Characteristics of Highly Rated Internal Medicine Attendings Before and After the 2004 Work-Hour Restrictions

Objectives: To describe the characteristics of top-rated Internal Medicine attendings and whether they changed after implementation of the 2004 work-hour restrictions. Methods: Mixed methods study of resident ratings of medicine attendings (Period 1: 1994-1996, n = 250 and Period 2: 2007-2009, n = 152). Residents evaluated 17 attending characteristics. The top 25% of "overall" ratings were classified as "highly rated." Two free-text questions included "What was your attending's best characteristic?" and "How could your attending best improve?" and were coded in duplicate, using grounded qualitative methods. Results: There were no differences in the characteristics of highly rated attendings in the two time periods. Characteristics associated with being a top-rated attending included enthusiasm (odds ratio [OR]: 5.69, 2.78-11.67), balanced teaching style (OR: 3.63, 1.64-8.02), promoting independent thinking (OR: 2.90, 0.96-8.74), fund of knowledge (OR: 2.73, 1.13-6.58), and time management (OR: 1.78, 1.14-2.80). Among the 1,410 utterances, valued attending attributes included helpfulness, promoting independent thinking, and having strong medical knowledge. Conclusions: The characteristics valued by residents in attendings did not change over time despite a major structural change in work hours and patterns of teaching. These valued characteristics continue to be a strong general fund of knowledge, enthusiasm for teaching, and balance between didactic and bedside approaches.