501 CONTINUITY IN A PRIMARY CARE RESIDENCY

Abstract

New Federal Regulations now require at least 25% continuity experience for housestaff participating in new federally supported 3 year Primary Care (PC) Training programs. A PC residency was established in 1973 at BCH to educate principally for inner city needs. Four cohorts of trainees (n=40) have entered training and one cohort (n=6) has completed training. The program is characterized by a psychosocial curriculum, integration of pediatric and internal medicine pathways, multidisciplinary faculty, and the use of multiple ambulatory sites. Continuity occupies 10% of year 1, either in hospital or neighborhood health center. Continuity increases to 20% for 1/2 of year 2 and is followed by a 6 month period of 30%. During year 3, 40% time is spent in continuity clinic following patients longitudinally as well as in selected specialty clinics. During continuity, residents provide care to an identified panel of families. Total continuity for the three year program is 26% meeting the federal requirement. A modified pairing system has been established to free housestaff for expanded educational and clinical experiences Small structural changes in scheduling without major change in the number of housestaff allowed the added continuity experiences These changes included giving up elective time during years 2 and 3 to meet both service and educational requirements. Continuity is an important feature of PC Training and achieving a 25% goal requires multiple strategies.