were introduced in the 1970s to attract skilled primary care physicians.^{1, 2} In the 1990s, the field of “hospital medicine” was established, catalyzing the development of hospitalist tracks.³ Research tracks, clinician-educator tracks, and others soon followed.^{4, 5} Though PCTs have been characterized in the literature,⁶ a recent report on all available tracks is lacking. We investigated the prevalence and types of curricular tracks offered across all US Accreditation Council for Graduate Medical Education (ACGME)–accredited IM residency programs. Our goal was to better inform current and future discussions on iterative changes to residency curricula.

METHODS

We compiled a list of all US ACGME-accredited IM programs from the ACGME website (n = 539). From December 2019 to June 2020, we used a data abstraction tool to review each program for track offerings in two publicly available sources: (1) American Medical Association’s Fellowship and Residency Electronic Interactive Database Access System (FREIDA^TM), and (2) residency program websites. Understanding the potential for outdated information, we included all reported tracks from either source and did not directly contact programs for data clarification. In FREIDA^TM, we used the program search feature to identify IM programs with primary care, hospitalist, women’s health, and rural health tracks; we reviewed each program’s individual FREIDA^TM webpage for presence of research and “other” tracks. In program website reviews, we considered any listed “pathway,” “track,” “area of distinction,” or focused program offered within the residency to be a track. We collectively reviewed 10 program websites to revise our data abstraction tool and train reviewers. Three investigators (E.H., J.C., E.R.) independently reviewed the remaining programs, with regular adjudication sessions to reconcile challenges.

RESULTS

Of the 539 US IM residency programs, 529 (98%) had program websites for review, 435 (81%) had track information included on FREIDA^TM, 431 (80%) had information in both sources, and 6 (1%) had no data available for review. Of the 533 reviewed programs, 258 (48%) reported no tracks, 99 (19%) had 1 track, 85 (16%) had 2 tracks, 79 (15%) had 3–5 tracks, and 12 (2%) had 6 or more tracks. The most prevalent track types were primary care (n = 228, 43%), hospitalist (n = 115, 22%), and research (n = 82, 15%) (Table ​(Table1).1). Of programs with ≥ 1 track, 83% included a PCT, and 64% offered multiple track types. There was notable discordance between the data identified from program websites and FREIDA^TM (Fig. ​(Fig.1).1). Out of the 654 total distinct tracks identified, 192 (29%) were reported on both FREIDA^TM and program websites, 294 (45%) were reported only on FREIDA^TM, and 168 (26%) were reported only on program websites.

DISCUSSION

Our findings highlight the individualization of US IM residency training, as greater than 50% of programs offered at least one track, and 21 different track types were reported. Most programs offering track(s) included one in primary care, suggesting that, with the Health Resources and Services Administration’s support, many IM residency programs are striving to fill primary care needs. Programs with any track were likely to have two or more tracks, which may reflect the start-up resources and experience necessary to create specialized curricular opportunities. Potential drivers for track development include diverse workforce needs, learner attraction, and funding support. Tracks may better prepare residents for their specific career goals, encourage trainees to fill workforce gaps, and attract residency and faculty candidates with particular areas of interest and expertise. The significant discrepancies in track reporting between the two sources present a challenge and highlight a limitation. Inaccurate or outdated material could not be reconciled without directly contacting each program. This presents an obstacle to student, resident, and faculty consumers of these resources as they explore training opportunities offered by residency programs. Despite its limitations, this study characterizes an evolving trend in US IM residency programs to further individualize training and prepare residents to meet the increasingly complex needs of patients and health systems.

Acknowledgments

The authors would like to thank the resident and faculty physicians in the Department of Medicine at the Penn State College of Medicine for their dedication to patient care and education.

Authors’ Contributions

Concept and design: Cooper, Gonzalo, Hempel

Acquisition, analysis, or interpretation of data: Cooper, Gonzalo, Hempel, Raoof

Drafting of the manuscript: Cooper, Gonzalo, Hempel, Raoof

Critical revision of the manuscript for important intellectual content: Cooper, Gonzalo, Hempel, Raoof

Data Availability

The dataset is available upon request.

Compliance with Ethical Standards

Footnotes

References