Residents' perceptions of the effects of a practice plan on their training.

Residents were surveyed about the characteristics and quality of their education before and twice after a new practice plan for faculty members was implemented at a county medical center. The residents assessed the impact of the practice plan on their training programs. Compared with the ratings before the plan began (1984), the responses one and two years (1985 and 1986) after institution of the plan were significantly more positive on three of nine characteristics: quality of staff, quality of supervision, and heterogeneity of patients. Contrary to concerns expressed by faculty members and residents prior to the plan, the 1985 and 1986 residents did not identify significant decline in the level of their patient care responsibility and opportunities for independent decision-making. One-third of the residents in 1985 and 1986, however, commented (usually negatively) about increased time required for attending rounds due to involvement of faculty members in ward care and documentation activities. These results suggest that changes in faculty organization to increase patient care reimbursement are not necessarily incompatible with maintaining and even improving graduate education.