Advertisement

Impact of X+Y Scheduling on Pediatric Resident and Faculty Perceptions of Education and Patient Care

Published:March 11, 2021DOI:https://doi.org/10.1016/j.acap.2021.02.018

      Abstract

      Purpose

      Traditional half-day per week continuity clinic experiences can lead to fragmented education in both the inpatient and outpatient arenas. Five pediatric residency programs were granted the ability from the ACGME to create X+Y scheduling where residents have continuity clinic in “blocks” rather than half-day per week experiences. The aim of this study is to assess the impact X+Y scheduling has on pediatric resident and faculty perceptions of patient care and other educational experiences.

      Methods

      Electronic surveys were sent to residents and faculty of the participating programs both prior to and 12 months after implementing X+Y scheduling. Survey questions measured resident and faculty perception of continuity clinic schedule satisfaction and the impact of continuity clinic schedules on inpatient and subspecialty rotation experiences using a 5-point Likert Scale. Data were analyzed using z-tests for proportion differences for those answering Agree or Strongly Agree between baseline and post-implementation respondents.

      Results

      Hundred and twenty-six out of 186 residents (68%) responded preimplementation and 120 out of 259 residents (47%) responded post-implementation. 384 faculty members were sent the survey with 51% response pre-implementation and 26% response at 12 months. Statistically significant (P < .05) improvements were noted in resident and faculty perceptions of ability to have continuity with patients and inpatient workflow affected by clinic scheduling.

      Conclusions

      From both resident and faculty perspectives, X+Y scheduling may improve several aspects of patient care and education. X+Y scheduling could be considered as a potential option by pediatric residency programs, especially if validated with more objective data.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. ACGME Program Requirements for Graduate Medical Education in Pediatrics. 2020. Available at:https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/320_Pediatrics_2020.pdf?ver=2020-06-29-162726-647. Accessed September 11, 2020.

        • Cabana MD
        • Jee SH.
        Does continuity of care improve patient outcomes?.
        J Fam Pract. 2004; 53: 974-980
        • Chaudhry SR
        • Hanna-Attisha M
        • LaChance J
        • et al.
        Primary resident physician: improving continuity of care.
        J Grad Med Educ. 2015; 7: 291-292
        • Salerno SM
        • Faestel PM
        • Mulligan T
        • et al.
        Disruptions and satisfaction in internal medicine resident continuity clinic differ between inpatient and outpatient rotations.
        Teach Learn Med. 2007; 19: 30-34
      2. ACGME Program Requirements for Graduate Medical Education in Internal Medicine. 2020. Available at: https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/140_InternalMedicine_2020.pdf?ver=2020-06-29-161610-040. Accessed September 11, 2020.

        • Meyers FJ
        • Weinberger SE
        • Fitzgibbons JP
        • et al.
        Redesigning residency training in internal medicine: the consensus report of the Alliance for academic internal medicine education redesign task force.
        Acad Med. 2007; 82: 1211-1219
        • Mariotti JL
        • Shalaby M
        • Fitzgibbons JP.
        The 4∶1 schedule: a novel template for internal medicine residencies.
        J Grad Med Educ. 2010; 2: 541-547
        • Chaudhry SI
        • Balwan S
        • Friedman KA
        • et al.
        Moving forward in GME reform: a 4 + 1 model of resident ambulatory training.
        J Gen Intern Med. 2013; 28: 1100-1104
        • Shalaby M
        • Yaich S
        • Donnelly J
        • et al.
        X + Y Scheduling models for internal medicine residency programs-A look back and a look forward.
        J Grad Med Educ. 2014; 6: 639-642
        • Harrison JW
        • Ramaiya A
        • Cronkright P.
        Restoring emphasis on ambulatory internal medicine training-the 3 1 model.
        J Grad Med Educ. 2014; 6: 742-745
        • Heist K
        • Guese M
        • Nikels M
        • et al.
        Impact of 4 + 1 block scheduling on patient care continuity in resident clinic.
        J Gen Intern Med. 2014; 29: 1195-1199
        • Osborn R
        • Bullis E
        • Fenick AM
        • et al.
        Asnes A. X + Y scheduling in pediatric residency: continuity, handoffs, and trainee experience.
        Acad Pediatr. 2019; 19: 489-494
      3. Advancing Innovation in Residency Education (AIRE). Available at: https://www.acgme.org/What-We-Do/Accreditation/Advancing-Innovation-in-Residency-Education-AIRE. Accessed September 11, 2020.

        • Blankfield RP
        • Kelly RB
        • Alemagno SA
        • et al.
        Continuity of care in a family practice residency program. Impact on physician satisfaction.
        J Fam Pract. 1990; 31: 69-73
        • Barnett DR
        • Bass 3rd, PF
        • Griffith 3rd, CH
        • et al.
        Determinants of resident satisfaction with patients in their continuity clinic.
        J Gen Intern Med. 2004; 19: 456-459
        • Fan VS
        • Burman M
        • McDonell MB
        • et al.
        Continuity of care and other determinants of patient satisfaction with primary care.
        J Gen Intern Med. 2005; 20: 226-233
        • Nutting PA
        • Goodwin MA
        • Flocke SA
        • et al.
        Continuity of primary care: to whom does it matter and when?.
        Ann Fam Med. 2003; 1: 149-155
        • Zastoupil L
        • McIntosh A
        • Sopfe J
        • et al.
        Positive impact of transition from noon conference to academic half day in a pediatric residency program.
        Acad Pediatr. 2017; 17: 436-442
        • Starmer AJ
        • Sectish TC
        • Simon DW
        • et al.
        Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle.
        JAMA. 2013; 310: 2262-2270
        • Kemper KJ
        • Schwartz A
        • Wilson PM
        • et al.
        Burnout in pediatric residents: three years of national survey data.
        Pediatrics. 2020; 145e20191030
        • Noronha C
        • Chaudhry S
        • Chacko K
        • et al.
        X + Y Scheduling models in internal medicine residency programs: a national survey of program directors' perspectives.
        Am J Med. 2018; 131: 107-114