Evening Continuity Clinic: Preserving Primary Care Education in the Face of Duty Hour Limitations? (original) (raw)
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Journal of graduate medical education, 2011
T he traditional marriage between teaching hospitals and residents pivots on a central prenuptial agreement: residents offer their hospitals round-theclock patient care, and, in exchange, hospitals provide an experiential learning modality. This long-held covenant may require an update due to 3 significant changes: the increased spotlight on protecting resident education from excessive service demands; the development of hospital medicine as a specialty; and the need to provide more experiential learning in ambulatory care settings for primary care programs, including family medicine.
Journal of graduate medical education, 2009
To examine the opinions of family medicine residency program directors concerning the potential impact of the Institute of Medicine (IOM) resident duty hour recommendations on patient care and resident education. A survey was mailed to 455 family medicine residency program directors. Data were summarized and analyzed using Epi Info statistical software. Significance was set at the P < .01 level. A total of 265 surveys were completed (60.9% response rate). A majority of family medicine residency program directors disagreed or strongly disagreed that the recent IOM duty hour recommendations will, in general, result in improved patient safety and resident education. Further, a majority of respondents disagreed or strongly disagreed that the proposed IOM rules would result in residents becoming more compassionate, more effective family physicians. A majority of family medicine residency program directors believe that the proposed IOM duty hour recommendations would have a primarily d...
Pediatrics, 2001
Objectives. To survey a large group of residents from different institutions to delineate whether there are significant perceptive differences pertaining to the clinical and educational strengths and weaknesses of their continuity experiences by the 3 types of continuity sites. Background. The residency review committee requires a 3-year continuity experience for pediatric residents. Residents receive this experience at a variety of practice sites: hospital-based sites (HBS), community health centers (CHC), and private practices (PP)/health maintenance organizations (HMOs). Design/Methods. Continuity clinic directors who attended the Ambulatory Pediatric Association Continuity Clinic Special Interest Group at the 1999 annual Pediatric Academic Societies Meeting were invited to participate in this cross-sectional study. Thirty-six agreed and distributed a 60-item questionnaire to their residents at the end of the academic year. The questionnaire addressed quality and quantity of the educational and patient care experiences, overall satisfaction, and future career plans. Results. Of the 1167 categorical residents (71%) who returned the questionnaire, 28% were postgraduate level (PL)-1s, 34% were PL-2s, and 37% were PL-3s. Ninetyfour percent of the 36 programs had residents in HBS (n ؍ 807 residents), 58% in CHC (n ؍ 106), and 69% in PP/HMO (n ؍ 254). Compared with other groups, residents in HBS were more likely to report having seen patients more than once, being involved during patients' hospitalizations, taking phone calls from patients, and perceiving that the parents identified them as the primary care provider. HBS and CHC residents felt more autonomous and were more likely to believe that they were advocates for their patients, compared with PP/ HMO residents. The number of patients seen per session was greater in PP/HMO, whereas residents in PP/HMO were more likely to perceive that they had received the right amount of exposure to practice management and billing issues and the appropriate amount of nursing and office support. Although numbers of newborn visits were reported as adequate across sites, residents in HBS and CHC believed that they did not see enough adolescents. The majority of residents at all sites agreed that their preceptor was a good role model, was available for questions, and delivered the appropriate amount of teaching and feedback. Approximately two thirds of residents from all sites were satisfied with their experience and believed that it was preparing them for their future career. Conclusions. All 3 types of continuity sites have both strengths and weaknesses. No single type of continuity site met all expectations for clinical care or training. Most residents at all 3 types of sites reported overall satisfaction and believed that their continuity experience helped to prepare them for future career goals. The residency review committee, in collaboration with pediatric continuity educators, needs to prioritize what constitutes the essential experiences in resident continuity practices and to reemphasize that the ongoing relationship is an important component of the continuity experience.
Impact of 4 + 1 Block Scheduling on Patient Care Continuity in Resident Clinic
Journal of General Internal Medicine, 2014
BACKGROUND: Leaders in medical education have called for redesign of internal medicine training to improve ambulatory care training. 4+1 block scheduling is one innovative approach to enhance ambulatory education. AIM: To determine the impact of 4+1 scheduling on resident clinic continuity. SETTING: Resident continuity clinic in traditional scheduling in which clinics are scheduled intermittently one-half day per week, compared to 4+1 in which residents alternate 1 week of clinic with 4 weeks of an inpatient rotation or elective. PARTICIPANTS: First-year internal medicine residents. PROGRAM DESCRIPTION: We measured patient-provider visit continuity, phone triage encounter continuity, and lab follow-up continuity. PROGRAM EVALUATION: In traditional scheduling as opposed to 4+1 scheduling, patients saw their primary resident provider a greater percentage; 71.7 % vs. 63.0 % (p=0.008). In the 4+1 model, residents saw their own patients a greater percentage; 52.1 % vs. 37.1 % (p=0.0001). Residents addressed their own labs more often in 4+1 model; 90.7 % vs. 75.6 % (p=0.001). There was no significant difference in handling of triage encounters; 42.3 % vs. 35.8 % (p=0.12). DISCUSSION: 4+1 schedule improves visit continuity from a resident perspective, and may compromise visit continuity from the patient perspective, but allows for improved laboratory follow-up, which we pose should be part of an emerging modern definition of continuity.
Healthcare, 2015
Background: Implementation of more stringent regulations on duty hours and supervision by the Accreditation Council for Graduate Medical Education in July 2011 makes it challenging to design inpatient Medicine teaching service that complies with the duty hour restrictions while optimizing continuity of patient care. Objective: To prospectively compare two in-patient Medicine teaching service structures with respect to residents' impression of continuity of patient care (primary outcome), time available for teaching, resident satisfaction and length-of-stay (secondary endpoints). Design: Observational pre-post study. Methods: Surveys were conducted both before and after Conventional Medicine teaching service was changed to a novel model (MegaTeam). Settings: Academic General Medicine in-patient teaching service. Results: Surveys before and after MegaTeam implementation were completed by 68.5% and 72.2% of internal medicine residents, respectively. Comparing conventional with MegaTeam, the % of residents who agreed or strongly agreed that the (i) ability to care for majority of patients from admission to discharge increased from 29.7% to 86.6% (po 0.01); (ii) the concern that number of handoffs was too many decreased from 91.9% to 18.2% (po 0.01); (iii) ability to provide appropriate supervision to interns increased from 38.1% to 70.7% (p o0.01); (iv) overall resident satisfaction with in-patient Medicine teaching service increased from 24.7% to 56.4% (po 0.01); and (v) length-of-stay on in-patient Medicine service decreased from 5.37 6.2 to 4.9 76.8 days (po 0.03). Conclusions: According to our residents, the MegaTeam structure promotes continuity of patient care, decreases number of handoffs, provides adequate supervision and teaching of interns and medical students, increases resident overall satisfaction and decreases length-of-stay.