Abstract
Dermatology residents perform consults on hospitalized patients, but are often limited in their ability to follow-up with these patients after discharge, leading to inadequate follow-up and understanding of post-discharge transitions of care. In 2013, a discharge continuity clinic (DCC) staffed by the inpatient consult dermatology resident and attending dermatologist was established at one of the four adult hospital sites residents rotate through in the Harvard Combined Dermatology Residency Program. Resident perceptions about the DCC and their educational experience on inpatient consult rotations with a DCC and without a DCC were obtained using a cross-sectional survey instrument in June 2016. Self-reported data from a multi-year cohort of dermatology residents (n = 14 of 20, 70% response rate) reveals that the DCC enabled resident autonomy and resident satisfaction in care of their patients,insight into the disease-related challenges and the broader social context during transitions of care from inpatient to outpatient settings, and more enriching learning experiences than inpatient consult rotations without a DCC. Dermatology residents self-report participation in an inpatient consult rotation with aDCC supports their autonomy and achievement of post-discharge transitions-of-care competencies.
Highlights
Inpatient consults provide a unique and valuable learning experience for dermatology residents [1]
In June 2016, there were a total of 27 residents in the Harvard Combined Dermatology Residency Program (HCDRP), 20 of which were eligible for this study
The majority of respondents described their experience in the discharge continuity clinic (DCC) as “rewarding” (100%), “empowering” (93%), “satisfying” (93%), “confidence-building” (86%), “autonomous” (71%), and “humanizing” (64%) as shown in Figure 1; less than half of the respondents characterized their DCC experience as “hectic”, “stressful”, “frustrating”, or “marginalizing”
Summary
Inpatient consults provide a unique and valuable learning experience for dermatology residents [1]. A common scenario for a dermatology resident rotating through an inpatient consultation services is to provide an in-hospital evaluation for a patient they are unlikely to see again posthospitalization. In 2012, dermatology residents at our institution noted there were limited opportunities for post-discharge follow-up of patients seen on inpatient consults. To address this educational gap, we instituted a weekly discharge continuity clinic (DCC) for dermatology residents during inpatient consult rotations at one of the four main adult academic hospital sites at our program. We describe the DCC design, implementation, and initial evaluation of the DCC with cross-sectional resident survey data
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