Evaluation of a longitudinal subspecialty clinic for internal medicine residents

Abstract

BACKGROUND The traditional model for subspecialty education in internal medicine (IM) residencies is a short inpatient consult rotation, which often lacks outpatient exposure and continuity with faculty. Our IM residency program developed a longitudinal subspecialty clinic (LSC) experience, which pairs categorical IM residents with a faculty preceptor in their subspecialty of interest. Residents work in their preceptor’s clinic for one half-day per week during ambulatory blocks throughout the PGY2 year. OBJECTIVE To evaluate the LSC program’s educational impact and determine best practices for successful implementation. METHODS: From May to July 2019, we surveyed residents and preceptors who participated in an LSC between 2014 and 2019, gathering quantitative and qualitative data on their experiences RESULTS Survey response rates were 66.4% (N=93/140) for residents, 57.7% (N=15/26) for preceptors. Most residents and preceptors were very or extremely satisfied with their LSC experience (83.3% and 71.4%, respectively). Most residents and preceptors reported that the LSC experience was very or extremely effective in enabling residents to explore their subspecialty of interest (76.0%, 86.7%), form a mentoring relationship with their preceptor (71.3%, 80.0%), obtain a letter of recommendation (76.1%, 64.3%), prepare for fellowship (76.3%, 66.7%), gain exposure to outpatient subspecialty practice (90.0%, 73.3%), and gain medical knowledge (84.6%, 80.0%). CONCLUSIONS Our data showed that LSCs are effective in facilitating longitudinal subspecialty career exploration, mentorship, and education for residents. Opportunities for improvement include developing a more structured curriculum, addressing scheduling issues, and adding the option to extend the experience to the PGY3 year.

Learning pediatric emergency medicine over time: A realist evaluation of a longitudinal pediatric emergency medicine clinical experience

“…described in undergraduate medical education in the literature, [21][22][23][24][25][26][27] their impact on learning at the postgraduate level remains largely unexplored due to a paucity of program evaluation. [7][8][9][10][11] We present a To answer the question of which learners benefit from longitudinal experiences and in what circumstances, our findings suggest that block learning would be most beneficial for the novice learner who is looking to build a foundation of knowledge, skills, and clinical experience. The longitudinal component would be more useful for the senior trainees who are looking to consolidate their learning, which would be consistent with spaced repetition.…”

“…The implementation of CBD in Canada has brought about the need to reexamine the way we deliver clinical experiences, particularly designed in a way to meet the competencies set out by the specialty. While longitudinal clinical experiences have been extensively described in undergraduate medical education in the literature, 21–27 their impact on learning at the postgraduate level remains largely unexplored due to a paucity of program evaluation 7–11 . We present a program evaluation of a longitudinal PEM experience in an EM training curriculum through a realist framework of inquiry, to explore how longitudinal PEM clinical experiences work, for whom, in what circumstances, and the underlying mechanisms.…”

“…Longitudinal clinical experiences have the potential to bridge this gap created by the transition to competency‐based medical education (CBME). While longitudinal or integrated models of clinical education have been explored at the undergraduate medical education level, few studies have been done at the postgraduate level 7–11 . The few studies that have been done tended to focus on components of the postgraduate curriculum, rather than on whole clinical experiences, such as with point‐of‐care ultrasound 12,13 .…”

“…While longitudinal or integrated models of clinical education have been explored at the undergraduate medical education level, few studies have been done at the postgraduate level. [7][8][9][10][11] The few studies that have been done tended to focus on components of the postgraduate curriculum, rather than on whole clinical experiences, such as with point-of-care ultrasound. 12,13 Despite these limitations, however, these studies suggested that longitudinal clinical to a CBME model.…”