Training and Performance Differences in US Internal Medicine Residents Trained in Community- and University-Based Programs – a Systematic Review

Introduction:Residents’ learning and performance depends on program structures, clinical setting and faculty mentors; however,performance differences between and community based vs. university based residents have not been exploredsystematically.Objectives:To systematically review the performance differences between internal medicine residents trained in community-basedprograms [CBPs] versus university-based programs [UBPs] in the US.Methods:Eligible studies were identified in Medline and Embase databases from 1990- June 2018. Eligible studies comparedlearning and performance differences between UBP and CBP internal medicine residency programs aligned withACGME recommendations.Results:Out of 4916 titles, 14 cross-sectional studies were included in the analysis. Diverse reporting among the includedstudies precluded meta-analysis. Significant differences were found in specific practice areas, such as knowledge aboutHIV, nutrition training, and program accreditation cycle. Residents in UBPs participated more often in hypothesisdriven research and had higher publication rates than residents in CBPs. Residents trained in CBPs experienced moreburnt out than those in UBPs and had higher prevalence of residents with problematic behaviors and deficiencies.Nonsignificant differences were found among residents regarding ABIM pass rate, medical procedures, and publichealth training.Conclusion:Our review reports inconsistent trends in residents’ learning and performances following RRC- IM and ACGMErecommendations. Significant differences were noted in areas that required more practice and system based learning,non-procedural skills and patient care. Future studies with larger sample sizes and adjusted analyses are needed toevaluate the difference between residents’ performance and learning in UBPs versus CBPs.