• Kelly L Graham, And Rebecca Glassman, Roger B Davis, Mariam Ayub, Howard Libman, and Eileen Reynolds.
• Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA. kgraham@bidmc.harvard.edu.
• J Gen Intern Med. 2022 Aug 1; 37 (11): 263426412634-2641.

BackgroundResidents planning careers in primary care have unique training needs that are not addressed in traditional internal medicine training programs, where there is a focus on inpatient training. There are no evidence-based approaches for primary care training.ObjectivesDesign and test the effect of a novel immersive primary care training program on educational and clinical outcomes.DesignNested intervention study.Setting, ParticipantsTwelve primary care residents, 86 of their categorical peers, and an 11-year historical cohort of 69 primary care trainees in a large urban internal medicine residency training program.InterventionsTwo 6-month blocks of primary care immersion alternating with two 6-month blocks of standard residency training during the second and third post-graduate years.Main MeasuresTotal amount of ambulatory and inpatient training time, subjective and objective educational outcomes, clinical performance on cancer screening, and chronic disease management outcomes.Key ResultsParticipants in the intervention increased ambulatory training in both general medicine and specialty medicine and still met all ACGME training requirements. Residents reported improved subjective educational outcomes on a variety of chronic disease management topics and ambulatory care skills. They reported higher satisfaction with the amount of ambulatory training (4.3/5 vs. 3.6/5, p=0.008), attended more ambulatory clinics (242 vs. 154, p<0.001), and carried larger, more complicated panels (173 vs. 90 patients, p<0.001). They also performed better on diabetes management (86% vs. 76% control, p<0.001). Alumni who completed the intervention reported higher primary care career preparation (79% response rate) than those who did not (85% response rate) among an 11-year cohort of primary care alumni (4/5 vs. 3/5, p<0.001).ConclusionsA primary care training program that provides clinical immersion in the ambulatory setting improved educational outcomes for trainees and clinical outcomes for their patients. Providing more training in the ambulatory environment should be a priority in graduate medical education.© 2021. Society of General Internal Medicine.

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