Impact of 4 + 1 Block Scheduling on Patient Care Continuity in Resident Clinic

Abstract

4 + 1 schedule improves visit continuity from a resident perspective, and may compromise visit continuity from the patient perspective, but allows for improved laboratory follow-up, which we pose should be part of an emerging modern definition of continuity.

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

“…22,23 Given the noted strain between competing inpatient and outpatient responsibilities, 24 the continuity clinic experience for IM residents can become stressful and there is variable program compliance with ACGME ambulatory training requirements. 25 In an attempt to uncouple inpatient and outpatient training, a few new program models have developed, which include a year long ambulatory block 26 and an alternating 4:1 week inpatient to ambulatory schedule [27][28][29] that might help to support ambulatory education. Emphasizing outpatient training and education during residency while simultaneously providing protected time to practice ambulatory medicine may help retain resident interest in primary care.…”

Solutions to Common Problems in Training Learners in General Internal Medicine Ambulatory Settings

“…Such models have been shown to improve continuity for the resident, but patient access and patient perception of continuity may not improve. Ambulatory blocks improve laboratory follow-up among residents (22), but other data for residents is lacking.…”

Continuity of Care as an Educational Goal but Failed Reality in Resident Training: Time to Innovate

“…15 Although this approach has advantages, such as enabling engagement in quality improvement efforts, residents often spend significant time in other ''immersion'' activities, and are less available for their patients' longitudinal care. 16 In primary care specialties, academic practices are increasingly adopting training models consistent with the patient-centered medical home concept. 17 By leveraging interprofessional teammates to provide timely care, physician-patient continuity may be sacrificed.…”