Hospitals in pursuit of excellence

What Kind of Physician Will You Be? Variation in Health Care and Its Importance for Residency Training

This report is part of a new effort to provide medical students with information about the patterns of care provided by teaching hospitals with residency training programs. Most fourth-year medical students consider the reputation and training curriculum of the institution, as well as their own geographical and lifestyle preferences when choosing a residency program. This report offers medical students new ideas and information to help guide their choice. It shines a light on hospital characteristics that are often invisible but are part of the hidden training curriculum that can affect a lifetime of practice. These include how aggressively physicians at each hospital treat chronically ill patients at the end of life, and the frequency with which patients undergo surgery when other treatment options are available. The authors of this report (who are physicians in training) believe that the wise use of health care resources and respect for patient preferences are just as important as learning to work up a patient.

Understanding these patterns of care is particularly important for tomorrow's doctors in order to practice successfully in the new environment created by health care reform. The nation can no longer afford unrestricted growth in health care costs and health care systems that provide low quality and inefficient care. Teaching hospitals vary widely in their performance, and medical students should consider the advantages of training in hospitals that already deliver high-value health care. At the very least, they should be aware of the practice styles of residency programs they are considering ranking highly in the residency match.