Moving Forward in GME Reform: A 4 + 1 Model of Resident Ambulatory Training

Chaudhry, Saima; Balwan, Sandy; Friedman, Karen A.; Sunday, Suzanne R.; Chaudhry, Basit; DiMisa, Deborah; Fornari, Alice

doi:10.1007/s11606-013-2387-3

Cited by 50 publications

(58 citation statements)

References 8 publications

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“…22,23 Given the noted strain between competing inpatient and outpatient responsibilities, 24 the continuity clinic experience for IM residents can become stressful and there is variable program compliance with ACGME ambulatory training requirements. 25 In an attempt to uncouple inpatient and outpatient training, a few new program models have developed, which include a year long ambulatory block 26 and an alternating 4:1 week inpatient to ambulatory schedule [27][28][29] that might help to support ambulatory education. Emphasizing outpatient training and education during residency while simultaneously providing protected time to practice ambulatory medicine may help retain resident interest in primary care.…”

Section: Discussionmentioning

confidence: 99%

Is Training in a Primary Care Internal Medicine Residency Associated with a Career in Primary Care Medicine?

et al. 2015

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PURPOSE: Professional and governmental organizations recommend an ideal US physician workforce composed of at least 40 % primary care physicians. They also support primary care residencies to promote careers in primary care. Our study examines the relationship between graduation from a primary care or categorical internal medicine residency program and subsequent career choice. METHODS: We conducted a cross-sectional electronic survey of a cohort of internal medicine residency alumni who graduated between 2001 and 2010 from a large academic center. Our primary predictor was graduation from a primary care versus a categorical internal medicine program and our primary outcome is current career role. We performed chi-square analysis comparing responses of primary care and categorical residents. RESULTS: We contacted 481 out of 513 alumni, of whom 322 responded (67 %). We compared 106 responses from primary care alumni to 169 responses from categorical alumni. Fifty-four percent of primary care alumni agreed that the majority of their current clinical work is in outpatient primary care vs. 20 % of categorical alumni (p<0.001). While 92.5 % of primary-care alumni were interested in a primary care career prior to residency, only 63 % remained interested after residency. Thirty of the 34 primary care alumni (88 %) who lost interest in a primary care career during residency agreed that their ambulatory experience during residency influenced their subsequent career choice. CONCLUSIONS: A higher percentage of primary care alumni practice outpatient primary care as compared to categorical alumni. Some alumni lost interest in primary care during residency. The outpatient clinic experience may impact interest in primary care.

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Section: Discussionmentioning

confidence: 99%

Is Training in a Primary Care Internal Medicine Residency Associated with a Career in Primary Care Medicine?

et al. 2015

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“…7,8 Recent evidence has found that the quality of continuity clinic experience is related to internal medicine resident satisfaction, 9 and that training models with blocks of protected outpatient time that are separate from inpatient responsibilities may also increase resident satisfaction with their primary care rotations. 10 In addition, the outpatient clinic experiences of residents may be associated with retained interest in primary care careers, 11 though the influence of various factors may also differ by year of training and may be influenced by other experiences prior to residency. 12,13 However, these studies have focused on specific factors, such as residency training satisfaction, and there is a need to understand holistically how the diverse experiences of trainees impact the decision to pursue primary care or another Electronic supplementary material The online version of this article (doi:10.1007/s11606-016-3825-9) contains supplementary material, which is available to authorized users.…”

Section: Introductionmentioning

confidence: 99%

Why Aren’t More Primary Care Residents Going into Primary Care? A Qualitative Study

et al. 2016

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BACKGROUND:Workforce projections indicate a potential shortage of up to 31,000 adult primary care providers by the year 2025. Approximately 80 % of internal medicine residents and nearly two-thirds of primary care internal medicine residents do not plan to have a career in primary care or general internal medicine. OBJECTIVE: We aimed to explore contextual and programmatic factors within primary care residency training environments that may influence career choices. DESIGN: This was a qualitative study based on semistructured, in-person interviews. PARTICIPANTS: Three primary care internal medicine residency programs were purposefully selected to represent a diversity of training environments. Second and third year residents were interviewed. APPROACH: We used a survey guide developed from pilot interviews and existing literature. Three members of the research team independently coded the transcripts and developed the code structure based on the constant comparative method. The research team identified emerging themes and refined codes. ATLAS.ti was used for the analysis. KEY RESULTS: We completed 24 interviews (12 secondyear residents, and 12 third-year residents). The age range was 27-39 years. Four recurrent themes characterized contextual and programmatic factors contributing to residents' decision-making: resident expectations of a career in primary care, navigation of the boundary between social needs and medical needs, mentorship and perceptions of primary care, and structural features of the training program. CONCLUSIONS: Addressing aspects of training that may discourage residents from careers in primary care such as lack of diversity in outpatient experiences and resident frustration with their inability to address social needs of patients, and strengthening aspects of training that may encourage interests in careers in primary care such as mentorship and protected time away from inpatient responsibilities during primary care rotations, may increase the proportion of residents enrolled in primary care training programs who pursue a career in primary care.

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“…We added TBL to an existing ''4 þ 1'' block schedule, 10 in which residents are divided into 5 cohorts. Each cohort rotated every fifth week for 1 week, in 1 of 2 ambulatory clinics, including a patient-centered medical home and a hospital-based clinic.…”

Section: Setting and Participantsmentioning

confidence: 99%

“…Each cohort rotated every fifth week for 1 week, in 1 of 2 ambulatory clinics, including a patient-centered medical home and a hospital-based clinic. 10 Weekly, on average, 12 patient-centered medical home and 8 hospital-based clinic residents were divided into 2 groups at each site (4 to 6 residents per group, total of 4 groups). Groups were permanent, and group assignments were configured to reflect an equal distribution of residents during the 3 years of training.…”

Section: Setting and Participantsmentioning

confidence: 99%

Use of Team-Based Learning Pedagogy for Internal Medicine Ambulatory Resident Teaching

Balwan¹,

Fornari²,

DiMarzio³

et al. 2015

Journal of Graduate Medical Education

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Background Team-based learning (TBL) is used in undergraduate medical education to facilitate higher-order content learning, promote learner engagement and collaboration, and foster positive learner attitudes. There is a paucity of data on the use of TBL in graduate medical education. Our aim was to assess resident engagement, learning, and faculty/resident satisfaction with TBL in internal medicine residency ambulatory education.Methods Survey and nominal group technique methodologies were used to assess learner engagement and faculty/resident satisfaction. We assessed medical learning using individual (IRAT) and group (GRAT) readiness assurance tests.Results Residents (N ¼ 111) involved in TBL sessions reported contributing to group discussions and actively discussing the subject material with other residents. Faculty echoed similar responses, and residents and faculty reported a preference for future teaching sessions to be offered using the TBL pedagogy. The average GRAT score was significantly higher than the average IRAT score by 22%. Feedback from our nominal group technique rank ordered the following TBL strengths by both residents and faculty: (1) interactive format, (2) content of sessions, and (3) competitive nature of sessions.Conclusions We successfully implemented TBL pedagogy in the internal medicine ambulatory residency curriculum, with learning focused on the care of patients in the ambulatory setting. TBL resulted in active resident engagement, facilitated group learning, and increased satisfaction by residents and faculty. To our knowledge this is the first study that implemented a TBL program in an internal medicine residency curriculum.

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Moving Forward in GME Reform: A 4 + 1 Model of Resident Ambulatory Training

Cited by 50 publications

References 8 publications

Is Training in a Primary Care Internal Medicine Residency Associated with a Career in Primary Care Medicine?

Is Training in a Primary Care Internal Medicine Residency Associated with a Career in Primary Care Medicine?

Why Aren’t More Primary Care Residents Going into Primary Care? A Qualitative Study

Use of Team-Based Learning Pedagogy for Internal Medicine Ambulatory Resident Teaching

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