Three Years of X + Y Scheduling: Longitudinal Assessment of Resident and Faculty Perceptions

Myers, Ross; Thoreson, Lynn; Howell, Heather; Poitevien, Patricia; Wroblewski, Mary Beth; Ponitz, Keith; Lewis, Joanna

doi:10.1016/j.acap.2022.01.014

Cited by 3 publications

(3 citation statements)

References 15 publications

(13 reference statements)

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“…16 The advent of X + Y models in pediatric and internal medicine programs in the last decade arose out of the desire to simplify and separate the multitude of roles of a resident and adjust to mandated changes in resident work-hours. [1][2][3] Despite these changes, the prevalence of trainee burn-out remains high, the main driver of which are factors related to the learning environment. 18 Internal medicine residents on inpatient wards are at risk of moral distress, particularly in intensive care units and inpatient hospital rotations.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Such systems addressed competing resident demands of a busy inpatient rotations and resident continuity clinic by separating the inpatient rotations as a block (X) alternating with clinic experiences (Y) in some ratio of weeks worked, such as 4 + 1 or 6 + 2. 1,2 This has led to perceptions of improved teaching, inpatient work ow, and better continuity in clinic, 3 although others note a loss of patient continuity and of schedule exibility. 1,4 The intention of an X + Y model is to simplify the roles of an IM resident during a speci c rotation and thus reduce stress and ine ciency of task switching between clinic and inpatient duties.…”

mentioning

confidence: 99%

“…1,4 The intention of an X + Y model is to simplify the roles of an IM resident during a speci c rotation and thus reduce stress and ine ciency of task switching between clinic and inpatient duties. 1,3,4 However, the problem of emotional exhaustion and rates of burnout persist among IM residents, 5,6 only to be exacerbated by the COVID-19 pandemic in 2020. 7 What X + Y or traditional residency systems do not address is the structure of work within rotations, particularly within what many would deem the more 'high stress' rotations central to any IM residency program -including but not limited to general medical oors, night-oat, and medical intensive-care units.…”

mentioning

confidence: 99%

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‘Super’-ior Scheduling: A Novel Model for an Inpatient Internal Medicine Resident Service

Kunnath,

Sr,

Fritz

et al. 2024

Preprint

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Background Residency programs have adopted blocked scheduling to improve the learning climate yet more intensive rotations still impact resident wellness. The effect of changing the alignment of inpatient resident teams on patient care opportunities is not well known. We sought to evaluate the association of new daily schedule (dubbed ‘Mariokart’) compared to a traditional schedule on patient care opportunities, days off, and duty-hour violations. Methods A non-randomized pre - and post-intervention study examining the daily patient census for residents covering a general internal medicine inpatient service within an internal medicine residency program at a single academic medical center from July 2018 to June 2021. The main outcome was the median daily patient census per resident inpatient team before and after the implementation of the ‘Mariokart’ schedule. Secondary outcomes included days off in a 28-day cycle, patient-care opportunities, and resident-reported duty-hour violations. A two-sided t-test was used to determine differences between the groups. Results In comparing 20 months prior to implementation of the ‘Mariokart’ schedule to 15 months post-implementation, the median census of the resident service was 60 patients (IQR 53.0–67.0) for the traditional model and 54 (IQR 49.0–59.0) for the MarioKart model. The median census per team was 12 (IQR 10.0–15.0) for the traditional model and 13.5 (IQR 12.25–14.75) for the MarioKart model. Total patient days per team were 288 (IQR 254.4-321.6) for the traditional model and 303.8 (275.6-331.9) for the MarioKart model (p < 0.001). Under the MarioKart model, residents had an extra 1.5 days off per 28 days compared to the traditional model. Short break violations for the entire program and for the general inpatient service were significantly reduced. Conclusions In this nonrandomized study of an alternate day-to-day schedule that reduced days worked for residents in a general medicine inpatient service, there was no decline in patient-care opportunities. This alternate organization of residents suggests that residency programs can innovate at a systems level to adjust resident schedules to provide more time off without a detriment to patient care opportunities.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

mentioning

confidence: 99%

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‘Super’-ior Scheduling: A Novel Model for an Inpatient Internal Medicine Resident Service

Kunnath,

Sr,

Fritz

et al. 2024

Preprint

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Annual Vision Check: A 2022 Year in (Re)View from the APPD

Aylor

Poitevien

Pitt

2023

Academic Pediatrics

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

Szalda,

Stehouwer,

Walsh

et al. 2024

Cureus

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Objective: The study aims to elicit perceived benefits and downsides of X+Y scheduling for combined Internal Medicine-Pediatrics (Med-Peds) residents via focus groups.Methods: Five focus groups were conducted with Med-Peds residents in participating programs which utilized X+Y scheduling. One focus group was held per participating institution. Each focus group was facilitated by a chief resident from a different participating institution. Questions were developed by the study team after a review of the literature and local experience with X+Y scheduling and included openended questions. Focus groups were recorded and transcribed. Transcripts were reviewed by study team members, and representative themes and quotes were presented. The main outcome was to evaluate the perceived benefits and downsides of X+Y scheduling for Med-Peds.Results: Results from four of the five focus groups were fully reviewed. Themes regarding the benefits of X+Y scheduling included (1) improved inpatient and outpatient experience, (2) predictability in schedule which improved wellness, and (3) longitudinal time for career exploration. Downsides of X+Y scheduling were highlighted as well including (1) condensing too many experiences into Y time and (2) challenges that exist when categorical medicine and pediatrics programs use different block schedules.Conclusions: X+Y schedules create potential solutions for longstanding barriers to medical education and notably conflict with inpatient and outpatient responsibilities. Our data shows similar benefits to X+Y scheduling for combined residents as for their categorical colleagues and sheds light on some unique considerations for combined programs and trainees. Additional studies should continue to assess the effect of X+Y scheduling on our combined trainees.

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Three Years of X + Y Scheduling: Longitudinal Assessment of Resident and Faculty Perceptions

Cited by 3 publications

References 15 publications

‘Super’-ior Scheduling: A Novel Model for an Inpatient Internal Medicine Resident Service

‘Super’-ior Scheduling: A Novel Model for an Inpatient Internal Medicine Resident Service

Annual Vision Check: A 2022 Year in (Re)View from the APPD

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

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Three Years of X + Y Scheduling: Longitudinal Assessment of Resident and Faculty Perceptions

Cited by 3 publications

References 15 publications

‘Super’-ior Scheduling: A Novel Model for an Inpatient Internal Medicine Resident Service

‘Super’-ior Scheduling: A Novel Model for an Inpatient Internal Medicine Resident Service

Annual Vision Check: A 2022 Year in (Re)View from the APPD

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

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Three Years of X + Y Scheduling: Longitudinal Assessment of Resident and Faculty Perceptions