Professor University of Maryland School of Medicine OWINGS MILLS, Maryland, United States
Background: Although RC guidelines have changed since the late 1970s, no data has comprehensively reviewed the clinical or educational structure or function of the pediatric continuity experience. In addition, secular changes and challenges have occurred. Objective: This study explores changes and trends in resident continuity clinics over the past 30 years. Design/Methods: A survey of site characteristics as well as clinical and educational opportunities was sent 30 years ago to all continuity clinic directors (1). In 2023, the survey was expanded, and sent via RedCap to all 201 categorical pediatric training programs. Data from the 1992 study were obtained and available for comparison. Responses were compared via chi-square, t-test, and ANOVA. Results: Response rate was 75% (N =157) in 1992, and 56% (N =114) in 2023. Representative results are given comparing 2023 data to that of 1992. Continuity settings. Continuity practices shifted away from private practice sites. The majority of programs continue to have university affiliated practices (p=0.52). Clinical operations. While nearly all sites continue to have afternoon continuity sessions, many have expanded to morning sessions. More programs had variable clinic day assignments for residents. Residents saw similar numbers of patients. Currently, nearly all programs discourage residents from handling other responsibilities during the continuity session (P = .0002). Clinic resources. Attention to child development was similar. On-site microscopy and office-based spirometry fell, but the ability to process blood samples remains similar. Continuity of care. Compared to 1993, all sites include acute care in their schedules (P <.0001). However, perceived continuity between assigned resident and the acute-care patient has fallen. 68% of programs do not measure continuity. Director satisfaction. Perceived support from the administrative level has diminished, although other areas of support were similar. Overall satisfaction with the functioning of the continuity experience has remained constant.
Conclusion(s): Continuity between resident and patient may have fallen due to changes in staffing and other efficiencies. Use of EHR has not led to increased resident productivity. Variability in resident schedules may lead to decreased resident-preceptor continuity. These findings have implications for improving the continuity experience, including recommendations for structural changes in resident education. 1. Dumont-Driscoll MC, Barbian LT, Pollock BH; Pediatric Residents' Continuity Clinics: How Are We Really Doing?. Pediatrics October 1995;96(4):616–621.
