Effects of Clinic First Educational Interventions on Resident Wellness and Engagement

Abstract

Background and Objectives: Tensions between clinical and hospital training, along with dysfunctional family medicine training clinics, have resulted in continuity clinic being the least favorite part of training for some residents. These factors are all contributors to burnout. We hypothesized that following Clinic First action steps to prioritize and enhance outpatient clinic would positively affect resident wellness and clinic engagement. This study describes our interventions and their effects within the Oregon Health & Science University (OHSU) Family Medicine 4-year Portland residency program. Methods: In July 2017 the Oregon Health & Science University Family Medicine Portland residency program implemented scheduling and curricular interventions inspired by the Clinic First model. We conducted a mixed-methods cross-sectional study using focus groups and surveys to understand the effects of these interventions on resident wellness and engagement. Results: Clinic First-inspired interventions, particularly a 2+2 scheduling model, decreased transitions within the day, and a clinic immersion month were associated with improved residents’ perception of wellness. These interventions had variable effects on clinic engagement. Eighty-eight percent of interns surveyed about the month-long clinic orientation in the beginning of residency reported that they felt prepared managing continuity patients in the clinic setting and their upcoming rotations. Conclusions: This study demonstrates that Clinic First-inspired structural changes can be associated with improvement in resident perceptions of wellness and aspects of clinic engagement. This can give educators a sense of hope as well as tangible steps to take to improve these difficult and important issues.

Adaptation and validation of the Adult Dispositional Hope Scale in the Ecuadorian context

“…The evidence of convergent validity showed that dispositional hope obtained a positive association with work engagement, evidencing that dispositional hope may promote higher levels of positive work well-being states (Hofkamp et al, 2020 ; Sarfraz et al, 2019 ). Also, following hypothesis 4, dispositional hope was negatively associated with burnout and its dimensions, showing that higher levels of hope may act as a protective factor to prevent the development of burnout (Hofkamp et al, 2020 ; Passmore et al, 2020 ; Yotsidi et al, 2018 ).…”

“…The evidence of convergent validity showed that dispositional hope obtained a positive association with work engagement, evidencing that dispositional hope may promote higher levels of positive work well-being states (Hofkamp et al, 2020 ; Sarfraz et al, 2019 ). Also, following hypothesis 4, dispositional hope was negatively associated with burnout and its dimensions, showing that higher levels of hope may act as a protective factor to prevent the development of burnout (Hofkamp et al, 2020 ; Passmore et al, 2020 ; Yotsidi et al, 2018 ). The protective role that dispositional hope plays in the context of the professionals’ work shows that it is characterized as a personal resource that contributes to planning their professional goals and driving their actions to achieve them (Snyder et al, 1991 ).…”

“…Hope serves as a personal resource in the workplace, where an individual is constantly subjected to emotional, physical, and psychological demands. It has the potential to promote a future-oriented motivational state that can help those individuals plan ways to achieve their goals and develop practical actions to succeed (Bakker & Demerouti, 2017 ; Leiter, 2021 ; Vazquez et al, 2019 ), and experience higher levels of work engagement (Hofkamp et al, 2020 ; Sarfraz et al, 2019 ). Also, there is evidence that hope acts as a protective factor against burnout at work (Passmore et al, 2020 ; Yotsidi et al, 2018 ).…”

A novel model of ambulatory teaching of residents in general practice in China: a cross-sectional study

“…Hence, training programs for outpatient teaching and ward teaching should differ in terms of both training patterns and training priorities. The “clinic first model” of general practice residency training aims to improve the quality of patient management and the participation of residents in ambulatory teaching programs [ 2 – 4 ]. According to the Chinese Medical Doctor Association (CMDA) [ 5 ], ambulatory teaching is a key part of standardized residency training that focuses on promoting the residents’ ability to independently manage outpatients under the supervision of preceptors.…”

Breaking Down Silos by Sharing Innovation in Academic Family Medicine

“…Emphasizing the importance of our learners, Dr Hofkamp et al describe the potential of curricular changes in ambulatory settings to improve resident engagement and foster their well-being, demonstrating improvement in resident self-perception of personal wellness and preparedness reflected in postimplementation survey results. 16 The final paper addresses the need for today's family physicians to possess practice management acumen, positing that an understanding of financial issues and quality improvement is key to innovative and sustainable practice. The article demonstrates that practice management residency curricula can lead to an increase in resident ability to subsequently implement processes that will improve patient care.…”