“Block” Ambulatory Schedules For Residents Have Advantages And Disadvantages

Two articles discuss new ways of scheduling continuity clinic for internal medicine residents.  Both systems keep residents completely out of their continuity clinic during their inpatient rotations, and increase the total number of hours spent in clinic.  Comparisons were made to the previous year’s traditional weekly clinic model.  In both new systems, there were modest increases in resident patient panel sizes.  In the “4+1” model (4 weeks inpatient alternating with 1 week outpatient), residents were overall more satisfied with clinic and felt less conflicted between inpatient and outpatient responsibilities.  However, they were less likely to think that outpatient medicine was an enjoyable field.  Problems with the new systems included diminished continuity of care, difficulties with evaluations of residents, and difficulty following up on teaching points. – Laura Willett, MD

Wieland ML, Halvorsen AJ, Chaudhry R, Reed DA, McDonald FS, Thomas KG. An Evaluation of Internal Medicine Residency Continuity Clinic Redesign to a 50/50 Outpatient–Inpatient Model. J Gen Intern Med. 2013 Aug; 28(8): 1014–1019.

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Saima I. Chaudhry, Sandy Balwan, Karen A. Friedman, Suzanne Sunday, Basit Chaudhry, Deborah DiMisa, Alice Fornari Moving Forward in GME Reform: A 4 + 1 Model of Resident Ambulatory Training. J Gen Intern Med. 2013 Aug; 28(8): 1100–1104.

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