Continuity Clinic Experience Research Articles

Factors Influencing Primary Care Career Choice: A Multi-Institutional Cross-sectional Survey of Internal Medicine Primary Care Residency Graduates.

Although primary care is associated with population health benefits, the supply of primary care physicians continues to decline. Internal medicine (IM) primary care residency programs have produced graduates that pursue primary care; however, it is uncertain what characteristics and training factors most affect primary care career choice. To assess factors that influenced IM primary care residents to pursue a career in primary care versus a non-primary care career. Multi-institutional cross-sectional study. IM primary care residency graduates from seven residency programs from 2014 to 2019. Descriptive analyses of respondent characteristics, residency training experiences, and graduate outcomes were performed. Bivariate logistic regression analyses were used to assess associations between primary care career choice with both graduate characteristics and training experiences. There were 256/314 (82%) residents completing the survey. Sixty-six percent of respondents (n = 169) practiced primary care or primary care with a specialized focus such as geriatrics, HIV primary care, or women's health. Respondents who pursued a primary care career were more likely to report the following as positive influences on their career choice: resident continuity clinic experience, nature of the PCP-patient relationship, ability to care for a broad spectrum of patient pathology, breadth of knowledge and skills, relationship with primary care mentors during residency training, relationship with fellow primary care residents during training, and lifestyle/work hours (all p < 0.05). Respondents who did not pursue a primary care career were more likely to agree that the following factors detracted them from a primary care career: excessive administrative burden, demanding clinical work, and concern about burnout in a primary care career (all p < 0.05). Efforts to optimize the outpatient continuity clinic experience for residents, cultivate a supportive learning community of primary care mentors and residents, and decrease administrative burden in primary care may promote primary care career choice.

Internal Medicine Residents' Perceptions of Their Continuity Clinic Training.

Internal Medicine (IM) residents have reported dissatisfaction with continuity clinic (CC) training, which may contribute to the increasing shortage of primary care physicians. Studies show balancing inpatient and outpatient duties as a driver of dissatisfaction, but few studies have compared CC with inpatient (IP) training, following transition to an X + Y model, or assessed the impact of show rates, continuity, and telemedicine use on resident perceptions. The aim of this study was to adapt a validated survey to compare residents' perceptions of their CC with their inpatient medicine training and examine the impact of objective clinic measures on training. This quantitative cross-sectional study included a survey that was sent to 152 residents at an academic IM program in May-June 2021. Clinic measures such as show versus no-show rates, continuity with the residents' own patients, and visit modality were obtained through the electronic health records at Veterans Affairs and non-Veterans Affairs CCs. The survey response rate was 78% (118/152). Residents were more satisfied with inpatient general medicine rotations than their CC experience (4.5 vs 3.3 on a 5-point scale, P < 0.001). Residents were more likely to pursue a profession in inpatient IM than in primary care (3.7 vs 2.3, P < 0.001). No correlation was found between higher show rates, continuity with patients, or proportion of visits conducted through telemedicine and resident satisfaction with CC. This study aligns with previous findings of IM resident dissatisfaction with CC training while adding a side-by-side comparison to inpatient training and including objective CC data. We identified new areas for improvement of CC training, including residents' medical knowledge through review of quality metrics, making CC representative of real-world practice, and mentorship from faculty.

Management of the Electronic Health Record Inbox: Results From a National Survey of Internal Medicine Program Directors.

Background Internal medicine (IM) resident physicians spend a considerable amount of time managing their inbox as part of their longitudinal continuity clinic experience. There are no standardized guidelines for how programs should train, monitor, or supervise residents in this type of patient care. Objective To understand how IM residency programs educate, monitor, and supervise resident electronic health record (EHR) inbox management as part of their longitudinal continuity clinic and determine whether patient safety events have occurred due to EHR inbox-related patient care decisions made by unsupervised resident physicians. Methods In August 2021, 439 program directors at accredited US IM residency programs who were members of the Association of Program Directors in Internal Medicine (APDIM) were asked 12 questions developed by the study authors and APDIM survey committee members regarding resident EHR inbox management as part of the annual APDIM survey. Results Two hundred and sixty-seven (61%) PDs responded. The majority (224 of 267, 84%) of programs provided guidelines for expected message response times; less than half (115, 43%) monitored timeliness metrics. Only half (135; 51%) of programs required faculty supervision of inbox messages for all residents; 28% (76) did not require supervision for any residents. Twenty-one percent of PDs (56) reported awareness of a patient safety event occurring due to an unsupervised resident inbox-related patient care decision. Conclusions Substantial variability exists in how IM residency programs train, monitor, supervise, and provide coverage for resident inbox work. Program directors are aware of patient safety events resulting from unsupervised resident inbox management.

Resident Visit Productivity and Attitudes About Continuity According to 3 Versus 4 Years of Training in Family Medicine: A Length of Training Study.

Training models in the Length of Training Pilot (LOTP) vary. How innovations in training length affect patient visits and resident perceptions of continuity is unknown. We analyzed resident in-person patient encounters (2013-2014 through 2018-2019) for each postgraduate year (PGY) and total visits at graduation derived from the Accreditation Council for Graduate Medical Education reports for each LOTP program. We collected data on residents' perceptions of continuity from annual surveys (2015-2019). We analyzed continuous variables using independent samples t tests with unequal variance and categorical variables using χ2 tests in comparing 3-year (3YR) versus 4-year (4YR) programs. PGY-1 and PGY-2 residents in 4YR programs saw statistically more patients than their counterparts in 3YR programs. In PGY3, 3YR program residents had statistically higher visit volume compared to 4YR program residents. Visits conducted in PGY4 ranged from 832 to 884. The additional year of training resulted in approximately 1,000 more total patient visits. Most residents in 3YR and 4YR programs rated their continuity clinic experience as somewhat or very adequate (range 86.3% to 93.7%), which did not statistically differ according to length of training. Resident visits were significantly different at each PGY level when comparing 3YR and 4YR programs in the LOTP and the additional year of training resulted in about 1,000 more total visits. Resident perspectives on the adequacy of their continuity clinic experience appeared to not be affected by length of training. Future research should explore how the volume of patient visits performed in residency affects scope of practice and clinical preparedness.

Education Research: Appraisal of Outpatient Clinical Experience During Neurology Residency.

Outpatient clinical experience is a key component of neurology residency. Understanding the educational environment for residents in the outpatient setting can inform educators to maximize teaching and learning opportunities, enhance resident exposure to subspecialty diagnoses and management, and deliver quality care. We studied the continuity clinic experience of 5 neurology residents over the course of their residency to determine the breadth of their ambulatory experience. We used administrative health data from new and return patient visits scheduled with 5 neurology residents of the same class over 3 years of continuity clinic. International classification of disease codes pertaining to neurologic diagnoses and symptoms associated with these visits were analyzed. Frequency and proportions of the most commonly evaluated diagnoses and symptoms were tabulated. These were compared with previously published data about resident experience during training. We also analyzed resident experience over time. Five neurology residents evaluated 948 patients (mean 189.6; range 180-202; 59.2% female) during 2,699 clinic visits (mean 539.8; range 510-576) over 3 years in their continuity clinics. There were 6,555 international classification of disease codes associated with these visits (2,948 [44.9%] neurologic diagnoses, 2,249 [34.3%] neurologic symptoms, and 1,358 [20.8%] comorbidities). The most common neurologic diagnoses were as follows: headache disorders (24.5%), neuromuscular disorders (17.3%), movement disorders (12.1%), cerebrovascular disorders (11.5%), and epilepsy (7.5%). The most common neurologic symptoms evaluated by residents were as follows: seizure-like events (16.5%), sensory symptoms (12.4%), pain (10.3%), headache (9.7%), and motor symptoms (8.1%). The clinical experience of residents in the continuity clinic was diverse, but it was skewed toward headache, neuromuscular, and movement disorders, which constituted 54% of the workload. When compared with previous studies, the range of resident's outpatient clinical experience differed from that of inpatient experience. Based on the results of this study, we made changes to our outpatient curriculum by adding 2-month-long rotations in subspecialty clinics from postgraduate year 2 to 4 with the aim of boosting resident exposure to neurologic disorders in the outpatient setting.

Culture and language coaching for bilingual residents: the first 10 years of the CHiCoS model

Problem In the US, there are neither professional standards nor adequate formal training opportunities related to physician use of non-English languages, the most common of which is Spanish. To achieve safe, effective health care for culturally and linguistically diverse patients, the medical profession needs clear standards for physician language use and proven culture and language training models that include validated assessment of linguistic proficiency. Intervention The authors describe the first decade of an innovative culture and language coaching program for bilingual (Spanish-English) pediatric residents, including the model’s evolution and outcomes, as well as recommendations for implementing similar programs elsewhere. Over 10 years, the model has grown from a central innovation—the professional culture and language coach (CLC). The CLC provides 1:1 in-visit support and post-visit coaching to individual residents during three years of continuity clinic experience in a Spanish-language setting (Clínica Hispana de Cuidados de Salud—CHiCoS). They also provide a range of supplementary learning activities (e.g., simulations, immersion rotations, mock testing) and periodic formal assessment of language proficiency. Foundational program elements include cultural and linguistic humility, variations in language, pragmatic linguistics and trans-languaging, the inseparability of culture and language, health literacy, and a flat teaching hierarchy (“all teach, all learn”). Context CHiCoS has been implemented continuously since 2009 in the primary care clinic of a stand-alone academic pediatric hospital in the Midwest, where pediatric residents have their continuity clinic experience over three years of residency. Impact Fifty-six residents have participated, reporting improved language skills, cultural knowledge, and ability to care for Spanish-speaking patients. Sixty-eight percent of residents not qualified bilingual upon program entry passed a validated physician language assessment by graduation. Spanish-speaking patients seen by CHiCoS residents and faculty reported higher satisfaction, trust, and communication scores than those seen in non-bilingual areas of the same clinic (p < .05 for all scores). The program increased bilingual faculty six-fold and changed attitudes and practices related to language supports throughout the residency program. Lessons Learned Culture and language coaching provides effective preparation and assessment of bilingual physicians, leading to improved care for culturally and linguistically diverse patients. Our model offers an example for developing similar approaches for a variety of clinicians throughout health care. Such approaches should include professional standards for non-English language use, training supports customized to bilingual learners’ proficiency levels, and a focus on integrating practical cultural and linguistic skills to achieve safe, effective clinical communication.

Optimizing the fellow oncology continuity clinic: Factors associated with a meaningful experience.

e23012 Background: Fellowship programs use a variety of continuity clinic models including general, disease/system specific, or both. The longitudinal timing also varies from 6-months, 1-year, or the entirety of fellowship. At WVU, we use a 6-month disease specific model where fellows rotate with a specific attending. Given the increasing complexity of care for patients with oncologic diagnoses, we sought to establish a general continuity clinic within an academic cancer institute to model the skills needed to effectively transition to independent practice. Additionally, we proposed to identify key elements that make for a meaningful continuity clinic experience. Methods: We created a 42 question, anonymous online survey comparing general clinic to the disease specific clinic and administered it to our current 2nd and 3rd year fellows. Independent variables were Likert-scale ratings (1=strongly disagree, 2= disagree, 3=neutral, 4=agree, 5=strongly agree) on four main themes: patient characteristics, clinic operations, preceptor characteristics, and educational value. Results: Seven out of seven fellows responded. The majority of them answered that 1 new patient and 4 return patients were “just right” per half day of general clinic, while 1-2 new patients and 5 or more return patients were “just right” per half day of disease specific clinic. Within the general clinic, the number of patients with lung, GU, and GI oncology was noted as “just right” while breast and other (e.g., CNS, head and neck, sarcoma) were identified as “too few”. Table shows a sample of questions asked and differences among the two clinics. The most evident disparity was autonomy of patients. A weekly, multispecialty planning session was also rated highest in terms of educational value for general clinic. Conclusions: We demonstrated a general continuity clinic can be successfully implemented within an academic cancer center. While there are pros and cons to both types, several key characteristics to a meaningful continuity clinic experience were identified including: adequate ratio of new and return patients, wide variety of diagnoses, increased autonomy and ownership of patients, consistent preceptor and support staff, and weekly planning session for increased preparation and educational value.[Table: see text]

Continuity Clinic Experience in Neurology Residency (P8-6.001)

Continuity Clinic Experience in Neurology Residency (P8-6.001)

Impact of X+Y Scheduling on Pediatric Resident and Faculty Perceptions of Education and Patient Care.

Traditional half-day per week continuity clinic experiences can lead to fragmented education in both the inpatient and outpatient arenas. Five pediatric residency programs were granted the ability from the ACGME to create X+Y scheduling where residents have continuity clinic in "blocks" rather than half-day per week experiences. The aim of this study is to assess the impact X+Y scheduling has on pediatric resident and faculty perceptions of patient care and other educational experiences. Electronic surveys were sent to residents and faculty of the participating programs both prior to and 12 months after implementing X+Y scheduling. Survey questions measured resident and faculty perception of continuity clinic schedule satisfaction and the impact of continuity clinic schedules on inpatient and subspecialty rotation experiences using a 5-point Likert Scale. Data were analyzed using z-tests for proportion differences for those answering Agree or Strongly Agree between baseline and post-implementation respondents. Hundred and twenty-six out of 186 residents (68%) responded preimplementation and 120 out of 259 residents (47%) responded post-implementation. 384 faculty members were sent the survey with 51% response pre-implementation and 26% response at 12 months. Statistically significant (P < .05) improvements were noted in resident and faculty perceptions of ability to have continuity with patients and inpatient workflow affected by clinic scheduling. From both resident and faculty perspectives, X+Y scheduling may improve several aspects of patient care and education. X+Y scheduling could be considered as a potential option by pediatric residency programs, especially if validated with more objective data.

Factors Associated with a Career in Primary Care Medicine: Continuity Clinic Experience Matters.

Due to concerns of inadequate primary care access, national agencies like the Health Resources and Services Administration (HRSA) support primary care (PC) residencies. Recent research demonstrates that up to 35% of PC alumni lost interest in PC during residency. These alumni who lost interest noted that their continuity clinic experience influenced their career choice. The purpose of this study was to identify the specific aspects of PC residency experience that influenced career choice. We conducted a cross-sectional electronic survey of a PC internal medicine alumni cohort (2000-2015) from a large, academic residency. Our primary predictor was PC career and our primary outcome was influential factors on career choice. We performed chi-squared or Fisher's exact tests for categorical variables and t tests for continuous variables. Of the 317 PC alumni in the last 15 years, 305 were contacted. One hundred seventy-two (56%) responded with 94 (55%) reporting current careers in PC and 78 (45%) in non-PC fields. Ninety-four percent of respondents expressed interest prior to residency, while only 68% remained interested at the conclusion of residency. Sixty-one percent of PC alumni rated the overall clinic experience as the most influential factor towards their ultimate career choice. The patient-physician relationship was the most frequently endorsed positively influential factor in career choice in both groups (95% of PC alumni, 76% non-PC). There was no difference among all alumni in common frustrations of clinic including clerical duties, encounter documentation, or visit length. Similarly, resident debt did not differ between groups. Strong interpersonal relationships with patients and clinic mentors were associated with a PC career. These factors may compensate for the reported frustrations of clinic. Enhancing patient and mentor relationships may increase the retention of PC residents in ambulatory careers and may help address the current and projected shortage of primary care physicians.

Satisfaction of General Versus Specialized Continuity Clinic in Hematology Oncology Fellowship Training: A Survey.

Background:At the University of Florida (UF), hematology-oncology (HO) fellows participate in 2 general types of continuity clinic as part of their fellowship training. One clinic, at the Veterans Hospital (VA), allows fellows to care for patients with a variety of hematology oncology diagnoses in a general clinic setting. The other clinic, located at the university site, is disease or system specific (such as breast or GI clinic). Considerable research supports the value of continuity clinic in residency and fellowship training, but the differences in having a general versus specialized clinic for HO fellows have not been explored. The purpose of this study was to investigate the perceived differences of general versus specialized continuity clinics by recent HO graduates from UF. Specifically, we were interested in learning which features of a continuity clinic they felt were most impactful for their current clinical practice.Methods:An anonymous survey was sent to the last 6 graduating classes of HO fellows at UF, between years of 2013 and 2018. The survey contained short demographic questions, followed by 5 open ended questions pertaining to the differing continuity clinic experiences. Graduates were asked about their opinions of both the general and specialized clinics during their training at UF. Survey responses were reviewed and coded for common themes by the authors.Results:Of 28 graduating fellows surveyed, 13 responded to the survey (response rate 46%). In thematic review of survey responses, the most common themes that emerged concerned autonomy, level of supervision, and the diversity of the patient population. A majority of respondents felt they had more autonomy and personal responsibility at the VA general clinic, but less direct supervision than at the specialized clinics. They also believed they got a broader exposure to different disease types at the VA general clinic. Surveyed participants also commented on the quality of educational seminars and activities, preceptor expertise and teaching, and ability to observe cutting edge practice and clinical trials.Conclusions:Graduated oncology fellows from UF believe that there is a balance that exists between having autonomy and ownership of their patients versus having adequate supervision. Many believe that having “controlled autonomy” and “as much independence as is safe for patients” is key to a meaningful continuity clinic experience during oncology fellowship training.

Creating a Satisfying Continuity Clinic Experience for Primary Care Trainees

The considerable gap in the primary care workforce of the United States is anticipated to widen over the next 10 to 15 years.1 Numerous physician groups have called for increased focus on primary care training in medical education.2-4 In 2009, the Accreditation Council on Graduate Medical Education (ACGME) mandated an increase for ambulatory training during internal medicine residency, requiring a minimum of 130 half-day clinics over 3 years. This increased requirement presupposes that greater exposure will inevitably lead to more primary care physicians, but some have argued it is increased exposure to high-quality, high-functioning primary care experiences that inspire trainees to contemplate a career in primary care.

2. IMPACT OF X+Y SCHEDULING ON FACULTY PERCEPTIONS OF RESIDENT EDUCATION - RESULTS FROM THE PEDIATRIC X+Y SCHEDULING COLLABORATIVE

Background Traditional half-day per week continuity clinic experiences can lead to fragmented education in both the inpatient and outpatient arenas. Five pediatric residency programs were granted the ability from the ACGME in 2018 to create true X+Y scheduling models where residents see continuity clinic patients in blocks rather than half-day per week experiences. Objective Assess the impact X+Y scheduling has on pediatric faculty perceptions of patient care and other educational experiences. Methods Surveys were sent via REDCap to faculty of the five participating X+Y pilot programs both prior to and 12 months after implementing an X+Y scheduling model. The surveys elicited the clinical focus of the faculty (general pediatrics, hospital medicine, or other subspecialties). Questions were then tailored to the area of clinical focus to determine the impact continuity clinic schedules had on general pediatrics, hospitalist, and subspecialty rotation experiences using a 5-point Likert scale. Data were analyzed using z-tests for proportion differences for those answering Agree or Strongly Agree between baseline and post-implementation respondents. Results 384 faculty members were sent the survey with 51% response pre-implementation and 32% response at 12 months. Each general pediatrics faculty outcome was improved in the X+Y model compared to traditional clinic schedules (p Conclusions General pediatric and hospitalist faculty perceive improved patient continuity and enhanced educational opportunities in X+Y scheduling compared to traditional half-day per week continuity clinics. Hospitalist and other subspecialty faculty note no significant impact on educational time after X+Y schedule implementation.

80. X+Y SCHEDULING IMPROVES SEVERAL ASPECTS OF RESIDENT EDUCATION YEAR 1 RESULTS FROM THE PEDIATRIC X+Y SCHEDULING COLLABORATIVE

Background Traditional half-day per week continuity clinic experiences can lead to fragmented education in both the inpatient and outpatient arenas. Five pediatric residency programs were granted the ability from the ACGME in 2018 to create true X+Y scheduling models where residents see continuity clinic patients in “blocks” rather than half-day per week experiences. Objective Assess the impact X+Y scheduling has on pediatric resident perceptions of patient care and other educational experiences. Methods Surveys were sent via REDCap to pediatric residents of the five participating X+Y pilot programs both prior to and 12 months after implementing an X+Y scheduling model. Survey questions measured resident perception of outpatient continuity, clinic schedule satisfaction, and the impact continuity clinic schedules had on inpatient and subspecialty rotation experiences using a 5-point Likert scale. Data were analyzed using z-tests for proportion differences for those answering Agree or Strongly Agree between baseline and post-implementation respondents. Results 126 out of 183 residents responded to the pre survey and 122 out of 259 residents responded to the post-implementation survey. Each outcome measure evaluated showed significant difference (p Conclusions Residents perceive improved patient continuity and better quality of inpatient handoffs along with enhanced educational opportunities in X+Y scheduling compared to traditional half-day per week continuity clinic scheduling.

The George Washington University School of Medicine and Health Sciences.

The George Washington University School of Medicine and Health Sciences.

48. CONTINUITY CLINIC PRACTICE FEEDBACK: WHAT DO RESIDENTS WANT?

Background The Accreditation Council of Graduate Medical Education (ACGME) recommends that residents receive data on quality metrics and benchmarks related to patient care. Continuity clinic (CC) is an ideal setting to obtain practice habit data. Objective To determine which CC practice habit data residents would find beneficial to receive during feedback. Methods A multicenter qualitative study was conducted with pediatric continuity clinic residents at 3 academic medical centers in two different phases. During phase 1, small resident focus groups were conducted at each site. The focus groups explored preferred content feedback on CC practice habit data. The qualitative data were reviewed by all investigators to identify major themes. For the second phase of the study, the results obtained from the focus group were used to develop a survey in order to determine how strongly residents felt about the particular areas of feedback that were identified in phase one of the study. This survey, which utilized a 5-point Likert scale to determine the importance of each feedback item, was sent out electronically to all categorical residents at each academic center. Results were analyzed with the mean and standard deviation for each question calculated. Results Focus groups were held at 3 sites with 3-10 residents per focus group. Consistent major themes which arose from the focus groups at all sites as desired areas to receive feedback on CC practice included the following categories: patient panel characteristics, quality measures, measures of efficiency in patient care, population management and information on specific patients. For the second phase of the study, 277 residents received the survey with 92 responding (33% response rate). The mean value that residents placed on the importance of each content area is displayed (table 1) with 1 being not important at all and 5 being very important. Conclusion Residents are interested in receiving practice habit data from continuity clinic. Presentation of the feedback described may enhance the resident continuity clinic experience and improve overall performance and enhance patient care.

Satisfaction of general versus specialized continuity clinic in hematology oncology fellowship training: A survey.

10529 Background: At the University of Florida (UF), oncology fellows participate in two general types of continuity clinic as part of their training. One clinic at the Veterans Hospital (VA) allows them to care for patients in a general clinic setting that encompasses a variety of hematology oncology diagnoses. The other clinic, located at the university site, is disease or system specific (such as breast or GI clinic). Considerable research supports the value of continuity clinic in residency and fellowship training, but the differences in having a general versus specialized clinic for oncology fellows have not been explored. The purpose of this study is to investigate the perceived differences of general versus specialized continuity clinics by recent oncology graduates from UF, and what features of a continuity clinic they feel were most important for an effective and meaningful experience. Methods: An anonymous survey was sent to the last six graduating classes of oncology fellows at UF. The survey contained short demographic questions, followed by five open ended questions pertaining to both continuity clinic experiences. Graduates were asked about their opinions of both the general and specialized clinics during their training at UF. Survey responses were reviewed and coded for common themes. Results: The most common themes that emerged from the surveys were concerning autonomy, supervision, and the diversity of cases and patient population. A majority of respondents felt they had more autonomy and personal responsibility at the VA general clinic, but less direct supervision than at the specialized clinics. They also believed they got a broader exposure of different disease types at the VA general clinic. Surveyed participants also commented on the quality of educational seminars and activities, preceptor expertise and teaching, and ability to observe cutting edge practice and clinical trials. Eleven out of thirty surveys were returned and we anticipate a greater than 50% response for the final poster. Conclusions: Graduated oncology fellows from UF believe that there is a balance that exists between having autonomy and ownership of their patients versus having adequate supervision. Many believe that having “controlled autonomy” and “as much independence as is safe for patients” is key to a meaningful continuity clinic experience during oncology fellowship training.

An Intensive Continuity Clinic Immersion Experience for Interns: A Springboard to Confidence and Satisfaction With Continuity Clinic.

Providing a robust continuity clinic experience is difficult due to uneven distribution of resident time. Immersion experiences early in training may improve residents' learning experiences. We designed and implemented a continuity immersion experience to improve internal medicine interns' satisfaction and confidence with their outpatient skills, and we evaluated the timing of the experience and its benefits for learners. Two cohorts of interns at 1 academic institution participated in a 3-week immersion block (during the first or second quarter of the intern year). Interns were surveyed twice about satisfaction and confidence. Analysis included independent and paired sample t tests to compare interns' responses pre- and postimmersion, and to evaluate effects over time. A total of 124 interns completed the immersion, with a survey response rate of 61%. Interns' self-rated confidence on a 5-point Likert scale improved significantly compared with preimmersion in the areas of medical knowledge and confidence with their electronic health record and communication skills (P ≤ .010 for all assessments). Interns reported high satisfaction with continuity clinic following immersion (cohort 1: 4.5 ± 0.54; cohort 2: 4.3 ± 0.68; on a 5-point scale with 5 = very satisfied). Improvements in knowledge, skills, and satisfaction in cohort 1 were sustained over 3 months. A 3-week immersion experience in the first 6 months of residency improved interns' confidence in ambulatory content areas and satisfaction with clinic.

Are Graduating Residents Trained and Prepared to Engage in Medical Home Activities in Practice?

A national, random sample of 1000 graduating pediatric residents was surveyed in 2014 on receipt of training in medical home activities and preparedness to engage in same in practice. Of 602 survey respondents (60% response), 71.8% reported being very/fairly knowledgeable about medical homes. Most residents (70.0% to 91.3%) reported they received training in 6 medical home activities; more than one fourth wished for more training in 4 of 6 activities. The majority (62.5% to 77.3%) reported very good/excellent perceived preparedness. Residents with continuity clinic experiences at 2 or more sites and with continuity clinic experience at a community health center were more likely to report very good/excellent preparedness in multiple medical home activities. Overall, residents feel knowledgeable, trained, and prepared to engage in medical home activities as they are leaving residency. Opportunities exist to further explore the influence of additional training in specific activities and the number and type of training site experiences on perceived preparedness.

Satisfaction

INTRODUCTION: Low provider satisfaction has been documented in trainee ambulatory clinics across specialties, despite the importance of ambulatory care and patient management. Our OB-GYN ambulatory clinic uses limited resources to serve a diverse, underserved population. We hypothesized that there was discordance between provider perception of patient satisfaction and patient reported experience. METHODS: We designed and piloted a provider and patient survey to assess satisfaction with all aspects of the clinic experience. We also asked providers to comment on how they perceived patient satisfaction. Patients were approached during their clinic visit and providers were invited to complete the survey during staff meetings. RESULTS: Of the 314 eligible patients, 200 (64%) completed surveys. Of the 32 residents invited to participate 28 (88%) completed surveys. Patients were racially diverse (33% White, 25.1% Black, 32.5% Hispanic), and were present for obstetric, gynecologic and specialty appointments (67, 27.6, 5.4% respectively). Resident providers uniformly underestimated patient satisfaction in every element of care (P<.0001), with biggest discrepancies in perception of registration, waiting room, the rooming process, continuity, and education. Patients reported feeling most respected by doctors when compared to other clinic staff. CONCLUSION: Residents perceive lower patient satisfaction than patients self-report. Resident dissatisfaction with the continuity clinic experience may be linked to the perception of providing suboptimal care. Resident ambulatory care experiences may be improved through setting realistic expectations and sharing formal patient feedback.