Separating Residents’ Inpatient and Outpatient Responsibilities

Bates, Carol K.; Yang, Julius; Huang, Grace C.; Tess, Anjala; Reynolds, Eileen E.; Vanka, Anita; Caines, Laurie C.; Smith, Christopher C.

doi:10.1097/acm.0000000000000849

Cited by 21 publications

(4 citation statements)

References 5 publications

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“…We found that opportunities and limitations of the health system have practical implications for resident learning. Seeing the importance of team-based care is contradicted by the inconsistent provider continuity while on other rotations, as described by Bates [32]. Residents in our study recognized that continuity in patient care has many benefits and yet acknowledged how the existing schedule structure during training limits accessibility and ownership, highlighting the tension between striving for ideal patient care while accepting the reality of practice.…”

Section: Discussionmentioning

confidence: 69%

Learning in Tension: A Case Study Examining What Internal Medicine Residents Learn in the Ambulatory Care Setting

Thomas¹,

Frambach²,

Teunissen³

et al. 2023

Perspect Med Educ

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Introduction: Medical care of patients with complex conditions has shifted to the ambulatory setting, whereas current knowledge of resident learning is primarily based on studies from inpatient settings. Preparing trainees to adapt to this shift necessitates an understanding of what internal medicine (IM) residents currently learn during ambulatory rotations. The aim of this study is to identify what residents learn during their ambulatory care experience. Methods: Using a qualitative instrumental case study design, the authors conducted separate focus groups with IM trainees (n = 15), supervisors (n = 16), and program directors (n = 5) from two IM programs in New York City, USA in 2019. Participants were invited via email, and focus group sessions were complemented by document analysis of ambulatory syllabi. Results: Based on focus group commentary and document analysis, content learned in the ambulatory setting encompassed three domains; 1) patient needs, 2) the resident’s role within a healthcare team, and 3) health system opportunities and limitations. Residents also learned about tensions within and between these domains including the skills needed to care for patients versus the skills acquired, a desire for ownership of patient care versus fragmented care, and time allotted versus time required. Discussion: This study revealed two outcomes about what residents learn during their ambulatory care experience. First, learning content largely fell into three domains. Second, residents learned about the tensions between ideal care delivery and the realities of practice. These results highlight the imperative to better align curricula with clinical environments to meet the learning needs of residents.

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Section: Discussionmentioning

confidence: 69%

Learning in Tension: A Case Study Examining What Internal Medicine Residents Learn in the Ambulatory Care Setting

Thomas¹,

Frambach²,

Teunissen³

et al. 2023

Perspect Med Educ

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“…Three articles focused on continuity with the introduction of an X þ Y schedule with mixed results. [29][30][31] Several studies focused on resident satisfaction with an overall trend toward improvement in reducing inpatient-outpatient conflict 30,[32][33][34][35] and resident satisfaction with ambulatory education, 30,33,36 but no studies found an increase in the desire to pursue primary care careers. 29,32,36 Only 2 studies evaluated improvement in quality of care in X þ Y schedules with mixed results.…”

Section: Clinic Redesignmentioning

confidence: 99%

A Decade of Teaching and Learning in Internal Medicine Ambulatory Education: A Scoping Review

Coyle

Helenius

Cruz

et al. 2019

Journal of Graduate Medical Education

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Background Ambulatory training in internal medicine residency programs has historically been considered less robust than inpatient-focused training, which prompted a 2009 revision of the Accreditation Council for Graduate Medical Education (ACGME) Program Requirements in Internal Medicine. This revision was intended to create a balance between inpatient and outpatient training standards and to spur innovation in the ambulatory setting. Objective We explored innovations in ambulatory education in internal medicine residency programs since the 2009 revision of the ACGME Program Requirements in Internal Medicine. Methods The authors conducted a scoping review of the literature from 2008 to 2017, searching PubMed, ERIC, and Scopus databases. Articles related to improving educational quality of ambulatory components of US-based internal medicine residency programs were eligible for inclusion. Articles were screened for relevance and theme categorization and then divided into 6 themes: clinic redesign, curriculum development, evaluating resident practice/performance, teaching methods, program evaluation, and faculty development. Once a theme was assigned, data extraction and quality assessment using the Medical Education Research Study Quality Instrument (MERSQI) score were completed. Results A total of 967 potentially relevant articles were discovered; of those, 182 were deemed relevant and underwent full review. Most articles fell into curriculum development and clinic redesign themes. The majority of included studies were from a single institution, used nonstandardized tools, and assessed outcomes at the satisfaction or knowledge/attitude/skills levels. Few studies showed behavioral changes or patient-level outcomes. Conclusions While a rich diversity of educational innovations have occurred since the 2009 revision of the ACGME Program Requirements in Internal Medicine, there is a significant need for multi-institution studies and higher-level assessment.

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“…9 In one internal medicine program, only 16% of residents felt that the program minimized conflict between inpatient and outpatient responsibilities; when these responsibilities were separated so residents do not work in the hospital and in the clinic on the same day, 98% of residents agreed that the conflict was minimized. 63 Resident scheduling in transforming programs follows several general principles: 1. Schedules are made far in advance so that clinics can plan their work.…”

Section: Resident Building Block 1: Resident Schedulingmentioning

confidence: 99%

Implementation of Case Conferences to Improve Interprofessional Collaboration in Resident Continuity Clinic

Nikiforova

Spagnoletti

Rothenberger

et al. 2019

Southern Medical Journal

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Separating Residents’ Inpatient and Outpatient Responsibilities

Abstract: Separating residents' inpatient and outpatient responsibilities may improve patient safety, the learning environment, and resident-patient relationships. Future innovations might focus on improving patient safety and decreasing stress in the outpatient environment.

Cited by 21 publications

References 5 publications

Learning in Tension: A Case Study Examining What Internal Medicine Residents Learn in the Ambulatory Care Setting

Learning in Tension: A Case Study Examining What Internal Medicine Residents Learn in the Ambulatory Care Setting

A Decade of Teaching and Learning in Internal Medicine Ambulatory Education: A Scoping Review

Implementation of Case Conferences to Improve Interprofessional Collaboration in Resident Continuity Clinic

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