Subspecialty training in the ambulatory clinic: a preliminary investigation of an endocrinology curriculum.

PURPOSE: There is scant literature on education in the ambulatory subspecialty clinic. This preliminary study was conducted to investigate subspecialty education, using endocrinology as a model.

METHOD: In 2002, a questionnaire was mailed to 90 former University of Virginia internal medicine (IM) residents who completed training between 1998 and 2001. The questionnaire asked how well residency prepared them to take care of patients with various endocrine disorders, and to state the best and worst parts of their endocrine training. In 2001-02, 11 fourth-year medical students and 26 senior IM residents rotating on the endocrinology service were asked to record their patient encounters in logbooks. This information was compared to the perceived strengths and weaknesses of endocrine training.

RESULTS

Sixty-one residents (68%) completed questionnaires. Significant differences were found in perceived preparedness to care for patients with various endocrine disorders, with diabetes, hypothyroidism, and osteoporosis as strengths and reproductive disorders representing a significant weakness. Fifteen residents (58%) and ten students (91%) completed logs. The logbooks revealed that current learners were well exposed to patients with diabetes and thyroid disorders during the block rotation, but saw relatively few patients with other endocrine disorders.

CONCLUSION

Former IM residents felt well prepared by residency to manage certain common endocrine problems, but felt significantly less prepared for other problems, most notably reproductive disorders. University of Virginia's curriculum was modified using information from this study to improve the educational experience in endocrinology. More studies are needed to define optimal strategies for teaching and learning in the subspecialty clinic.