X + Y Scheduling Models in Internal Medicine Residency Programs: A National Survey of Program Directors' Perspectives

Noronha, Craig; Chaudhry, Saima; Chacko, Karen M.; McGarry, Kelly; Agrawal, Anoop; Yadavalli, Gopal; Shalaby, Marc

doi:10.1016/j.amjmed.2017.09.012

Cited by 16 publications

(16 citation statements)

References 18 publications

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“…Second, a rapidly increasing number of IM residency programs in the USA have adopted the "X+Y" format to better balance the training environment between the inpatient and outpatient settings. Residents have dedicated ambulatory weeks ("Y weeks") where didactic sessions and administrative time occur prior to the start of the next inpatient block ("X weeks") [22]. This intervention was accessible to the trainees as preparatory learning during their more flexible administrative time prior to starting their HOS rotation; thus optimizing their time.…”

Section: Discussionmentioning

confidence: 99%

Just-in-Time Teaching (JiTT) Screencasts: a Randomized Controlled Trial of Asynchronous Learning on an Inpatient Hematology-Oncology Teaching Service

et al. 2021

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Background The efficacy of just-in-time teaching (JiTT) screencasts for graduate medical education on an inpatient adult hematology-oncology service (HOS) setting is not known. Our preceding pilot data identified six high-yield topics for this setting. The study objective was to evaluate screencast educational efficacy. Methods Internal medicine residents scheduled to start a rotation on the primary HOS of an academic medical center were eligible for this parallel, unblinded, randomized controlled trial with concealed allocation. Participants underwent block randomization to the usual educational curriculum either with or without access to a series of novel screencasts; all participants received an anonymous online end-of-rotation survey and a $20 gift certificate upon completion. The primary outcome was the change in attitude among learners, measured as their self-reported confidence for managing the clinical topics. Results From 12/9/2019 through 6/15/2020, accrual was completed with 67 of 78 eligible residents (86%) enrolled and randomized. Analysis was by intention-to-treat and participant response rate was 91%. Sixty-four percent of residents in the treatment arm rated their clinical management comfort level as "comfortable" or "very comfortable" versus 21% of residents in the usual education arm (p = 0.001), estimated difference = 43% (95% CI: 21-66%), using a prespecified cumulative cutoff score. Treatment arm participants reported that the screencasts improved medical oncology knowledge base (100%), would improve their care for cancer patients (92%), and had an enjoyable format (96%). Conclusion Residents on a busy inpatient HOS found that a JiTT screencast increased clinical comfort level in the management of HOS-specific patient problems.

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Section: Discussionmentioning

confidence: 99%

Just-in-Time Teaching (JiTT) Screencasts: a Randomized Controlled Trial of Asynchronous Learning on an Inpatient Hematology-Oncology Teaching Service

et al. 2021

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“…After a 2009 ACGME policy to improve resident continuity clinics and reduce the tension between inpatient and outpatient patient care responsibilities, 44% of PDs surveyed moved to an X + Y schedule model, most within a year. 26 Although the baseline rate of residency program schedule changes is unknown, we would have anticipated a similar rate of change to the new ACGME flexible work hours. Perhaps the difference reflects more compliance with restrictive policies than liberalizing policies.…”

Section: Discussionmentioning

confidence: 99%

Does Increased Schedule Flexibility Lead to Change? A National Survey of Program Directors on 2017 Work Hours Requirements

et al. 2020

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BACKGROUND:The learning and working environment for resident physicians shifted dramatically over the past two decades, with increased focus on work hours, resident wellness, and patient safety. Following two multicenter randomized trials comparing 16-h work limits for PGY-1 trainees to more flexible rules, the ACGME implemented new flexible work hours standards in 2017. OBJECTIVE: We sought to determine program directors' (PDs) support for the work hour changes and programmatic response. DESIGN: In 2017, US Internal Medicine PDs were surveyed about their degree of support for extension of PGY-1 work hour limits, whether they adopted the new maximum continuous work hours permitted, and reasons for their decisions. KEY RESULTS: The response rate was 70% (266/379). Fifty-seven percent of PDs (n = 151) somewhat/strongly support the new work hour rules for PGY-1 residents, while only 25% of programs (N = 66) introduced work periods greater than 16-h on any rotation. Higher rates of adopting change were seen in PDs who strongly/ somewhat supported the change (56/151 [37%], P < 0.001), had tenure of 6+ years (33/93 [35%], P = 0.005), were of non-general internal medicine subspecialty (30/80 [38%], P = 0.003), at university-based programs (35/101 [35%], P = 0.009), and with increasing number of approved positions (< 38, 10/63 [16%]; 38-58, 13/69 [19%]; 59-100, 15/64 [23%]; > 100, 28/68 [41%], P = 0.005). Areas with the greatest influence for PDs not extending work hours were the 16-h rule working well (56%) and risk to PGY1 well-being (47%). CONCLUSIONS: Although the majority of PDs support the ACGME 2017 work hours rules, only 25% of programs made immediate changes to extend hours. These data reveal that complex, often competing, forces influence PDs' decisions to change trainee schedules.

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“…24 X + Y scheduling, a model that schedules residents' inpatient or non-ambulatory rotations (BX^blocks) in discrete periods with alternating ambulatory or BY^blocks, is instituted specifically to decrease the conflict between inpatient and outpatient patient care responsibilities. 25,26 Several studies of X + Y scheduling have found this model to be associated with less care fragmentation, increased perception of clinic continuity among residents, and higher resident satisfaction. [27][28][29] Our study unearthed the association that primary care programs using the X + Y scheduling model were less likely to have a majority of their program graduates pursue primary care at the time of graduation.…”

Section: Discussionmentioning

confidence: 99%

A National Survey of Internal Medicine Primary Care Residency Program Directors

et al. 2019

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X + Y Scheduling Models in Internal Medicine Residency Programs: A National Survey of Program Directors' Perspectives

Cited by 16 publications

References 18 publications

Just-in-Time Teaching (JiTT) Screencasts: a Randomized Controlled Trial of Asynchronous Learning on an Inpatient Hematology-Oncology Teaching Service

Just-in-Time Teaching (JiTT) Screencasts: a Randomized Controlled Trial of Asynchronous Learning on an Inpatient Hematology-Oncology Teaching Service

Does Increased Schedule Flexibility Lead to Change? A National Survey of Program Directors on 2017 Work Hours Requirements

A National Survey of Internal Medicine Primary Care Residency Program Directors

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