Educating Generalists: Factors of Resident Continuity Clinic Associated With Perceived Impact on Choosing a Generalist Career

Laponis, Ryan; O’Sullivan, Patricia; Hollander, Harry; Cornett, Patricia; Julian, Katherine

doi:10.4300/jgme-d-10-00227.1

Cited by 15 publications

(13 citation statements)

References 13 publications

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“…Emphasizing outpatient training and education during residency while simultaneously providing protected time to practice ambulatory medicine may help retain resident interest in primary care. In addition to maximizing protected outpatient training time, there have been multiple appeals for a reform of the clinic experience itself 24,[30][31][32][33][34] as satisfaction with IM residency continuity clinic directly influences career choice toward primary care. 31,32 A recent study compared internal medicine residents' likelihood of entering GIM as a result of clinic to likelihood of entering a career in GIM before clinic, and demonstrated that 28 % were less likely to enter GIM as a result of their clinic experience, 59 % had no difference in likelihood, and only 11 % were more likely to enter general IM as a result of clinic.…”

Section: Discussionmentioning

confidence: 99%

Is Training in a Primary Care Internal Medicine Residency Associated with a Career in Primary Care Medicine?

et al. 2015

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PURPOSE: Professional and governmental organizations recommend an ideal US physician workforce composed of at least 40 % primary care physicians. They also support primary care residencies to promote careers in primary care. Our study examines the relationship between graduation from a primary care or categorical internal medicine residency program and subsequent career choice. METHODS: We conducted a cross-sectional electronic survey of a cohort of internal medicine residency alumni who graduated between 2001 and 2010 from a large academic center. Our primary predictor was graduation from a primary care versus a categorical internal medicine program and our primary outcome is current career role. We performed chi-square analysis comparing responses of primary care and categorical residents. RESULTS: We contacted 481 out of 513 alumni, of whom 322 responded (67 %). We compared 106 responses from primary care alumni to 169 responses from categorical alumni. Fifty-four percent of primary care alumni agreed that the majority of their current clinical work is in outpatient primary care vs. 20 % of categorical alumni (p<0.001). While 92.5 % of primary-care alumni were interested in a primary care career prior to residency, only 63 % remained interested after residency. Thirty of the 34 primary care alumni (88 %) who lost interest in a primary care career during residency agreed that their ambulatory experience during residency influenced their subsequent career choice. CONCLUSIONS: A higher percentage of primary care alumni practice outpatient primary care as compared to categorical alumni. Some alumni lost interest in primary care during residency. The outpatient clinic experience may impact interest in primary care.

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Section: Discussionmentioning

confidence: 99%

Is Training in a Primary Care Internal Medicine Residency Associated with a Career in Primary Care Medicine?

et al. 2015

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“…Our findings are corroborated by a similar smaller study that found an association between workflow and professional/personal satisfaction and choice of GIM. 11 Collectively, these results demonstrate potential areas in which to focus efforts on improving the resident ambulatory clinic experience that may sway IM residents in the direction of primary care careers. Time management issues, such as the number of patients on their schedule, time allotted for patient care, and workflow issues, may adversely affect residents' perception of a future GIM career.…”

Section: Discussionmentioning

confidence: 99%

“…4 Many believe that dissatisfaction with the continuity clinic experience may discourage trainees from selecting primary care careers. [8][9][10][11] The challenges residents face during their continuity clinics include lack of continuity Published online April 18, 2013 with patients, burdensome administrative duties, lack of support for coordination of care and disease management, staffing shortages, distraction from inpatient duties, and dissatisfied primary care role models, all against the backdrop of managing patient panels full of medically and socially complex patients. [8][9][10][11] In an effort to improve the ambulatory continuity experience, several important stakeholders in IM have called for reform.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10][11] The challenges residents face during their continuity clinics include lack of continuity Published online April 18, 2013 with patients, burdensome administrative duties, lack of support for coordination of care and disease management, staffing shortages, distraction from inpatient duties, and dissatisfied primary care role models, all against the backdrop of managing patient panels full of medically and socially complex patients. [8][9][10][11] In an effort to improve the ambulatory continuity experience, several important stakeholders in IM have called for reform. 7,[12][13][14] Specifically, in 2009, the ACGME IM Residency Review Committee required IM residents to have 130 ambulatory half-day sessions over 3 years, up from 108 in 2004, and mandated decreased conflict between ambulatory and inpatient experiences and improved coordination of care and mentorship in clinic.…”

Section: Introductionmentioning

confidence: 99%

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Resident Satisfaction with Continuity Clinic and Career Choice in General Internal Medicine

et al. 2013

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BACKGROUND: The quality of the continuity clinic experience for internal medicine (IM) residents may influence their choice to enter general internal medicine (GIM), yet few data exist to support this hypothesis. OBJECTIVE: To assess the relationship between IM residents' satisfaction with continuity clinic and interest in GIM careers. DESIGN: Cross-sectional survey assessing satisfaction with elements of continuity clinic and residents' likelihood of career choice in GIM. PARTICIPANTS: IM residents at three urban medical centers. MAIN MEASURES: Bivariate and multivariate associations between satisfaction with 32 elements of outpatient clinic in 6 domains (clinical preceptors, educational environment, ancillary staff, time management, administrative, personal experience) and likelihood of considering a GIM career. KEY RESULTS: Of the 225 (90 %) residents who completed surveys, 48 % planned to enter GIM before beginning their continuity clinic, whereas only 38 % did as a result of continuity clinic. Comparing residents' likelihood to enter GIM as a result of clinic to likelihood to enter a career in GIM before clinic showed that 59 % of residents had no difference in likelihood, 28 % reported a lower likelihood as a result of clinic, and 11 % reported higher likelihood as a result of clinic. Most residents were very satisfied or satisfied with all clinic elements. Significantly more residents (p≤0.002) were likely vs. unlikely to enter GIM if they were very satisfied with faculty mentorship (76 % vs. 53 %), time for appointments (28 % vs. 11 %), number of patients seen (33 % vs. 15 %), personal reward from work (51 % vs. 23 %), relationship with patients (64 % vs. 42 %), and continuity with patients (57 % vs. 33 %). In the multivariate analysis, being likely to enter GIM before clinic (OR 29.0,) and being very satisfied with the continuity of relationships with patients (OR 4.08, were the strongest independent predictors of likelihood to enter GIM as a result of clinic. CONCLUSIONS:Resident satisfaction with most aspects of continuity clinic was high; yet, continuity clinic had an overall negative influence on residents' attitudes toward GIM careers. Targeting resources toward improving ambulatory patient continuity, workflow efficiency and increasing pre-residency interest in primary care may help build the primary care workforce.

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“…We included composite indices of learning opportunities (nine items), faculty teaching (10 items), and staff roles (eight items) by Roth et al [20]. We included two previously published items on likelihood of entering a general medicine career [21], one item on number of patients seen in a typical half-day session [22], and two items on satisfaction with the clinic [21,23] which used 5-point Likert scales ranging from ‘disagree strongly’ = 1 to ‘agree strongly’ = 5. The survey was pilot tested for face and content validity with five chief residents at one of the programs.…”

Section: Methodsmentioning

confidence: 99%

Do medical residents perform patient-centered medical home tasks? A mixed-methods study

Block

LaVine

Verbsky

et al. 2017

Medical Education Online

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Background: Increasingly, residents are being trained in Patient-centered Medical Home (PCMH) settings. A set of PCMH entrustable professional activities (EPAs) for residents has been defined but not evaluated in practice. Objective: To understand whether residents trained at PCMH sites reported higher likelihood of engaging in PCMH tasks than those training in non-PCMH sites. Design: Survey and nominal group data from post-graduate trainees at three residency programs. Results: A total of 179 residents responded (80% response). Over half (52%) cared for patients at PCMH sites. Residents at PCMH sites were more likely to report engaging in tasks in the NCQA domains of enhancing access and continuity (p < 0.01 for 4/11 tasks), planning and managing care (p < 0.01 for 3/4 tasks), providing self-care and community support (p < 0.01 for 3/5 tasks), and identifying and managing patient populations (p < 0.01 for 1/6 tasks), but were not more likely to report tracking and coordinating care or measuring and improving performance. Residents at PCMH sites were more likely to report working with medical assistants (p < 0.01), but not other healthcare professionals. Qualitative data showed staff teamwork and continuity of care as facilitators of patient-centered care, and technological problems and office inefficiencies as barriers to care. Conclusions: Residents trained at PCMH sites were more likely to engage in tasks in several NCQA domains, but not care coordination and quality assessment. Similar facilitators and barriers to trainee provision of patient-centered care were cited regardless of PCMH status. Curricula on PCMH principles and workflows that foster continuity and communication may help to inform residents on PCMH tenets and incorporate residents into team-based care. Abbreviations: EPA: Entrustable professional activity; GIM: General Internal Medicine; NCQA: National Center for Quality Assurance; PCMH: Patient-centered medical home

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Educating Generalists: Factors of Resident Continuity Clinic Associated With Perceived Impact on Choosing a Generalist Career

Cited by 15 publications

References 13 publications

Is Training in a Primary Care Internal Medicine Residency Associated with a Career in Primary Care Medicine?

Is Training in a Primary Care Internal Medicine Residency Associated with a Career in Primary Care Medicine?

Resident Satisfaction with Continuity Clinic and Career Choice in General Internal Medicine

Do medical residents perform patient-centered medical home tasks? A mixed-methods study

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