Care In Resident Clinics Research Articles

THU006 Exploring Primary Care Resident Perspectives On Diabetes Education In Training

Abstract Disclosure: N. Francis: None. S. Cardillo: None. D.R. Nandiwada: None. Background: The training residents gain in Family Medicine (FM) and Internal Medicine (IM) residency programs provide a critical foundation for their knowledge in diabetes (DM) management. It is one of the most common diagnoses physicians-in-training will encounter in their residency training programs and in clinical settings. However, a 2012 study compared diabetes care in resident clinics versus private physicians and found significant decrease in patient satisfaction (56.5% vs. 71.3%) in resident clinics. A 2020 study surveying primary care (PC) residency program directors showed that most FM and IM residency training programs focus on the core diabetes care and management topics with much less focus on emerging topics, such as 2nd generation insulin analogs and digital health technologies. The purpose of our survey was to better assess current resident perceptions and attitudes towards their DM education and their perceived comfort level in comprehensive DM counseling, evaluation, and management. Methods: A 12 item survey was designed using the Qualtrics program. The survey link was sent via email to IM- PC and FM residents at a major academic medical center. Data was collected from September 13th, 2022 to present. The survey included a combination of multiple choice, Likert scale and ranking questions. Results: 14 residents responded to the survey to date with the majority (71%) belonging to the IM-PC group and the remainder (29%) family medicine. Residents felt most comfortable managing diabetes related complications and counseling on foot and eye care and hypoglycemia. Respondents reported being most uncomfortable in prescribing non-insulin medication (50%) and initiating an insulin regimen (43%) and less comfortable counseling patients on continuous glucose monitoring systems (83%) and insulin administration (66%). While majority of residents (72%) found their DM curriculum clinically relevant, 85% of residents reported there was not enough time allotted. Respondents felt a more longitudinal lecture series, with increased access to treatment frameworks and on-site feedback on their DM counseling and care would best supplement their DM curriculum. Conclusion: This survey data explores specific areas that residents have identified as being least comfortable and also expresses what they identified as the most preferable ways to modify and design an educational intervention. This information allows for tailored curricular intervention highlighting diabetes technologies, insulin and non-insulin prescribing practice in a longitudinal lecture style format that provides access to DM treatment frameworks and incorporates direct on-site feedback to the residents. This provides evidence for the development of a novel clinically integrated DM curriculum. Presentation: Thursday, June 15, 2023

A quality improvement project to increase compliance with diabetes measures in an academic outpatient setting

BackgroundAmerican Diabetes Association (ADA) sets annual guidelines on preventative measures that aim to delay the onset of severe diabetes mellitus complications. Compared to private internal medicine clinics, resident clinics provide suboptimal diabetic preventative care as evidenced by decreased compliance with ADA guidelines. The purpose of our study is to improve diabetic care in resident clinics through quality improvement (QI) projects, with A1C value as primary outcome and other ADA guidelines as secondary outcomes.MethodsOur resident clinic at Beaumont Hospital, Royal Oak consists of 76 residents divided in 8 teams. In November 2016, baseline data on ADA guideline measures was obtained on 538 patients with diabetes mellitus. A root cause analysis was conducted. 5 teams developed a QI intervention plan to improve their diabetes care and 3 teams served as comparisons without intervention plans. In November 2017, post-intervention data was collected.ResultsBaseline characteristics demonstrate mean age of intervention groups at 60.9 years and of comparison groups at 58.9 years. The change in A1C value from baseline to post-intervention was + 0.09 vs. + 0.322 in the intervention and comparison groups respectively (p = 0.174). As a group, the changes in secondary outcome measures were as follows: eye examinations (+ 5% in intervention vs. -7% in comparison, p < 0.01), foot examinations (+ 13% vs. + 5%, p = 0.09), lipid panel testing (+ 7% vs. -5%, p < 0.01), micro-albumin/creatinine ratio testing (+ 4% vs. + 1%, p = 0.03), and A1C testing (+8% vs. + 5%, p = 0.24).ConclusionsWhile the QI project did not improve A1C value, it did have significant improvement in several secondary outcomes within intervention groups. One resident team implemented an intervention involving protected half-day blocks to identify overdue examinations and consequently had the largest improvements, thus serving as a potential intervention to further study. Given our study results, we believe that QI interventions improve preventative care for patients with diabetes in resident clinics.

We’re better together: A curriculum for enhancing interprofessional care in resident clinic

We’re better together: A curriculum for enhancing interprofessional care in resident clinic

Improving asthma care in a pediatric resident clinic

There is variation in pediatric asthma management in the outpatient setting. Adherence to national asthma guidelines provides a systematic standardized approach to asthma management. There is a gap between usual...

Resident Physician Perspectives on Outpatient Continuity of Care

The outpatient continuity clinic is an essential component of internal medicine residency programs, yet continuity of patient care in these clinics is suboptimal. Reasons for this discontinuity have been inadequately explored. We sought to assess perceived factors contributing to discontinuity in trainee ambulatory clinics. The study encompassed 112 internal medicine residents at a large academic medical center in the Midwest. We conducted 2hours of facilitated discussion with 18 small groups of residents. Residents were asked to reflect on factors that pose barriers to continuity in their ambulatory practice and potential mechanisms to reduce these barriers. Resident comments were transcribed and inductive analysis was performed to develop themes. We used these themes to derive recommendations for improving continuity of care in a resident ambulatory clinic. Key themes included an imbalance of clinic scheduling that favors access for patients with acute symptoms over continuity, clinic triage scripts that deemphasize continuity, inadequate communication among residents and faculty regarding shared patients, residents' inefficient use of nonphysician care resources, and a lack of shared values between patients and providers regarding continuity of care. The results offer important information that may be applied in iterative program changes to enhance continuity of care in resident clinics.