A comparison of the methods and criteria used by traditional and primary care internal medicine programs to select residents

OBJECTIVE: To determine whether there are differences in the methods and criteria used by primary care and traditional internal medicine programs to select first-year residents. DESIGN: A questionnaire was sent to primary care and traditional internal medicine program directors, who were asked to rank in importance ten documents of an applicant’s file and to score the relative importance, on a scale of −5 to +5, of 21 candidate traits of four types: academic, demographic, personal, and career goal. SETTING: Programs at institutions (n=54) that have categorical residency programs in both traditional and primary care internal medicine. PARTICIPANTS: Of 108 questionnaires, the overall response rate was 81%, with 40 pairs (74%) of matched respondents. Seventy-two percent of the responding institutions were university- administered. RESULTS: Primary care and traditional programs use similar methods to process applicants, rank similarly ten documents in an applicant’s file, and value academic success during the clinical years as the most important candidate trait. Compared with traditional tracks, primary care tracks place greater emphasis on a candidate’s career goals and select for candidates planning to pursue primary care careers (3.9±1.4 vs 0.9±1.5, p<0.001), enter practice (1.4±1.5 vs 0.1±1.2, p<0.001), or serve medically indigent populations (2.7±1.5 vs 1.2±1.2, p<0.001). Primary care programs rate negatively candidates who intend to subspecialize, whereas traditional programs view them almost neutrally (−1.8±2.2 vs 0.5±1.5, p<0.001). CONCLUSION: Primary care and traditional track internal medicine programs use similar methods to select residents and both rank academic achievement during the clinical years as a candidate’s most important attribute. However, only primary care programs strongly select for candidates on the basis of their career plans and in particular prefer candidates who are committed to pursuing primary care careers and serving the medically indigent. Received from the Division of General Internal Medicine and Primary Care, Department of Medicine, University of California, Irvine, California. Presented in part at the annual meeting of the Society of General Internal Medicine, Washington, DC, April 29-May 1, 1992. Supported in part by a grant from the U.S. Public Health Service (2 D28 PE19154).