Assistant Professor Northwestern University The Feinberg School of Medicine Chicago, Illinois, United States
Background: Balancing inpatient and outpatient clinical service and education is a common challenge in pediatric residency programs. Our program piloted a transition from one half-day continuity clinic session per week to two full-day clinic sessions per month in one of our continuity clinics from March through October 2023. Objective: To determine the impact of a full-day continuity clinic pilot on 1) provider continuity (PC) at well child and follow-up visits and 2) resident and attending experience. Design/Methods: Encounter data (visit date, visit provider, primary care provider [PCP], and visit type) were extracted from the electronic medical record from November 1, 2022 to June 30, 2023 for residents participating in the pilot and those in an unchanged clinic session used as a control. New and sick visits were excluded. Continuity was considered met if visit provider = PCP and was calculated using frequency analysis. Unpaired t-tests were used to compare continuity between the pilot and control clinic sessions and to assess change over time. Surveys were distributed to residents and attendings at 3 months (wave 1) and 7 months (wave 2) after pilot implementation. Survey responses were coded as “positive” if 4 or 5, on a scale of 1 to 5. Frequency analysis was used to assess resident and attending perceptions of continuity clinic. Unpaired t-tests were used to compare change between baseline and 3 months and baseline and 7 months. Results: A total of 2077 visits were included in the PC analysis. Overall PC during the study period was 76% for both the full-day pilot and control clinic sessions (p not calculated). PC for visits by full-day clinic residents was 76.3% before and 74.7% after pilot implementation (p=0.55). Survey completion rates were 45% (44/99) for baseline & wave 1 and 34% (34/99) for wave 2. After 3 months, 67% of pilot residents were satisfied with the pilot. At 7 months post implementation, 12% were satisfied and 50% felt it had not affected them. Residents perceived inpatient coverage was either negatively (40%) or neutrally (52%) impacted. Pilot residents reported decreased comradery after 7 months (Table 1). Pilot clinic attendings reported overall satisfaction of 25% at 3 months and 50% at 7 months.
Conclusion(s): A twice monthly full day continuity clinic pilot did not negatively impact continuity. Most residents either felt satisfied with the pilot or felt that the change had not affected them. There was a statistically significant negative impact on comradery among pilot residents. Residents noted an overall neutral impact on inpatient coverage. Attending satisfaction was mixed.
