The University of Missouri integrated residency: evaluating a 4-year curriculum

Several approaches to merging residency training and medical school education have been attempted over the past 20 years. This study describes and evaluates an integrated family medicine residency programa 4-year program that overlaps with the final year of medical school. We retrospectively analyzed multiple data sources, including In-Training Examination scores, patient visit profiles, resident demographics, and graduate surveys. Integrated residents (IRs) perform significantly better than traditional residents on In-Training Examinations at each year of residency training, with the difference in mean scores decreasing over time (67.8, 39.6, and 33.0 points better in the first, second, and third residency years). No evidence of increased patient continuity or panel size was noted. A higher proportion of IRs serve as chief residents, rate their residency experience as "excellent," and remain with the program through graduation. Practice characteristics immediately after residency do not significantly differ. Financial benefits are evident for the IRs as well as the hosting department. This integrated program offers several benefits for both the medical student and the residency program, and it is a potential model for academic residencies aiming to recruit and retain a higher percentage of their own schools' students.