Ágoston Kecskés

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January 10, 2012

Blog Entry #6: Changing habits of practice

            I found Bowen et al.’s article[1] on the transformation of internal medicine residency education in the ambulatory setting frustrating. Right at the outset, I felt that the authors had bitten off more than they – or anyone, really - could chew.

The authors open with the anecdotal observation that there’s a discrepancy between the total amounts of time that internists spend in the ambulatory setting and that internal medicine residents spend training in said setting. The authors cited data neither about the distribution of internists’ time by setting nor about that of residents’ time. I am not sure I doubt their claim per se but presumably the data is not difficult to acquire. In fact, the data could easily generate enough material to fuel a second publication. It’s conceivable that the data is not easy to acquire owing of the enormous variation in the way different residency training programs are structured across time and space. In fact, this is very likely true. Consequently, the authors’ claim seems more of a sweeping generalization than appropriate motivation for a publication.

The authors also claim that there are significant differences between inpatient and outpatient practices. The authors even go as far as to give examples of such differences despite that, again, the data to support their claims is lacking. At the very least, one would expect the authors to cite a few case examples. As before, one would expect the data to demonstrate quite a bit of variation across time and space, rendering the claim a sweeping generalization.

…to be continued…

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[1] Judith L. Bowen et al., “Changing habits of practice,” Journal of General Internal Medicine, http://onlinelibrary.wiley.com/doi/10.1111/j.1525-1497.2005.0248.x/abstract; accessed 9 January 2012.