Changes in the educational value of inpatients at a major teaching hospital: implications for medical education.

Authors of recent studies have expressed concern about the adequacy of training for internal medicine housestaff, because a number of economic factors may be affecting the case mix on inpatient services. Major alterations in training programs have been recommended, including more training in ambulatory settings and minimizing house staff responsibility for procedure-oriented admissions. Almost no data have been collected regarding actual case-mix changes. In 1987, the author asked the faculty members of the Department of Medicine at the University of Florida College of Medicine to assess the educational value of two groups of patients admitted to the same hospital 15 years apart, one group in 1971 and the other in 1986; the faculty members were not told the difference in dates or the study hypothesis. They found the group of patients from 1971 to have significantly greater educational value than the group from 1986. There were no differences in the estimations of "sickness" of the two groups of patients. These findings support the hypothesis that changes in patient populations resulting from recent economic changes may have diminished the educational value of medical inpatients in academic settings.