Combined Internal Medicine-Pediatrics Continuity Clinic
Background. We sought to examine the ambulatory experience in our medicine-pediatrics clinic.
Methods. Data on patient visits were abstracted from the hospital's clinic utilization summary and charge sheets. A survey assessed resident satisfaction.
Results. Residents saw 63% adult and 37% pediatric patients, with an average of 3.5 patients per clinic. There was no significant difference in the mean number of patients seen by residents when compared by postgraduate year. Half of all visits were coded for 2 or more diagnoses. Hypertension and diabetes were the most common adult diagnoses, and well-child care and asthma were the most common pediatric diagnoses. Residents were satisfied with the clinic.
Conclusions. The adult and pediatric patient visits were well balanced, with broad complexity. Residents rated their satisfaction with the clinic highly. Our experience may provide valuable information to programs that have a med-peds clinic or are considering creating one.

Residency training in combined internal medicine and pediatrics (med-peds) is emerging as an important source of primary care physicians. A survey of graduates of med-peds training programs found that 80% of recent med-peds graduates are practicing generalists who care for adults and children. Assuring that residents are adequately trained to practice in an ambulatory setting has become a priority in both internal medicine and pediatrics. One important source of experience in ambulatory training for residents is the weekly or in some instances twice weekly continuity of care clinic, where residents see patients with diagnoses similar to those they will see in practice after residency. Thus, it is vital that residents training in internal medicine, pediatrics, med-peds, and family practice have substantial and consistent training in ambulatory settings such as their continuity clinics. The Guidelines for Combined Training in Internal Medicine and Pediatrics state that whenever it is feasible, joint med-peds experiences should be encouraged. Forty-six percent of med-peds programs report that they have combined internal medicine/ pediatric continuity clinics (D. S. Miner, MD, Written Communication, November, 1999). This combined experience provides an opportunity for residents to care for families in one clinical setting, similar to how they will likely practice after residency, while working closely with other med-peds residents and faculty. Many studies have examined the content and quality of the ambulatory training in continuity clinics in internal medicine, pediatric, and family practice training programs. We believe this is the first systematic analysis of a combined internal medicine/pediatrics continuity clinic. We describe our experience with a recently created combined med-peds resident continuity clinic in a large university hospital setting, detailing specifically our patients' demographics, the relative percentage of adult and pediatric patients, the number of patients and complexity of cases seen by residents, and the residents' satisfaction with the experience.