The Implementation of X + Y Scheduling in Combined Internal Medicine-Pediatrics Residency Programs: Practical Considerations for Program Leadership

Abstract

The X + Y scheduling approach, or block scheduling, is common among internal medicine residency programs. With the beginning of a pilot program through the American College of Graduate Medical Education in 2018, pediatrics and internal medicine-pediatrics (Med-Peds) residency programs have been able to adopt X + Y scheduling as well. The X + Y scheduling approach presents unique challenges and opportunities for combined Med-Peds residencies. This paper describes an early experience with X + Y scheduling in Med-Peds residencies and describes practical considerations for Med-Peds programs considering or planning a transition to the X + Y schedule. These considerations include strategies for gaining stakeholder support; selecting the appropriate block structure; opportunities for designing the ambulatory curriculum; and maximizing the clinical benefit in the residency continuity clinic.

Perceptions of X+Y Scheduling Among Combined Internal Medicine-Pediatrics Residency Trainees: A Qualitative Program Evaluation

“…These barriers contribute to exhaustion among residents, and many of the early X+Y benefits demonstrate the expected improvements in these areas without resident perception of harm to the educational experience, as seen both in our results and in studies in Pediatrics residency programs [8]. While our programs have evaluated practical considerations in implementing X+Y scheduling for combined programs, it is important to capture the perception of Med-Peds residents with X+Y scheduling [10].…”

“…Residents expressed a need to prioritize continuity clinic time during ambulatory blocks and minimize conflict with other requirements. Importantly, though the details of X+Y implementation may be different across institutions [10], these themes are relevant no matter what specific X+Y templates or clinic structure is utilized.…”

“…These residents experienced both systems in real-time and perhaps indicate the strongest evidence for X+Y schedules. Other literature has suggested that X+Y schedules require additional resources, however, and additional factors such as backup pool availability, night schedules, and percentage of time on scheduled elective rotations may impact overall resident experience significantly [7,10].…”