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Changes in Pediatric Residents' Perceptions of Their Continuity Experience During Their Training: A National Study

  • Susan Feigelman
    Correspondence
    Address correspondence to Susan Feigelman, MD, University of Maryland School of Medicine, 655 West Lombard St, Ste 311, Baltimore, MD, 21201
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  • John Olsson
    Affiliations
    From the Department of Pediatrics (Dr Feigelman), University of Maryland School of Medicine, Baltimore, Md; the Brody School of Medicine (Dr Olsson), Greenville, NC; Baylor College of Medicine (Dr Drutz), Houston, Tex; the University of Iowa (Dr Dungy), Iowa City, Iowa; Uniformed Services University (Dr Lopreiato), Bethesda, Md; and the Johns Hopkins School of Medicine (Dr Serwint), Baltimore, Md
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  • Jan Drutz
    Affiliations
    From the Department of Pediatrics (Dr Feigelman), University of Maryland School of Medicine, Baltimore, Md; the Brody School of Medicine (Dr Olsson), Greenville, NC; Baylor College of Medicine (Dr Drutz), Houston, Tex; the University of Iowa (Dr Dungy), Iowa City, Iowa; Uniformed Services University (Dr Lopreiato), Bethesda, Md; and the Johns Hopkins School of Medicine (Dr Serwint), Baltimore, Md
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  • Claibourne I. Dungy
    Affiliations
    From the Department of Pediatrics (Dr Feigelman), University of Maryland School of Medicine, Baltimore, Md; the Brody School of Medicine (Dr Olsson), Greenville, NC; Baylor College of Medicine (Dr Drutz), Houston, Tex; the University of Iowa (Dr Dungy), Iowa City, Iowa; Uniformed Services University (Dr Lopreiato), Bethesda, Md; and the Johns Hopkins School of Medicine (Dr Serwint), Baltimore, Md
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  • Joseph Lopreiato
    Affiliations
    From the Department of Pediatrics (Dr Feigelman), University of Maryland School of Medicine, Baltimore, Md; the Brody School of Medicine (Dr Olsson), Greenville, NC; Baylor College of Medicine (Dr Drutz), Houston, Tex; the University of Iowa (Dr Dungy), Iowa City, Iowa; Uniformed Services University (Dr Lopreiato), Bethesda, Md; and the Johns Hopkins School of Medicine (Dr Serwint), Baltimore, Md
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  • Janet R. Serwint
    Affiliations
    From the Department of Pediatrics (Dr Feigelman), University of Maryland School of Medicine, Baltimore, Md; the Brody School of Medicine (Dr Olsson), Greenville, NC; Baylor College of Medicine (Dr Drutz), Houston, Tex; the University of Iowa (Dr Dungy), Iowa City, Iowa; Uniformed Services University (Dr Lopreiato), Bethesda, Md; and the Johns Hopkins School of Medicine (Dr Serwint), Baltimore, Md
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  • Continuity Research Network (CORNET) of the Ambulatory Pediatric Association
      Objective.—To determine how pediatric residents' perceptions of continuity clinic experiences vary by level of training, after controlling for the effect of continuity setting.
      Method.—Cross-sectional survey of pediatric and combined pediatric trainees in US residency programs.
      Results.—Survey responses were received from 1355 residents in 36 training programs. Residents' continuity experiences were in hospital-based and community settings. Numbers of patients seen increased between PGY-1 and PGY-3 years, but not in the PGY-4 and PGY-5 years. Compared to PGY-1 residents, PGY-2 and PGY-3 residents were more likely to report more encounters with established patients, but were not more likely to feel like the primary care provider. There were no significant differences by training level in terms of involvement in panel patients' laboratory results, hospitalizations, or telephone calls, although nursery involvement decreased with increasing training level. Autonomy was directly related to training level. The perception of having the appropriate amount of exposure to practice management issues was low for all respondents.
      Conclusions.—Residents perceived that they had greater autonomy and continuity with patients as they become more senior, yet they were not more likely to feel like the primary care provider. Lack of increased involvement in key patient care and office responsibilities across training years may reflect a need for changes in resident education. These data may be helpful in formulating recommendations to program directors with regard to determining which Accreditation Council for Graduate Medical Education competencies should be emphasized and evaluated in the continuity experience.

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      REFERENCES

        • American Medical Association.
        Graduate Medical Education Directory, 1997–1998. American Medical Association, Chicago, Ill1997: 211-220
        • Rice TD
        • Holmes SE
        • Drutz JE
        Comparison of continuity clinic experience by practice setting and postgraduate level.
        Arch Pediatr Adolesc Med. 1996; 150: 1299-1304
        • Garfunkel LC
        • Byrd RS
        • McConnochie KM
        • Auinger P
        Resident and family continuity in pediatric continuity clinic: nine years of observation.
        Pediatrics. 1998; 101: 37-42
        • Outlaw DT
        • Kahn MJ
        • DeSalvo K
        • Cummings TL
        Description of a combined internal medicine-pediatrics continuity clinic for combined program residents.
        South Med J. 2001; 94: 1173-1176
        • Sargent JR
        • Osborn LM
        Resident training in community pediatricians' offices. Not a financial drain.
        Am J Dis Child. 1990; 144: 1356-1359
        • Dumont-Driscoll MC
        • Barbian LT
        • Pollock BH
        Pediatric residents' continuity clinics: how are we really doing?.
        Pediatrics. 1995; 96: 616-621
        • Recchia KC
        • Petros TM
        • Spooner A
        • Cranshaw JL
        Implementation of the community outpatient practice experience in a large pediatric residency program.
        Pediatrics. 1995; 96: 90-98
        • Osborn LM
        • Sargent JR
        • Williams SD
        Effects of time-in-clinic, clinic setting, and faculty supervision on the continuity clinic experience.
        Pediatrics. 1993; 91: 1089-1093
        • Croskell SE
        • Young PC
        How well does the continuity experience prepare residents for practice?.
        Ambul Pediatr. 2002; 2: 401-405
        • Ponitz KL
        • Needlman RD
        • Kilkenny TJ
        Primary care relationships in pediatric hospital clinics vs private offices.
        Arch Pediatr Adolesc Med. 2000; 154: 1209-1213
        • Serwint JR
        • and the Continuity Clinic Special Interest Group, Ambulatory Pediatric Association.
        Multisite survey of pediatric residents' continuity experiences: their perceptions of the clinical and educational opportunities.
        Pediatrics. 2001; 107: 1171
        • Kroboth FJ
        • Hanusa BH
        • Parker SC
        Didactic value of the clinical evaluation exercise: missed opportunities.
        J Gen Intern Med. 1996; 11: 551-553
        • Norcini JJ
        • Blank LL
        • Duffy FD
        • Fortna GS
        The mini-CEX: a method for assessing clinical skills.
        Ann Intern Med. 2003; 138: 476-481
        • Accreditation Council for Graduate Medical Education.
        General Competencies. ACGME, Chicago, Ill1999
        • Roberts KB
        • Starr S
        • DeWitt TG
        The University of Massachusetts Medical Center office-based continuity experience: are we preparing pediatric residents for primary care practice?.
        Pediatrics. 1997; 100: 715
        • Young PC
        Should we be teaching residents how to bill for their outpatient services?.
        Pediatrics. 2001; 108: 999-1000
        • Badgett JT
        General pediatric teaching clinics and managed care.
        Pediatrics. 1998; 101: 775-778
        • Devries JM
        • Berkelhamer JE
        • Molteni RA
        • et al.
        Developing models for pediatric residency training in managed care settings.
        Pediatrics. 1998; 101: 753-759