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Abstract: A goal of internal medicine training programs is to provide trainees with supervised clinical experiences in preparation for their future professional careers. Previous work has identified varied patient presentations relevant to general internal medicine practice in the United States that are underrepresented in traditional internal medicine training settings. The current study was designed to test the hypothesis that a general medicine urgent care clinic experience would provide exposure to relevant clinical problems not seen in other training experiences. Discharge diagnoses based on ICD-9 codes were identified for a 12-month period for all patients seen in an internal medicine primary care clinic, inpatient medicine service, and urgent care center operated by the Division of General Internal Medicine in a university-affiliated county hospital. The data were compared to the top 20 diagnoses made by internists in practice as reported in the 1993 National Ambulatory Medical Care Survey (NAMCS).
Diagnoses of acute upper respiratory infection, chronic sinusitis, osteoarthritis, bronchitis, otitis media, disorders of soft tissues, gastritis and duodenitis, and acute pharyngitis as well as general symptoms were underrepresented in the primary care clinic compared with NAMCS data. The inpatient ward experiences supplemented the clinic experience by including a significant number of patients with bronchitis, and the emergency department provided experience with general symptoms and disorders of soft tissues. The urgent care clinic provided substantial numbers of patients with NAMCS-relevant diagnoses of upper respiratory infection, bronchitis, chronic sinusitis, otitis media, disorders of soft tissues and acute pharyngitis. Additionally, urgent care provided training experience in joint pain, breast lumps and minor surgical procedures not encountered in the primary care clinic. An urgent care clinic provides potentially valuable exposure to diagnoses relevant to general internal medicine practice that are not represented in other components of the general medicine training experience.
During the last several years, interest in residency curriculum reform has increased in the United States. Profound changes are occurring in internal medicine training programs across the country. [1-5] These changes are driven in part by the increased ambulatory-based patient care provided by the primary care general internist, with decreasing inpatient and subspecialty utilization. [1,4-9] The adequacy of traditional internal medicine training settings, particularly in U.S. academic medical centers, has been challenged in the context of education for the general internist. Various models have been proposed for education in the ambulatory setting while meeting prospectively defined educational objectives. However, despite this need, consensus on neither optimal teaching experiences nor the benchmarks of success is available.
Previous investigations have attempted both to survey attitudes and assess the adequacy of residency training in preparation for office-based internal medicine practice. [5,10] A survey from a residency training program suggests an underemphasis of certaintraditionally non-internal medicine areas.  The principal disorders seen by practicing general internists (as coded under the International Classification of Diseases, 9th Revision [ICD-9]) account for 90% of those seen in a training program's general medicine primary care clinic.  However, this same study also identified several disorders seen by the general internist in practice that were not represented in the residency primary care clinic experience. 
The present report is one of the few attempts to specifically describe the clinical material present in teaching venues, and to assess their …