As highlighted in the September 2014 issue of JAMA Internal Medicine, a new study shows physicians trained in locations with less rigorous practice models may excel at consistently making clinical decisions that keep patients from unneeded medical care.
According to The Dartmouth Institute, study authors found—apart from overall medical knowledge—internal medicine exam takers who graduated from residency programs distinguished by lower intensity practice patterns recurrently fared better on the Appropriately Conservative Management exam subscale.
This same group of clinicians did just as well, and sometimes better, at identifying when aggressive management was indicated. It’s a finding that surprised the lead author—Brenda Sirovich of the Veterans Affairs Outcomes Group and The Dartmouth Institute for Health Policy & Clinical Practice—and her colleagues.
“Growing concern about the costs and harms of medical care has spurred interest in assessing physicians’ ability to avoid the provision of unnecessary care,” said Sirovich.
The objective of the research: to determine if residency training impacts physicians’ ability to make optimal management decisions, even when such decisions necessitate skipping expensive medical interventions for management approaches of less intensity
To reach a conclusion, as reported by The Dartmouth Institute, the authors established a measure based on questions from the American Board of Internal Medicine certifying exam.
The researchers found “conservative training environments may promote more thoughtful clinical decision making at both ends—conservative and aggressive—of the spectrum of appropriate practice.”
The gauge of healthcare intensity they used was physician visits among a similarly ill group of patients. Nonetheless, study authors conveyed the outcomes held for other intensity measures, as well.
“While healthcare certainly offers important benefits to many, a growing body of evidence points to serious problems of overuse and harm,” said Sirovich. “Reporting feedback to programs about residents’ performance on a prospectively designed, appropriately conservative management certifying examination subscale might help address the problem of overuse and promote attention to value in medical practice in the United States.”
