To our knowledge, this study is novel in reporting the change in
diabetic quality measures according to the level of experience of
internal medicine trainees in an academic medical centre.
Strengths of the study include use of integrated electronic health
records that increase accuracy of abstraction and the large sample
size, including a high proportion of African-American patients who
are particularly vulnerable to type 2 diabetes. Limitations of the
study include the observational, nonrandomized design and the
source of data being only from 1 division of 1 academic medical
centre. Thus, it is possible that results may not generalize to other
patient populations. As another study limitation, we did not keep
track of the same resident over 3 years, and it is possible that cohort
differences may have influenced results. Last, given that the electronic
health record was implemented a few months before some
visits, lack of electronic health record expertise may have impacted
documentation of quality metrics, which could impact the overall
level of documented quality indicators but would not account for
differences between year of residency.