Abstract
The Association of Chiefs and Leaders of General Internal Medicine (ACLGIM), a group of division chiefs and other division leaders within the Society for General Internal Medicine (SGIM), convened the Hess Initiative Work Group on Learner Experience in Primary Care in 2023 to (1) identify the gaps between the current state of resident continuity clinic and current standards for a high-functioning primary care setting, (2) review the evidence to identify solutions, and (3) develop a set of evidence-based recommendations. These recommendations align with the current Accreditation Council for Graduate Medical Education (ACGME) IM milestones, with the goal to improve the experience of resident continuity clinic and meet the needs of the three key stakeholders of GME: residents, patients, and the healthcare system. We recruited experts in internal medicine ambulatory training from across the country, representing a variety of US regions, membership in professional societies and organizations related to internal medicine, community and academic settings, and residency program sizes during national and regional meetings at SGIM between 2023 and 2025. Using standard frameworks of high-functioning primary care practice, we performed an extensive review of the literature to identify discrepancies between these standards and resident continuity clinics, then, using the expertise of the group, produced a set of recommendations, which were reviewed and endorsed by the SGIM Council in September 2025.