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Heppe D, Baduashvili A, Limes JE, Suddarth K, Mann A, Gottenborg E, Sacro Y, Davis L, Chacko K, Connors G. Resident Burnout, Wellness, Professional Development, and Engagement Before and After New Training Schedule Implementation. JAMA Netw Open 2024; 7:e240037. [PMID: 38416498 PMCID: PMC10902722 DOI: 10.1001/jamanetworkopen.2024.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/29/2023] [Indexed: 02/29/2024] Open
Abstract
Importance Burnout is a work-related syndrome of depersonalization (DP), emotional exhaustion (EE), and low personal achievement (PA) that is prevalent among internal medicine resident trainees. Prior interventions have had modest effects on resident burnout. The association of a new 4 + 4 block schedule (4 inpatient weeks plus 4 outpatient weeks) with resident burnout has not previously been evaluated. Objective To evaluate the association of a 4 + 4 block schedule, compared with a 4 + 1 schedule, with burnout, wellness, and self-reported professional engagement and clinical preparedness among resident physicians. Design, Setting, and Participants This nonrandomized preintervention and postintervention survey study was conducted in a single academic-based internal medicine residency program from June 2019 to June 2021. The study included residents in the categorical, hospitalist, and primary care tracks in postgraduate years 1 and 2 (PGY1 and PGY2). Data analysis was conducted from October to December 2022. Intervention In the 4 + 4 structure, resident schedules alternated between 4-week inpatient call-based rotations and 4-week ambulatory non-call-based rotations. Main Outcomes and Measures The primary outcome was burnout, assessed using the Maslach Burnout Inventory subcategories of EE (range, 0-54), DP (range, 0-30), and PA (range, 0-48), adjusted for sex and PGY. Secondary outcomes included In-Training Examination (ITE) scores and a questionnaire on professional, educational, and health outcomes. Multivariable logistic regression was used to assess the primary outcome, 1-way analysis of variance was used to compare ITE percentiles, and a Bonferroni-adjusted Kruskal Wallis test was used for the remaining secondary outcomes. The findings were reexamined with several sensitivity analyses, and Cohen's D was used to estimate standardized mean differences (SMDs). Results Of the 313 eligible residents, 216 completed the surveys. A total of 107 respondents (49.5%) were women and 109 (50.5%) were men; 119 (55.1%) were PGY1 residents. The survey response rates were 78.0% (85 of 109) in the preintervention cohort and 60.6% (63 of 104) and 68.0% (68 of 100) in the 2 postintervention cohorts. The PGY1 residents had higher response rates than the PGY2 residents (119 of 152 [78.2%] vs 97 of 161 [60.2%]; P < .001). Adjusted EE scores (mean difference [MD], -6.78 [95% CI, -9.24 to -4.32]) and adjusted DP scores (MD, -3.81 [95% CI, -5.29 to -2.34]) were lower in the combined postintervention cohort. The change in PA scores was not statistically significant (MD, 1.4 [95% CI, -0.49 to 3.29]). Of the 15 items exploring professional, educational, and health outcomes, a large positive association was observed for 11 items (SMDs >1.0). No statistically significant change in ITE percentile ranks was noted. Conclusions and Relevance In this survey study of internal medicine resident physicians, a positive association was observed between a 4 + 4 block training schedule and internal medicine resident burnout scores and improved self-reported professional, educational, and health outcomes. These results suggest that specific 4 + 4 block combinations may better improve resident burnout than a 4 + 1 combination used previously.
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Affiliation(s)
- Daniel Heppe
- University of Colorado Internal Medicine Residency, Department of Hospital Medicine, University of Colorado School of Medicine, Aurora
| | - Amiran Baduashvili
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora
| | - Julia E. Limes
- Division of Hospital Medicine, University of Colorado, Aurora
| | - Katie Suddarth
- Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Adrienne Mann
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora
| | - Emily Gottenborg
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora
| | - Yasmin Sacro
- Department of General Internal Medicine, University of Colorado School of Medicine, Aurora
| | - Lisa Davis
- Division of Rheumatology, Denver Health and Hospital Authority, Denver, Colorado
- Internal Medicine Training Program, University of Colorado School of Medicine, Aurora
| | - Karen Chacko
- Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Geoffrey Connors
- Internal Medicine Residency Program, Pulmonary and Critical Care Medicine, University of Colorado School of Medicine, Aurora
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Nandiwada DR, Farkas AH, Nikiforova T, Leung PB, Donovan AK, Killian K, Thomas ML, Singh MK, Gallagher B, Callender DM. Exploring Models of Exposure to Primary Care Careers in Training: a Narrative Review. J Gen Intern Med 2024; 39:277-282. [PMID: 37989819 PMCID: PMC10853099 DOI: 10.1007/s11606-023-08532-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023]
Abstract
Multiple models of clinical exposure to primary care exist within undergraduate medical education (UME) and graduate medical education (GME). In this narrative review, we explore the evidence behind these different models of exposure, their alignment with positive promoters of primary care careers, and the pros and cons of each. Without positive exposure to primary care during training, sustaining the future primary care work force becomes increasingly challenging. Here, we explore multiple models of clinical exposure in UME, including longitudinal integrated clerkships, primary care tracks, and primary care clerkships. Within GME, we will review the impact of primary care tracks, Area Health Education Centers, block scheduling models, and continuity clinic scheduling models. The goal of this narrative review is to allow educators to think broadly and intentionally about the array of models to develop positive primary care experiences and perceptions in training, ultimately sustaining the primary care workforce.
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Affiliation(s)
- D Rani Nandiwada
- Perelman School of Medicine, University of Pennsylvania, 51 North 39Th Street, MAB 102, Philadelphia, PA, 19104, USA
| | - Amy H Farkas
- Milwaukee VA Medical Center, 5000 W National Ave, Milwaukee, WI, 53211, USA
| | - Tanya Nikiforova
- Division of General Internal Medicine, UPMC Montefiore Hospital, 9 West 921, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Peggy B Leung
- Weill Cornell Internal Medicine Associates, 505 East 70Th St, HT-4, New York, NY, 10021, USA
| | - Anna K Donovan
- Division of General Internal Medicine, UPMC Montefiore Hospital, 9 West 930, 200 Lothrop Street, Pittsburgh, PA, 15213, USA
| | - Katherine Killian
- Weill Cornell Internal Medicine, 178 East 85Th Street, Floor 2, New York, NY, 10028, USA
| | - Mary L Thomas
- University of Tennessee, 920 Madison Ave, Suite 531, Memphis, TN, 38163, USA
| | - Mamta K Singh
- Case Western Reserve University, VA Northeast Ohio Healthcare System, 1620 Magnolia Drive, Administrative Building, RM 5M678, Cleveland, OH, 44106, USA
| | | | - David M Callender
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA.
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Szalda D, Stehouwer NR, Walsh JB, Diamond-Falk K, Patel B, Spangler H, Nadamuni M, Contarino M. Perceptions of X+Y Scheduling Among Combined Internal Medicine-Pediatrics Residency Trainees: A Qualitative Program Evaluation. Cureus 2024; 16:e52983. [PMID: 38406009 PMCID: PMC10893991 DOI: 10.7759/cureus.52983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
OBJECTIVE The study aims to elicit perceived benefits and downsides of X+Y scheduling for combined Internal Medicine-Pediatrics (Med-Peds) residents via focus groups. METHODS Five focus groups were conducted with Med-Peds residents in participating programs which utilized X+Y scheduling. Onefocus group was held per participating institution. Each focus group was facilitated by a chief resident from a different participating institution. Questions were developed by the study team after a review of the literature and local experience with X+Y scheduling and included open-ended questions. Focus groups were recorded and transcribed. Transcripts were reviewed by study team members, and representative themes and quotes were presented. The main outcome was to evaluate the perceived benefits and downsides of X+Y scheduling for Med-Peds. RESULTS Results from four of the five focus groups were fully reviewed. Themes regarding the benefits of X+Y scheduling included (1) improved inpatient and outpatient experience, (2) predictability in schedule which improved wellness, and (3) longitudinal time for career exploration. Downsides of X+Y scheduling were highlighted as well including (1) condensing too many experiences into Y time and (2) challenges that exist when categorical medicine and pediatrics programs use different block schedules. CONCLUSIONS X+Y schedules create potential solutions for longstanding barriers to medical education and notably conflict with inpatient and outpatient responsibilities. Our data shows similar benefits to X+Y scheduling for combined residents as for their categorical colleagues and sheds light on some unique considerations for combined programs and trainees. Additional studies should continue to assess the effect of X+Y scheduling on our combined trainees.
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Affiliation(s)
- Dava Szalda
- Internal Medicine-Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Nathan R Stehouwer
- Internal Medicine-Pediatrics, Case Western Reserve University School of Medicine, Cleveland, USA
| | - Jennifer B Walsh
- Internal Medicine-Pediatrics, University of Texas Southwestern Medical Center, Dallas, USA
| | | | - Bhavesh Patel
- Internal Medicine-Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Hillary Spangler
- Internal Medicine-Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Mridula Nadamuni
- Internal Medicine-Pediatrics, University of Texas Southwestern Medical Center, Dallas, USA
| | - Michael Contarino
- Internal Medicine-Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, USA
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hua L, Dongmei M, Xinyu Y, Xinyue Z, Shutong W, Dongxuan W, Hao P, Ying W. Research on outpatient capacity planning combining lean thinking and integer linear programming. BMC Med Inform Decis Mak 2023; 23:32. [PMID: 36782168 PMCID: PMC9924205 DOI: 10.1186/s12911-023-02106-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 01/09/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The size and cost of outpatient capacity directly affect the operational efficiency of a whole hospital. Many scholars have faced the study of outpatient capacity planning from an operations management perspective. OBJECTIVE The outpatient service is refined, and the quantity allocation problem of each type of outpatient service is modeled as an integer linear programming problem. Thus, doctors' work efficiency can be improved, patients' waiting time can be effectively reduced, and patients can be provided with more satisfactory medical services. METHODS Outpatient service is divided into examination and diagnosis service according to lean thinking. CPLEX is used to solve the integer linear programming problem of outpatient service allocation, and the maximum working time is minimized by constraint solution. RESULTS A variety of values are taken for the relevant parameters of the outpatient service, using CPLEX to obtain the minimum and maximum working time corresponding to each situation. Compared with no refinement stratification, the work efficiency of senior doctors has increased by an average of 25%. In comparison, the patient flow of associate senior doctors has increased by an average of 50%. CONCLUSION In this paper, the method of outpatient capacity planning improves the work efficiency of senior doctors and provides outpatient services for more patients in need; At the same time, it indirectly reduces the waiting time of patients receiving outpatient services from senior doctors. And the patient flow of the associate senior doctors is improved, which helps to improve doctors' technical level and solve the problem of shortage of medical resources.
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Affiliation(s)
- Li hua
- grid.430605.40000 0004 1758 4110Abdominal Ultrasound Department, Diagnostic Ultrasound Center, First Hospital of Jilin University, Changchun, Jilin China ,grid.64924.3d0000 0004 1760 5735School of Public Health, Jilin University, Changchun, Jilin China
| | - Mu Dongmei
- Department of Clinical Research, First Hospital of Jilin University, Changchun, Jilin, China. .,School of Public Health, Jilin University, Changchun, Jilin, China.
| | - Yang Xinyu
- grid.64924.3d0000 0004 1760 5735School of Public Health, Jilin University, Changchun, Jilin China
| | - Zhang Xinyue
- grid.64924.3d0000 0004 1760 5735School of Public Health, Jilin University, Changchun, Jilin China
| | - Wang Shutong
- grid.64924.3d0000 0004 1760 5735School of Public Health, Jilin University, Changchun, Jilin China
| | - Wang Dongxuan
- Abdominal Ultrasound Department, Diagnostic Ultrasound Center, First Hospital of Jilin University, Changchun, Jilin, China.
| | - Peng Hao
- grid.64924.3d0000 0004 1760 5735School of Public Health, Jilin University, Changchun, Jilin China
| | - Wang Ying
- grid.64924.3d0000 0004 1760 5735School of Public Health, Jilin University, Changchun, Jilin China
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Stehouwer NR, Contarino MR, Szalda D, Diamond-Falk K, Walsh JB. The Implementation of X + Y Scheduling in Combined Internal Medicine-Pediatrics Residency Programs: Practical Considerations for Program Leadership. Cureus 2022; 14:e29743. [PMID: 36340526 PMCID: PMC9621718 DOI: 10.7759/cureus.29743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/29/2022] [Indexed: 11/24/2022] Open
Abstract
The X + Y scheduling approach, or block scheduling, is common among internal medicine residency programs. With the beginning of a pilot program through the American College of Graduate Medical Education in 2018, pediatrics and internal medicine-pediatrics (Med-Peds) residency programs have been able to adopt X + Y scheduling as well. The X + Y scheduling approach presents unique challenges and opportunities for combined Med-Peds residencies. This paper describes an early experience with X + Y scheduling in Med-Peds residencies and describes practical considerations for Med-Peds programs considering or planning a transition to the X + Y schedule. These considerations include strategies for gaining stakeholder support; selecting the appropriate block structure; opportunities for designing the ambulatory curriculum; and maximizing the clinical benefit in the residency continuity clinic.
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Watanabe T, Takayama H, Hamada H, Kaneko K, Matsushima K, Nagatani A. Introduction of Otolaryngology Outpatient Examination Training Program for junior residents as part of rural regional medical support in Japan. J Gen Fam Med 2022; 23:363-369. [PMID: 36349206 PMCID: PMC9634132 DOI: 10.1002/jgf2.565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/18/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022] Open
Abstract
Background Nagasaki Prefecture is located in the most western part of Japan, and there are a considerable number of clinics in its many remote islands and rural areas. Thus, the Regional Medical Support Center in Nagasaki Prefecture dispatches doctors to rural hospitals to provide medical support. We introduced an outpatient training program at these rural hospitals for all residents to improve their clinical training in the field of otorhinolaryngology, whereby one otolaryngologist trains one resident. Methods This otolaryngology outpatient training program is randomly assigned, and conducted for 4–5 days a year, transported by a helicopter in Nagasaki Prefecture, which is a 30‐minute one‐way trip. We used a case checklist that included the 35 items that should be experienced and are defined as frequent by the Ministry of Health, Labor and Welfare. We also conducted a survey using an anonymous questionnaire. Results The survey response rate was 100%. Comparing the experience rate of symptoms between the pre‐introduction resident and the post‐introduction resident who underwent the otolaryngology outpatient training program, the experience rates of common diseases, including vertigo and otolaryngologic symptoms such as nasal bleeding and hoarseness, significantly increased after the program was introduced (p ≤ .001). Notably, the experience rate of headache, cough/sputum, and vertigo was 100%. Conclusion Our training program provides a suitable medical environment for the resident and secures a doctor who can provide secondary medical service support. Furthermore, the program will improve the level of primary care provided by the residents in remote island and rural area hospitals.
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Affiliation(s)
- Takeshi Watanabe
- Department of Regional Medical Support Center Nagasaki University Hospital Nagasaki Japan
- Department of Medical Education Development Center Nagasaki University Hospital Nagasaki Japan
- Regional Medical Resources Support Center in Nagasaki Nagasaki Japan
- Nagasaki Prefecture Kamigoto Hospital Nagasaki Japan
- Department of Emergency Medical Education Center Nagasaki University Hospital Nagasaki Japan
| | - Hayato Takayama
- Department of Regional Medical Support Center Nagasaki University Hospital Nagasaki Japan
- Regional Medical Resources Support Center in Nagasaki Nagasaki Japan
| | - Hisayuki Hamada
- Department of Regional Medical Support Center Nagasaki University Hospital Nagasaki Japan
- Department of Medical Education Development Center Nagasaki University Hospital Nagasaki Japan
| | - Kenichi Kaneko
- Department of Medical Education Development Center Nagasaki University Hospital Nagasaki Japan
| | - Kayoko Matsushima
- Department of Medical Education Development Center Nagasaki University Hospital Nagasaki Japan
| | - Atsuko Nagatani
- Department of Emergency Medical Education Center Nagasaki University Hospital Nagasaki Japan
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Fortuna RJ, Tobin DG, Sobel HG, Barrette EP, Noroha C, Laufman L, Huang X, Staggers KA, Nadkarni M, Lu LB. Perspectives of internal medicine residency clinics: A national survey of US medical directors. EDUCATION FOR HEALTH (ABINGDON, ENGLAND) 2022; 35:58-66. [PMID: 36647933 DOI: 10.4103/efh.efh_75_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND Ambulatory training is an integral component of internal medicine residency programs, yet details regarding operational processes in resident continuity clinics remain limited. METHODS We surveyed a convenience sample of medical directors of residency practices between 2015 and 2019 (n = 222) to describe and share operational and scheduling processes in internal medicine resident continuity clinics in the US. RESULTS Among residency practices, support for the medical director role ranged substantially, but was most commonly reported at 11%-20% full-time-equivalent support. By the end of the survey period, the majority of programs (65.1%) reported obtaining patient-centered medical home (PCMH) certification (level 1-3). For new patient appointments, 34.9% of programs reported a 1-7 day wait and 25.8% reported an 8-14 day wait. Wait times for new appointments were generally shorter for PCMH certified practices (P = 0.029). No-show rates were most commonly 26%-50% for new patients and 11%-25% for established patients. Most programs reported that interns see 3-4 patients per ½-day and senior residents see 5-6 patients per ½-day. Most interns and residents maintain a panel size of 51-120 patients. DISCUSSION Creating high-performing residency clinics requires a focus on core building blocks and operational processes. Based on the survey results and consensus opinion, we provide five summary recommendations related to (1) support for the medical director leadership role, (2) patient-centered and coordinated models of care, (3) support for patient scheduling, (4) recommended visit lengths, and (5) ancillary support, such as social work.
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Affiliation(s)
- Robert J Fortuna
- Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Daniel G Tobin
- Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Halle G Sobel
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Ernie-Paul Barrette
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Craig Noroha
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Larry Laufman
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Xiaofan Huang
- Biostatics, Baylor College of Medicine, Houston, TX, USA
| | | | - Mohan Nadkarni
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Lee B Lu
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Chao SH, Kwok JY, Ubani BN, Rogers REP, Stark RL. Teaching medicine interns minimum geriatrics competencies within a "4 + 2" schedule. J Am Geriatr Soc 2021; 70:251-258. [PMID: 34741533 DOI: 10.1111/jgs.17543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/07/2021] [Accepted: 10/09/2021] [Indexed: 11/30/2022]
Abstract
The increased ambulatory training time in an "X + Y" (inpatient + ambulatory) residency schedule affords more opportunities to teach geriatrics principles of care. We describe our internal medicine (IM) residency program's experience in teaching the IM-family medicine (FM) minimum geriatrics competencies (MGC) during a longitudinal geriatrics rotation embedded within interns' yearlong "4 + 2" schedule. Interns spend 1 day of the ambulatory block in a geriatrics outpatient setting (Program of All-Inclusive Care for the Elderly, house calls, nursing home), during which geriatrics division faculty members give core didactic seminars. We revamped core seminars to address MGC related to medication management, cognitive health, complex chronic illnesses, end of life care, and ambulatory care. Three consecutive intern cohorts completed anonymous surveys pre- and postrotation, rating their confidence level in MGC addressed by the curriculum on a 5-point Likert scale. On postrotation surveys, they also rated the curriculum's contribution to geriatrics skills enhancement. Interns who completed both surveys (N = 22, 92%) reported statistically significant improved confidence ratings on all items, with the greatest point gains seen in performance of functional assessment (1.56), practice of optimal geriatric pharmacotherapy (1.78), and identification of older patients eligible for skilled (1.71) and unskilled home-based services (1.65). They rated geriatrics curricular components as being more helpful than other rotations and conferences in enhancing their geriatric skills. In conclusion, we developed a longitudinal geriatrics curriculum within the context of our "4 + 2" immersion schedule which other programs can easily adapt. Aligning curricular content with the MGC has resulted in interns' improved confidence in several important geriatrics skills.
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Affiliation(s)
- Serena H Chao
- Department of Medicine-Geriatrics Division, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Judy Y Kwok
- Department of Medicine-Geriatrics Division, Cambridge Health Alliance, Cambridge, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | | | - Rebecca E P Rogers
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts, USA
| | - Rachel L Stark
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts, USA
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Kiger ME, Bautista E, Bertagnoli TM, Hammond CE, Meyer HS, Varpio L, Dong T. Defragmenting the Day: The Effect of Full-Day Continuity Clinics on Continuity of Care and Perceptions of Clinic. TEACHING AND LEARNING IN MEDICINE 2021; 33:546-553. [PMID: 33792437 DOI: 10.1080/10401334.2021.1879652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PROBLEM Traditional half-day continuity clinics within primary care residency programs require residents to split time between their assigned clinical rotation and continuity clinic, which can have detrimental effects on resident experiences and patient care within continuity clinics. Most previous efforts to separate inpatient and outpatient obligations have employed block scheduling models, which entail significant rearrangements to clinical rotations, team structures, and didactic education and have yielded mixed effects on continuity of care. A full-day continuity clinic schedule within a traditional, non-block rotation framework holds potential to de-conflict resident schedules without the logistical rearrangements required to adopt block scheduling models, but no literature has described the effect of such full-day continuity clinics on continuity of care or resident experiences within continuity clinic. INTERVENTION A pediatric residency program implemented full-day continuity clinics within a traditional rotation framework. We examined the change in continuity for physician (PHY) measure in the six months prior to versus the six months following the switch, as well as changes in how often residents saw clinic patients in follow-up and personally followed up clinic laboratory and radiology results, which we term episodic follow-up. Resident and attending perceptions of full-day continuity clinics were measured using a survey administered 5-7 months after the switch. CONTEXT The switch to full-day continuity clinics occurred in January 2018 within the Wright State University/Wright-Patterson Medical Center Pediatric Residency Program. The program has 46 residents who are assigned to one of two continuity clinic sites, each of which implemented the full-day continuity clinics simultaneously. OUTCOME The PHY for residents at one clinic decreased slightly from 18.0% to 13.6% (p<.001) with full-day continuity clinics but was unchanged at another clinic [60.6% vs 59.5%, p=.86]. Measures of episodic follow-up were unchanged. Residents (32/46 = 77% responding) and attendings (6/8 = 75% responding) indicated full-day continuity clinics improved residents' balance of inpatient and outpatient obligations, preparation for clinic, continuity relationships with patients, and clinic satisfaction. LESSONS LEARNED Full-day continuity clinics within a traditional rotation framework had mixed effects on continuity of care but improved residents' experiences within clinic. This model offers a viable alternative to block scheduling models for primary care residency programs wishing to defragment resident schedules. UNLABELLED Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1879652.
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Affiliation(s)
- Michelle E Kiger
- Wright-Patterson Medical Center, Pediatric Residency Program, Wright State University, Dayton, Ohio, USA
- Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Erica Bautista
- Pediatrics, Dayton Children's Hospital, Wright State University, Dayton, Ohio, USA
| | - Thomas M Bertagnoli
- Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Lakenheath Air Base, Brandon, UK
| | - Caitlin E Hammond
- Wright-Patterson Medical Center, Pediatric Residency Program, Wright State University, Dayton, Ohio, USA
- Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Holly S Meyer
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Lara Varpio
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Ting Dong
- Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Exploring the Intersections of Education and Healthcare Delivery Using a Clinical Learning Environment Framework. J Gen Intern Med 2019; 34:654-656. [PMID: 30993626 PMCID: PMC6502912 DOI: 10.1007/s11606-019-04929-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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11
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Windish DM, Reddy S. Beyond Bagels and Yoga: Early Detection and Containment in the Burnout Epidemic. J Gen Intern Med 2019; 34:657-658. [PMID: 30993620 PMCID: PMC6502891 DOI: 10.1007/s11606-019-04924-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Donna M Windish
- Department of Internal Medicine, Yale University School of Medicine, New Haven, USA. .,Yale Primary Care Residency Program, 1450 Chapel Street, Private 304, New Haven, CT, 06511, USA.
| | - Shalini Reddy
- Internal Medicine Residency Program, John H. Stroger Hospital of Cook County Health, Chicago, IL, USA
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