Berks County Medical Society Medical Record Fall 2018 - 24

Reading Hospital/Tower Health

Student Sum mer Research Projects
Clinic First: A New Scheduling
Model 3+1 and 2+2
by Michelle C. Hartzell, William Lovett, MD,
Department of Family Medicine, Reading Hospital,
Reading, PA
INTRODUCTION:
Family medicine residency training includes a combination of
inpatient, elective and ambulatory clinical experiences that prepare
residents to provide care to patients of all ages. A key aspect of the
residency curriculum is outpatient training in a family health care
office. A new block scheduling model replaces interspersed half day
office sessions with weeklong blocks, effectively separating residents'
outpatient office education from their other rotations. First and
second year residents will have 3 weeks of rotations followed by 1
week of office in a four week cycle, while third year residents will
have 2 weeks of rotations followed by 2 weeks of office.

METHODS:
In June 2018, a pre-implementation voluntary survey with 15
items was sent to all Reading Hospital family medicine residents
(n=23) and a 12 item survey was sent to all program faculty (n=10).
In July 2018, a 6 item survey was sent to outside clinical faculty
involved in teaching family medicine residents (n=38). Participants
were asked to rate each statement using a five point Likert scale
where 1=strongly disagree to 5=strongly agree. The mean, standard
deviation, and response rate of each question was recorded. Survey
questions were paired with identical questions in surveys conducted
by internal medicine residency programs who also transitioned from
half day scheduling to block scheduling. An independent t-test
was performed to compare survey responses between the family and
internal medicine residency programs.

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RESULTS:
The response rate of the residents was 93% (21/23) and for the
faculty was 100% (10/10). Results of the outside faculty survey
are pending. The highest scores among the residents included
statements related to their patients' access to office care and that
their absence on rotations due to clinic hours affects how they are
perceived by other attendings or residents. They neither agreed
nor disagreed that they are distracted by responsibilities while in
the office or that outside responsibilities affect their performance
in the office. In comparison to internal medicine residents, they
reported significantly higher values for their enjoyment of outpatient
practice (p<.001), access of their patients to care (p<.001), and
their ability to focus on outpatient education while in the clinic
(p<.01). The faculty scores were highest on statements related to
the importance of the clinic as part of residency training, the ability
of the nursing staff to work with the residents, and their ability to
suggest improvements for clinic operations. They disagreed that the
clinical curriculum is effective and that the clinic reinforces residents'
desire to practice outpatient family medicine. In comparison to
internal medicine faculty, the faculty reported significantly higher
responses for statements relating to the program's ambulatory
experience as adequate to prepare for outpatient practice (p<.01) and
the outpatient clinic as an ideal educational environment to train
residents for outpatient practice (p<.001).

CONCLUSION:
The pre-implementation survey results of the residents and
faculty suggest room for improvement with their satisfaction of
the program's outpatient clinic training. The effect of the new 3+1
and 2+2 scheduling model on their responses will be definitively
determined upon completion of the post-implementation survey in
October 2018. Pre-implementation survey results also demonstrate a
marked contrast to internal medicine programs in both the resident
and faculty studies.

Michelle C.Hartzell is a second-year medical
student at the Lake Erie College of Osteopathic
Medicine.


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Berks County Medical Society Medical Record Fall 2018

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