Should All Residency Programs Adopt The Block Ambulatory Schedule For Resident Continuity Clinic Or Stick With The Vanishing Traditional Weekly Schedule?

continuity_clinic  This study involved 11 internal medicine programs participating in the ACGME Educational Innovations Project Ambulatory Collaborative, representing both university and community-based programs utilizing a traditional weekly model, block model with separate ambulatory rotations, or a combination of both. Patient satisfaction was found to be statistically significantly higher in traditional weekly and block models compared to the combination model, though the absolute differences for most of the items were 0.1 or 0.2 points on a 1 to 6 Likert scale with overall very high means (e.g., 5.8 vs 5.7 for question on how often did this doctor show respect for what you had to say). The study also suggests patient satisfaction was correlated with better process outcomes such as HbA1C <8 and LDL <100 for patients with diabetes. Limitations of this study include its non-randomized design with multiple potential confounding variables including imbalance in patient and provider level differences among sites using different clinic models, as well as correlation without proof of causation in either the satisfaction findings or improved process outcomes for diabetes care. While the study adds to a body of evidence on this topic that is often based on pre/post designs, it’s worth noting that most residency programs have adopted changes to the resident continuity clinic model based on meeting competing demands for residency training while improving resident satisfaction, rather than improving patient satisfaction or outcomes. — Sarang Kim, MD

Link To Article (not yet available in PubMed)

Maureen D. Francis, Eric Warm, Katherine A. Julian, Michael Rosenblum, Kris Thomas, Sean Drake, Keri Lyn Gwisdalla, Michael Langan, Christopher Nabors, Anne Pereira, Amy Smith, David Sweet, Andrew Varney, and Mark L. Francis (2014) Determinants of Patient Satisfaction in Internal Medicine Resident Continuity Clinics: Findings of the Educational Innovations Project Ambulatory Collaborative. Journal of Graduate Medical Education: September 2014, Vol. 6, No. 3, pp. 470-477.
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