Preparedness for practice. Young physicians' views of their professional education

Objective. —To describe the views of young physicians (younger than age 45 years) regarding the appropriateness of specific aspects of medical training that have often been criticized as inadequate. Design. —Proportional analysis of survey data, stratified by medical school type and graduate medical education specialty and adjusted for demographics. Setting. —National sample of 4756 allopathic and osteopathic physicians trained in allopathic residencies representing a variety of practice settings. Dependent Variables. —Overall satisfaction with medical training, including medical school through residency and fellowship; satisfaction with preparedness for five aspects of practice and six types of patients; and satisfaction with the amount of time spent in each of six training settings. Results. —Eighty percent of young physicians reported that their formal medical training did an excellent or good job of preparing them for medical practice. Much smaller proportions (21% to 78%) reported excellent or good preparation to treat specific conditions or types of patients, and few (3%) reported being well prepared to manage business aspects of practice. Large proportions (35% to 63%) would prefer to have received more training in settings outside of hospitals, including managed care settings (67%). Significant differences in preparedness were observed by type of training; those trained in general and family practice reported better preparedness along many dimensions than did those trained in general internal medicine. Conclusions. —Young physicians generally confirm critiques of medical training noted by scholars and commissions. Health care reform is likely to increase the urgency for remedial action. (JAMA. 1993;270:1035-1040)