RESIDENTS AS TEACHERS. R.W. Janicik 1 , M.D. Schwartz 1 , A. Kalet 1 , S. Zabar 1 ; 1 New York University School of Medicine, New York, New York PURPOSE: We sought to measure residents' attitudes, preparation, and confidence about teaching and how these relate to their plans to teach. METHODS: We conducted an anonymous, cross-sectional survey of Medicine and Psychiatry residents at NYU. The questionnaire assessed attitudes and preparedness to teach, selfperceived teaching knowledge and skills, and plans to teach. RESULTS: Sixty-one residents (42 Psychiatry, 19 Internal Medicine) completed the questionnaire (79% response). Factor analysis confirmed scales for measuring residents' attitudes (Teaching Enthusiasm, Important Role in Department), preparedness to teach (Teaching Exposure, Teaching Capability) and self-perceived teaching knowledge and skills (Clinical Reasoning, Patient Management, and Procedural Skills) . Scales were dichotomized to present the % of residents with high scores: Teaching Enthusiasm -67% agree; Important Role in Department -34% agree; Teaching Exposure -only 7% reported high amount; Teaching Capability -23% high confidence; Knowledge of Clinical Reasoning -30% confident; Patient Management -49% confident; and Procedural Skills -21% confident. When asked the frequency with which they plan to teach, 75% planned to directly observe learners, 71% planned to give feedback, and 74% planned to teach with the patient present, all at least once per week. Plans to teach was not associated with resident age, gender, year of training, or department. Nearly significant trends suggested that residents with high teaching enthusiasm were more likely to plan to observe their learners and those with high prior teaching exposure were more likely to plan to give feedback. Teaching capability and all 3 knowledge variables were correlated with plans to teach with the patient present (p < .05). CONCLUSION: Residents value and look forward to their teaching roles despite having little preparation for teaching, and only modest confidence in their ability and knowledge to teach. Resident attitudes and self-perceived capabilities influenced their plans to teach. Programs to prepare residents as teachers that address attitudes, skills, and knowledge in these areas may lead to more teaching by residents. were general internists, 24% family practitioners and 5%``other medical specialties.'' Forty percent of respondents received some form of spirituality training. Twenty-nine percent received this training while medical students compared to 18% as residents or as fellows and 23% as attending physicians. The training received in medical school was largely in the form of small group lecture series, but during residency and fellowship, the training consisted of informal clinic discussions. Attendings primarily received training through self-education (books and journals). Forty-two percent of respondents agreed that they would desire further spirituality training while 20% disagreed, and 38% were neutral. The physicians scoring highest (greater than 4 out of a possible 6 on the Spiritual Well-Being Scale) were more likely to desire further training. In addition, those physicians who attended worship service (48%) and those who agree to the statement``faith alone could cure disease'' (60%) were more likely to desire further training (all p-values < .05). Also family physicians had a greater tendency to desire further training compared to general internists. CONCLUSION: Formal spirituality training related to medical care is sparse in medical school and almost non-existent thereafter. Although physicians with stronger religious predilections desire formal training, nearly half of all primary care physicians who returned the survey felt that further training in spirituality and medicine was desirable. A curriculum concerning patient spirituality and medicine at the medical school and residency level appears to be warranted. PURPOSE: Chart audits are used to assess physician performance and quality of care. Typically, records are reviewed for practicing physicians. Only recently have resident report cards been described. The purpose of this study was to compare performances of interns, senior residents, and faculty on adherence to national guidelines regarding prevention and management of common outpatient medical conditions. METHODS: The study was conducted at the outpatient practices of a university based internal medicine training program. For interns (n = 50), rosters of all new general medicine patients with 2 or more visits between July 1999 and April 2000 were generated. For senior residents (n = 39) and faculty (n = 30), the time frame extended from July 1998 to April 2000. A random sample of 9 patients per physician was identified. All visits with the designated provider through June 2000 were abstracted by nurse abstractors using a 115 item form. 91% (n= 965) of targeted charts were abstracted: 366 for interns, 349 for senior residents and 246 for faculty. Performance scores (the percent of indicated actions taken) were determined for each chart in the areas of cancer screening, immunizations, counseling, management of diabetes (DM), hypertension (HTN), asthma, coronary disease (CAD), and depression. Differences in intern, resident and faculty performance were assessed with ANCOVA and correlations. RESULTS: The mean patient age was 52.9 (sd=17.6); 68% were women. Patients had a mean of 0.77 comorbidities and 4.1 visits with the provider. These factors were covariates in the ANCOVA due to group differences. Faculty performed better than interns and senior residents overall (p = .03) and in the areas of counseling (p = .0007), immunizations (p = .003) and HTN (p = .002). Unadjusted mean performance scores for interns, senior residents and faculty were as follows: overall (46%,49%,52%), counseling (26%,27%,37%), immunizations (36%,37%,43%), and HTN (44%,50%,57%). There were no differences between intern, resident and faculty performance in the other areas. Mean performances were: cancer screening (66%), management of DM (48%), asthma (56%), CAD (67%), and depression (41%). Higher performance scores were associated with more visits (r = .19, p=.0001), fewer comorbidities (r = À.08, p = .02) and younger age (r = À.12, p = .0002). CONCLUSION: On only a few domains did performance improve with experience. In those domains, there was steady improvement through training. Average performance rates fell short of national guidelines for all groups, though some actions were likely not documented. Future efforts should explore how to improve adherence in training programs, including among the teaching faculty.