Acad Med. 1994 Jan; 69(1): 48-54.

Orientation of medical residents to the psychosocial aspects of primary care: influence of training program.

Eisenthal S, Stoeckle JD, Ehrlich CM.

Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston.

PURPOSE. To describe the attitudes of residents in general medicine to the psychosocial dimensions of primary care and to evaluate the influences of selected variables. METHOD. A cross-sectional analysis-of-variance design (two training programs involving residents in all three residency years) was used in the analysis of 21 psychosocial attitude items from a survey questionnaire completed by general medicine residents. In 1991-92, 77 general medicine residents in ambulatory care group practices associated with the Massachusetts General Hospital were surveyed. Eighteen of the residents were in a primary care program (PCP), and 59 were in a traditional medicine program (TMP). RESULTS. The overall response rate was 82% (63 of 77 residents), with slightly lower rates for four items. The residents' attitudes to the psychosocial role of the primary care physician were positive but with reservations: 55 (87%) endorsed asking psychosocial questions, while only 28 (44%) indicated that most internists felt competent to diagnose and treat. Most residents did not feel defensive about enacting the role (neither uncomfortable asking questions in ambulatory care settings, 58, 92%; nor nosey, 56, 89%; nor personally interfering, 47, 76%). Fifty-two residents (83%) perceived patients to be receptive to psychosocial questions, yet 31 (49%) indicated that patients were resistant to psychosocial attributions, and 48 (76%) indicated that patients need to be prompted to talk about life problems. The clearest and strongest influence on attitudes was setting: ambulatory care over inpatient (p < .0001). Overall, the responses of the residents from the PCP and TMP were more similar than different. CONCLUSION. The residents accepted the psychosocial role of the primary care physician, found it most appropriate in ambulatory care settings, felt ambivalent about their ability to carry it out, and assigned it a secondary priority in patient care. To interest residents in primary care, more training should be based in ambulatory care settings and more emphasis should be placed on improving residents' competency in psychosocial skills.