Alternative Scheduling Models: Improving Continuity of Care, Medical Outcomes, and Graduate Medical Education in Resident Ambulatory Training

Hussain, Ali J.

doi:10.7556/jaoa.2016.155

Cited by 3 publications

(3 citation statements)

References 30 publications

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“…Since the introduction of this model in 2010, a variety of benefits have been identified. The outpatient experience created by this system has produced a favourable educational environment, enhanced the ability of trainees to focus on patient care, and inspired an atmosphere of camaraderie and teamwork . As a result of the substantial time between assigned clinic weeks, however, several challenges related to continuity of care have also been recognized .…”

Section: Introductionmentioning

confidence: 99%

“…The outpatient experience created by this system has produced a favourable educational environment, enhanced the ability of trainees to focus on patient care, and inspired an atmosphere of camaraderie and teamwork. 3 As a result of the substantial time between assigned clinic weeks, however, several challenges related to continuity of care have also been recognized. 2 During the X weeks, residents are limited in their ability to follow-up on previously ordered diagnostic studies and in responding to patients' phone calls.…”

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confidence: 99%

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Challenges in an X + Y ambulatory model

Ibrahim

Adam

Mohamed

et al. 2019

The Clinical Teacher

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Summary Background Internal medicine training requires significant exposure to ambulatory practice. Ensuring continuity of patient care is challenging, especially with intermittent ambulatory resident assignments. A popular scheduling model is an X + Y block system where residents rotate for X weeks on inpatient rotations followed by Y weeks on ambulatory clinics. Although benefits exist with the X + Y model, it has drawbacks, particularly for continuity of care: residents struggle to obtain follow‐up test results and return patient calls promptly. To provide patients with seamless continuity the programme assigned two Managing Clinic Continuity Care Residents (MCCCRs) to cover all tasks. The MCCCRs were soon overwhelmed by the number of tasks and became dissatisfied with the workflow, however, resulting in a low task‐completion rate. Method In our 4 + 1 model residents are divided into five cohorts, we created mini‐practice groups (MPGs) consisting of one resident from each cohort. Each week the resident in the clinic is assigned to act as the Practice Clinic Continuity of Care Resident (PCCCR) for the MPG. This individual is responsible for addressing the patient tasks of the other four residents in the MPG. For optimal performance, the previous two MCCCRs are now assigned for oversight only each week. We tracked task‐completion rates weekly and surveyed residents for satisfaction. Results Following the redistribution of responsibilities, the task‐completion rates improved from 75 to 97%. The MCCCR satisfaction rate for the workflow increased from zero to 63%, and the on‐time note completion rates increased from 21 to 67%. Conclusion Modification of the X + Y model using the MPG structure ensured the timely completion of patient‐related tasks, and improved the overall experience for both patients and providers.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Challenges in an X + Y ambulatory model

Ibrahim

Adam

Mohamed

et al. 2019

The Clinical Teacher

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“…4,8,9 While studies have examined alternative scheduling models, few have evaluated comprehensive Clinic First educational interventions. 3,[10][11][12][13][14][15][16] Most studies focus on clinic metrics, leaving the effects on resident wellness and engagement largely unstudied.…”

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confidence: 99%

Effects of Clinic First Educational Interventions on Resident Wellness and Engagement

Hofkamp

Verdieck

Cheng

et al. 2020

Fam Med

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Background and Objectives: Tensions between clinical and hospital training, along with dysfunctional family medicine training clinics, have resulted in continuity clinic being the least favorite part of training for some residents. These factors are all contributors to burnout. We hypothesized that following Clinic First action steps to prioritize and enhance outpatient clinic would positively affect resident wellness and clinic engagement. This study describes our interventions and their effects within the Oregon Health & Science University (OHSU) Family Medicine 4-year Portland residency program. Methods: In July 2017 the Oregon Health & Science University Family Medicine Portland residency program implemented scheduling and curricular interventions inspired by the Clinic First model. We conducted a mixed-methods cross-sectional study using focus groups and surveys to understand the effects of these interventions on resident wellness and engagement. Results: Clinic First-inspired interventions, particularly a 2+2 scheduling model, decreased transitions within the day, and a clinic immersion month were associated with improved residents’ perception of wellness. These interventions had variable effects on clinic engagement. Eighty-eight percent of interns surveyed about the month-long clinic orientation in the beginning of residency reported that they felt prepared managing continuity patients in the clinic setting and their upcoming rotations. Conclusions: This study demonstrates that Clinic First-inspired structural changes can be associated with improvement in resident perceptions of wellness and aspects of clinic engagement. This can give educators a sense of hope as well as tangible steps to take to improve these difficult and important issues.

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Enhancing team development in an internal medicine resident continuity clinic

Wingo,

Halvorsen,

Leasure

et al. 2024

Medical Education Online

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Interprofessional teamwork is important for the provision of safe, high value patient care and is recognized as essential by the ACGME. We aimed to assess the impact of an interprofessional continuity clinic teamwork curriculum on perceptions of team development and patient safety. This project was conducted in an IM Resident Continuity Clinic where 96 residents, supported by 28 faculty and 48 interprofessional team members, attended continuity clinic two afternoons per week during alternating months of a 50/50 outpatient-inpatient training model. Teams were configured into two groups of residents, faculty and interprofessional team members. The randomly selected intervention group participated in strategically-timed TeamSTEPPS training. The control group received usual clinic education. Teamwork and safety climate were measured using the Team Development Measure (TDM) and Safety Attitudes Questionnaire (SAQ) collected before and after the intervention. Following the teamwork curriculum, team development improved in the intervention group as compared to control [mean change (95% CI) +13.9 (+9.3, +18.6) versus + 4.8 (+0.4, +9.1), p = 0.007]. Though 30% of the individual items on the SAQ improved significantly in the faculty intervention group as compared to control, the overall improvement in SAQ [intervention mean change + 0.4 (+0.2, +0.5), control mean change + 0.2 (−0.1, +0.5)] was not statistically significant ( p = 0.36). It is feasible to implement a TeamSTEPPs-based interprofessional teamwork curriculum among IM residents in a block clinic model and achieve enhanced teamwork and safety attitudes. Additional assessment of clinical and educational outcomes is ongoing.

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Alternative Scheduling Models: Improving Continuity of Care, Medical Outcomes, and Graduate Medical Education in Resident Ambulatory Training

Cited by 3 publications

References 30 publications

Challenges in an X + Y ambulatory model

Challenges in an X + Y ambulatory model

Effects of Clinic First Educational Interventions on Resident Wellness and Engagement

Enhancing team development in an internal medicine resident continuity clinic

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