At least, that is the implication of this paper – and even though it’s probably not the most reliable demonstration of such an effect, its observations are likely valid.
This is a very convoluted study design aiming to comment upon whether residents trained in “conservative” practice environments differed from residents trained in “aggressive” practice environments. However, “conservative” and “aggressive” were defined by utilizing a Medicare database to calculate the “End-of-Life Visit Index”. Residents trained in a region where elderly patients received greater frequency of inpatient and outpatient care at the end-of-life were judged to have trained in an “aggressive” environment.
Then, to measure whether residents themselves had tendencies towards “conservative” or “aggressive” management, the authors reviewed American Board of Internal Medicine board certification examination questions. Questions regarding management strategy were divided into “conservative” or “aggressive” strategies, based on the correct answers. Finally, examinees were measured on how many correct and incorrect answers were provided on these questions featuring the two management strategies. Correlating these test answers with the end-of-life environment presumes to measure an association between training and practice.
After all these calisthenics – yes, residents training in the lower-intensity environments were more likely to perform better on the “conservative” management questions. Thus, the authors make the expected extrapolation: trainees apparently learn to mimic inappropriately aggressive care.
This is probably true. Whether this study – with its limitations and surrogates – adequately supports such conclusions is another matter entirely.
“The Association Between Residency Training and Internists’ Ability to Practice Conservatively”
http://www.ncbi.nlm.nih.gov/pubmed/25179515