Internal Medicine Residents' Confidence and Preferences in Hospital Medicine Competencies: A Multi-Site Study.

Background: Hospital medicine (HM) is an important career option for internal medicine (IM) residency graduates. Limited data exist regarding preferences and educational gaps in HM competencies among IM residents.

Objective: To assess resident confidence and desire for additional instruction in HM competencies across a broad spectrum of residents.

Design: A multi-center survey-based assessment of IM resident confidence and desire for additional instruction in published HM competencies.

Participants: PGY-1 through PGY-4 residents from eight US IM residency programs, including academic medical center (AMC) and community-based programs (CBPs).

Main Measures: Resident confidence and desire for more teaching in HM competency domains including procedures, point-of-care ultrasound (POCUS), system-level competencies, clinical skills, patient-level competencies, palliative care, and care transitions.

Key Results: We received survey responses from 272 of 594 (46%) residents. More than half of respondents envisioned a future HM position. Results demonstrated lower than expected confidence for all HM competencies surveyed. Confidence was lowest (30-36% confident) for procedures, POCUS, and system-level competencies, and highest (65-78%) in care transitions, patient-level competencies, and palliative care. Desire for more instruction was highest in the same competency domains rated with the lowest confidence. Junior residents (PGY-1 and PGY-2) reported significantly lower confidence levels than senior residents (PGY-3 and PGY-4) across all domains except patient-level competencies. Junior residents expressed a significantly higher desire than senior residents for more teaching in all domains. There were no significant differences in confidence or desire for more instruction between trainees who envision a future HM position versus those who do not. Residents from AMCs expressed significantly higher confidence than those from CBPs in POCUS, clinical skill, patient-level, palliative care, and care transitions, while residents from CBPs reported significantly higher confidence in procedures.

Conclusions: Our data can inform targeted inpatient competencies and educational curricula for IM residents in the USA.