Optimizing the fellow oncology continuity clinic: Factors associated with a meaningful experience.

Abstract

e23012 Background: Fellowship programs use a variety of continuity clinic models including general, disease/system specific, or both. The longitudinal timing also varies from 6-months, 1-year, or the entirety of fellowship. At WVU, we use a 6-month disease specific model where fellows rotate with a specific attending. Given the increasing complexity of care for patients with oncologic diagnoses, we sought to establish a general continuity clinic within an academic cancer institute to model the skills needed to effectively transition to independent practice. Additionally, we proposed to identify key elements that make for a meaningful continuity clinic experience. Methods: We created a 42 question, anonymous online survey comparing general clinic to the disease specific clinic and administered it to our current 2nd and 3rd year fellows. Independent variables were Likert-scale ratings (1=strongly disagree, 2= disagree, 3=neutral, 4=agree, 5=strongly agree) on four main themes: patient characteristics, clinic operations, preceptor characteristics, and educational value. Results: Seven out of seven fellows responded. The majority of them answered that 1 new patient and 4 return patients were “just right” per half day of general clinic, while 1-2 new patients and 5 or more return patients were “just right” per half day of disease specific clinic. Within the general clinic, the number of patients with lung, GU, and GI oncology was noted as “just right” while breast and other (e.g., CNS, head and neck, sarcoma) were identified as “too few”. Table shows a sample of questions asked and differences among the two clinics. The most evident disparity was autonomy of patients. A weekly, multispecialty planning session was also rated highest in terms of educational value for general clinic. Conclusions: We demonstrated a general continuity clinic can be successfully implemented within an academic cancer center. While there are pros and cons to both types, several key characteristics to a meaningful continuity clinic experience were identified including: adequate ratio of new and return patients, wide variety of diagnoses, increased autonomy and ownership of patients, consistent preceptor and support staff, and weekly planning session for increased preparation and educational value.[Table: see text]