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Hypertension Knowledge, Training Lacking Within Internal Medicine Programs


Despite the commonality of hypertension among US adults—nearly half of them have elevated blood pressure—hypertension education among internal residents has not kept up with the condition’s prevalence.

Internal medicine residents are saying they would like more education on hypertension and that their current knowledge on this adverse blood pressure condition is insufficient as it relates to connections with other disease states, according to study findings presented at this year’s American Heart Association Scientific Sessions 2022 in Chicago.

Few internal medicine residents report extreme confidence in their ability to manage hypertension in a variety of settings. At the Yale School of Medicine, a survey was developed that was then administered to internal medicine residents in 14 US programs from November 2021 through March 2022. The survey asked about their postgraduate year of training (PGY), location of ambulatory experience, proportion of continuity with patients who had hypertension, type of hypertension training, confidence level in their hypertension knowledge, desire to learn, and preferred teaching methods.

“Little is known about the current state of hypertension education for internal medicine residents,” the study authors wrote. “We aimed to determine confidence and training in key hypertension topics, desire for future training, and preferred teaching methods for learning about hypertension.”

There was a 65% response rate (211 of 324 residents), with 25% to 40% reporting a lack of hypertension training and 52% to 81% reporting they lack confidence in key topics related to hypertension. Most were in their first (38%) or second (35%) year of training post medical school and were training at an academic hospital–based practice (37%) or a community hospital–based practice (29%).

More than half of the residents (52%) also reported continuity of care with their patients who had hypertension 51% to 75% of the time. In contrast, just 11% reported continuity of care 76% to 100% of the time.

In addition, 40% reported a lack of training in masked hypertension; 27%, no prior training for pregnancy-related or potential pregnancy-related hypertension; and 25%, no education for how to handle urgent hypertension events in an outpatient setting. Despite these findings, the residents surveyed did report wanting to learn more about masked hypertension (50%), resistant hypertension (68%), and urgent hypertension events (46%).

For most survey respondents, the prior hypertension education they had was through patient-related discussions with preceptors (66%), independent study (46%), or formal lectures (36%). Further, they noted a distinct lack of or very little confidence in the ability to manage hypertension as it relates to chronic kidney disease (52%), in the outpatient setting (57%), or in patients who are pregnant or thinking of becoming pregnant (81%), as well as little confidence in their ability to manage resistant (59%) or masked (76%) hypertension.

The most popular method of increasing their hypertension knowledge was through in-person didactic lectures (41%), followed by an in-person case-based lecture (37%), or a Zoom didactic lecture or study guide (35% each). The least popular methods were a Tweetorial (~9%), a standardized patient exercise (~17%), and an extended training workshop (~26%).

“Further curriculum development is needed to improve residents’ hypertension knowledge,” the authors concluded.


Gallagher BD, Windish D. State of ambulatory hypertension education in u.s. internal medicine residency programs: a needs assessment survey. Presented at: American Heart Association Scientific Sessions 2022; November 5-7, 2022; Chicago, IL. Abstract HTN44.

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