Published in:
01-08-2014 | Original Research
Impact of 4 + 1 Block Scheduling on Patient Care Continuity in Resident Clinic
Published in: Journal of General Internal Medicine | Issue 8/2014
Login to get accessABSTRACT
BACKGROUND
Leaders in medical education have called for redesign of internal medicine training to improve ambulatory care training. 4 + 1 block scheduling is one innovative approach to enhance ambulatory education.
AIM
To determine the impact of 4 + 1 scheduling on resident clinic continuity.
SETTING
Resident continuity clinic in traditional scheduling in which clinics are scheduled intermittently one-half day per week, compared to 4 + 1 in which residents alternate 1 week of clinic with 4 weeks of an inpatient rotation or elective.
PARTICIPANTS
First-year internal medicine residents.
PROGRAM DESCRIPTION
We measured patient–provider visit continuity, phone triage encounter continuity, and lab follow-up continuity.
PROGRAM EVALUATION
In traditional scheduling as opposed to 4 + 1 scheduling, patients saw their primary resident provider a greater percentage; 71.7 % vs. 63.0 % (p = 0.008). In the 4 + 1 model, residents saw their own patients a greater percentage; 52.1 % vs. 37.1 % (p = 0.0001). Residents addressed their own labs more often in 4 + 1 model; 90.7 % vs. 75.6 % (p = 0.001). There was no significant difference in handling of triage encounters; 42.3 % vs. 35.8 % (p = 0.12).
DISCUSSION
4 + 1 schedule improves visit continuity from a resident perspective, and may compromise visit continuity from the patient perspective, but allows for improved laboratory follow-up, which we pose should be part of an emerging modern definition of continuity.