Keywords: Primary-care, diagnoses, residency training, curriculum, medical education

Background:

Training programs are a key topic within the increasingly important field of medical education in residency. As such, they address the knowledge and skills required by young physicians, based on anticipation of the expected work ahead of them

Research questions:

To describe the topics in primary-care training as reflected in the certification test and compare them to the common diagnoses in primary-care encounters

Method:

Analysis of questions from prior primary-care formal certification tests classified by body systems, compared to common diagnoses recorded in primary-care encounters from Clalit Health Services in 2023

Results:

29,470,855 primary-care encounters were analyzed for visit characteristics, including children (7%), adults (61%), and elderly (32%). Top 600 Diagnoses were classified into chapters according to ICPC2. Excluding procedural diagnoses, “Musculoskeletal” was leading, “Respiratory” following and “Digestive” third. Zooming on top diagnoses, “back pain”, “upper respiratory tract infection”, “abdominal pain”, “trauma” and “sore throat” were the chief complaints.
The 150 questions from a formal certification test were analyzed and found to represent all ICPC2 chapters. “Musculoskeletal” was prominent (20,14.9%) with both “Cardiovascular” and “Respiratory” next (14,10.4%), then “General & unspecified” (13,9.7%), and “Skin” (11,8.2%). The least frequent was “Male genital system” (2,1.5%) and “Blood/immune” (3,2.2%).
The most evident diagnoses in the exam were “other musculoskeletal disease” (6,4.5%), “other metabolic, endocrine and nutritional” (4,3.0%), and “pneumonia”, “osteoporosis” and “Adverse effect medical agent” (3,2.2% each).
No questions regarding dental conditions were observed, and only one question addressed directly issues of geriatric medicine.

Conclusions:

While the leading body-systems match between diagnoses and the exam, some frequent diagnoses as dental complaints are under-represented while rare ones are over-represented, medical reasoning to be discussed. Additionally, while pediatrics is represented beyond its proportion, questions engaging distinctive geriatric matters are spars.

Points for discussion: