scholarly journals Resident Education in Free Clinics: An Internal Medicine Continuity Clinic Experience

2013 ◽  
Vol 5 (2) ◽  
pp. 327-331 ◽  
Author(s):  
Amber T. Pincavage ◽  
Rabia R. Razi ◽  
Vineet M. Arora ◽  
Julie Oyler ◽  
James N. Woodruff
Keyword(s):  
Internal Medicine ◽  
Free Clinics ◽  
Free Clinic ◽  
Community Based ◽  
Continuity Clinic ◽  
Ambulatory Training ◽  
Academic Medical ◽  
Primary Care Education ◽  
Clinic Experience ◽  
The University

Abstract Background Most internal medicine (IM) residency programs provide ambulatory training in academic medical centers. Community-based ambulatory training has been suggested to improve ambulatory and primary care education. Free clinics offer another potential training setting, but there have been few reports about the experience of IM residents in free clinics. Objective We assessed the feasibility and acceptability of inclusion of an ambulatory rotation in a free clinic and IM residency curriculum and the advantages of the free clinic setting over the traditional ambulatory clinic model. Methods In 2010, the University of Chicago Internal Medicine Residency Program partnered with a free clinic in order to establish a community-based continuity clinic experience. To assess the feasibility of this innovation, 16 residents were surveyed 9 months after implementation of the clinic to determine satisfaction, perceived preparation to address common medical conditions, and attitudes toward the underserved care population. A subset of these responses was compared to responses from residents in the traditional clinic model. Results Residents in the free clinic rotation were more satisfied and perceived they were more prepared to work in low-resource settings and reported similar levels of preparation regarding common outpatient conditions than residents in a traditional continuity clinic format. They reported increased future likelihood of working in an underserved clinic. Conclusions Our exploratory study suggests free clinics may be an effective platform for community-based continuity clinic training.

scholarly journals Satisfaction of General Versus Specialized Continuity Clinic in Hematology Oncology Fellowship Training: A Survey

2021 ◽  
Vol 8 ◽  
pp. 238212052110258
Author(s):  
Sama Ilyas ◽  
Martina Murphy ◽  
Jennifer Duff ◽  
Julia Close
Keyword(s):  
Personal Responsibility ◽  
Fellowship Training ◽  
Continuity Clinic ◽  
University Of Florida ◽  
Clinic Experience ◽  
Thematic Review ◽  
Survey Responses ◽  
The University ◽  
Adequate Supervision

Background: At the University of Florida (UF), hematology-oncology (HO) fellows participate in 2 general types of continuity clinic as part of their fellowship training. One clinic, at the Veterans Hospital (VA), allows fellows to care for patients with a variety of hematology oncology diagnoses in a general clinic setting. The other clinic, located at the university site, is disease or system specific (such as breast or GI clinic). Considerable research supports the value of continuity clinic in residency and fellowship training, but the differences in having a general versus specialized clinic for HO fellows have not been explored. The purpose of this study was to investigate the perceived differences of general versus specialized continuity clinics by recent HO graduates from UF. Specifically, we were interested in learning which features of a continuity clinic they felt were most impactful for their current clinical practice. Methods: An anonymous survey was sent to the last 6 graduating classes of HO fellows at UF, between years of 2013 and 2018. The survey contained short demographic questions, followed by 5 open ended questions pertaining to the differing continuity clinic experiences. Graduates were asked about their opinions of both the general and specialized clinics during their training at UF. Survey responses were reviewed and coded for common themes by the authors. Results: Of 28 graduating fellows surveyed, 13 responded to the survey (response rate 46%). In thematic review of survey responses, the most common themes that emerged concerned autonomy, level of supervision, and the diversity of the patient population. A majority of respondents felt they had more autonomy and personal responsibility at the VA general clinic, but less direct supervision than at the specialized clinics. They also believed they got a broader exposure to different disease types at the VA general clinic. Surveyed participants also commented on the quality of educational seminars and activities, preceptor expertise and teaching, and ability to observe cutting edge practice and clinical trials. Conclusions: Graduated oncology fellows from UF believe that there is a balance that exists between having autonomy and ownership of their patients versus having adequate supervision. Many believe that having “controlled autonomy” and “as much independence as is safe for patients” is key to a meaningful continuity clinic experience during oncology fellowship training.

Are Continuity Clinic Patients Less Satisfied When Residents Have a Heavy Inpatient Workload?

2005 ◽  
Vol 28 (4) ◽  
pp. 390-399 ◽  
Author(s):  
Christopher A. Feddock ◽  
Andrew R. Hoellein ◽  
Charles H. Griffith ◽  
John F. Wilson ◽  
Natasha S. Becker ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Patient Satisfaction ◽  
Clinic Visit ◽  
Self Report ◽  
Point Scale ◽  
University Of Kentucky ◽  
Continuity Clinic ◽  
Resident Continuity Clinic ◽  
The University ◽  
Heavy Patient

The purpose of this study was to assess the influence of resident nonclinic workload on the satisfaction of continuity clinic patients. Over a 2-month period in 2002, residents and patients were surveyed at the University of Kentucky internal medicine continuity clinic. Residents provided a self-report of their nonclinic workload as light or medium versus heavy or extremely heavy. Patient satisfaction was assessed with a 7-item, 10-point scale with items derived from commonly used patient satisfaction instruments. In 168 patient encounters, patients were significantly less satisfied with their clinic visit if they were seen by a resident who had a heavier workload. In addition, these patients gave significantly lower ratings with regard to the amount of time spent with the patient during the visit, and how well the resident listened and paid attention. Although alternative explanations exist, we propose that heavy hospital workload is associated with decreased patient satisfaction in resident continuity clinic.

scholarly journals Resident Physician Perspectives on Outpatient Continuity of Care

2013 ◽  
Vol 5 (4) ◽  
pp. 668-673 ◽  
Author(s):  
Mark L. Wieland ◽  
Thomas M. Jaeger ◽  
John B. Bundrick ◽  
Karen F. Mauck ◽  
Jason A. Post ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Continuity Of Care ◽  
Small Groups ◽  
Medical Center ◽  
Academic Medical Center ◽  
Continuity Clinic ◽  
Residency Programs ◽  
Physician Perspectives ◽  
Internal Medicine Residents ◽  
Academic Medical

Abstract Background The outpatient continuity clinic is an essential component of internal medicine residency programs, yet continuity of patient care in these clinics is suboptimal. Reasons for this discontinuity have been inadequately explored. Objective We sought to assess perceived factors contributing to discontinuity in trainee ambulatory clinics. Methods The study encompassed 112 internal medicine residents at a large academic medical center in the Midwest. We conducted 2 hours of facilitated discussion with 18 small groups of residents. Residents were asked to reflect on factors that pose barriers to continuity in their ambulatory practice and potential mechanisms to reduce these barriers. Resident comments were transcribed and inductive analysis was performed to develop themes. We used these themes to derive recommendations for improving continuity of care in a resident ambulatory clinic. Results Key themes included an imbalance of clinic scheduling that favors access for patients with acute symptoms over continuity, clinic triage scripts that deemphasize continuity, inadequate communication among residents and faculty regarding shared patients, residents' inefficient use of nonphysician care resources, and a lack of shared values between patients and providers regarding continuity of care. Conclusions The results offer important information that may be applied in iterative program changes to enhance continuity of care in resident clinics.

scholarly journals Satisfaction of general versus specialized continuity clinic in hematology oncology fellowship training: A survey.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 10529-10529
Author(s):  
Sama Imran Ilyas ◽  
Martina Cathryn Murphy ◽  
Jennifer Michelle Duff ◽  
Julia Lee Close
Keyword(s):  
Personal Responsibility ◽  
Fellowship Training ◽  
Continuity Clinic ◽  
University Of Florida ◽  
Considerable Research ◽  
Clinic Experience ◽  
Survey Responses ◽  
The University ◽  
Adequate Supervision

10529 Background: At the University of Florida (UF), oncology fellows participate in two general types of continuity clinic as part of their training. One clinic at the Veterans Hospital (VA) allows them to care for patients in a general clinic setting that encompasses a variety of hematology oncology diagnoses. The other clinic, located at the university site, is disease or system specific (such as breast or GI clinic). Considerable research supports the value of continuity clinic in residency and fellowship training, but the differences in having a general versus specialized clinic for oncology fellows have not been explored. The purpose of this study is to investigate the perceived differences of general versus specialized continuity clinics by recent oncology graduates from UF, and what features of a continuity clinic they feel were most important for an effective and meaningful experience. Methods: An anonymous survey was sent to the last six graduating classes of oncology fellows at UF. The survey contained short demographic questions, followed by five open ended questions pertaining to both continuity clinic experiences. Graduates were asked about their opinions of both the general and specialized clinics during their training at UF. Survey responses were reviewed and coded for common themes. Results: The most common themes that emerged from the surveys were concerning autonomy, supervision, and the diversity of cases and patient population. A majority of respondents felt they had more autonomy and personal responsibility at the VA general clinic, but less direct supervision than at the specialized clinics. They also believed they got a broader exposure of different disease types at the VA general clinic. Surveyed participants also commented on the quality of educational seminars and activities, preceptor expertise and teaching, and ability to observe cutting edge practice and clinical trials. Eleven out of thirty surveys were returned and we anticipate a greater than 50% response for the final poster. Conclusions: Graduated oncology fellows from UF believe that there is a balance that exists between having autonomy and ownership of their patients versus having adequate supervision. Many believe that having “controlled autonomy” and “as much independence as is safe for patients” is key to a meaningful continuity clinic experience during oncology fellowship training.

scholarly journals Educating Generalists: Factors of Resident Continuity Clinic Associated With Perceived Impact on Choosing a Generalist Career

2011 ◽  
Vol 3 (4) ◽  
pp. 469-474 ◽  
Author(s):  
Ryan Laponis ◽  
Patricia S. O'Sullivan ◽  
Harry Hollander ◽  
Patricia Cornett ◽  
Katherine Julian
Keyword(s):  
Internal Medicine ◽  
Career Choice ◽  
Personal Experience ◽  
Reliability And Validity ◽  
Veterans Health ◽  
Health Administration ◽  
Continuity Clinic ◽  
General Internal ◽  
Clinic Experience ◽  
Resident Continuity Clinic

Abstract Background Fewer residents are choosing general internal medicine (GIM) careers, and their choice may be influenced by the continuity clinic experience during residency. We sought to explore the relationship between resident satisfaction with the continuity clinic experience and expressed interest in pursuing a GIM career. Methods We surveyed internal medicine residents by using the Veterans Health Administration Office of Academic Affiliations Learners' Perceptions Survey—a 76-item instrument with established reliability and validity that measures satisfaction with faculty interactions, and learning, working, clinical, and physical environments, and personal experience. We identified 15 reliable subscales within the survey and asked participants whether their experience would prompt them to consider future employment opportunities in GIM. We examined the association between satisfaction measures and future GIM interest with 1-way analyses of variance followed by Student-Newman-Keuls post hoc tests. Results Of 217 residents, 90 (41%) completed the survey. Residents felt continuity clinic influenced career choice, with 22% more likely to choose a GIM career and 43% less likely. Those more likely to choose a GIM career had higher satisfaction with the learning (P  =  .001) and clinical (P  =  .002) environments and personal experience (P < .001). They also had higher satisfaction with learning processes (P  =  .002), patient diversity (P < .001), coordination of care (P  =  .009), workflow (P  =  .001), professional/personal satisfaction (P < .001), and work/life balance (P < .001). Conclusions The continuity clinic experience may influence residents' GIM career choice. Residents who indicate they are more likely to pursue GIM based on that clinical experience have higher levels of satisfaction. Further prospective data are needed to assess if changes in continuity clinic toward these particular factors can enhance career choice.

scholarly journals The 4∶1 Schedule: A Novel Template for Internal Medicine Residencies

2010 ◽  
Vol 2 (4) ◽  
pp. 541-547 ◽  
Author(s):  
Jennifer L. Mariotti ◽  
Marc Shalaby ◽  
John P. Fitzgibbons
Keyword(s):  
Internal Medicine ◽  
Primary Care Physicians ◽  
Present System ◽  
Internal Medicine Training ◽  
Continuity Clinic ◽  
Ambulatory Training ◽  
Immersion Experience ◽  
Before And After ◽  
Ambulatory Medicine ◽  
Ambulatory Education

Abstract Background It is widely acknowledged that there is need for redesign of internal medicine training. Duty hour restrictions, an increasing focus on patient safety, the possibility of inadequate training in ambulatory care, and a growing shortage of primary care physicians are some factors that fuel this redesign movement. Intervention We implemented a 4∶1 scheduling template that alternates traditional 4-week rotations with week-long ambulatory blocks. Annually, this provides 10 blocks of traditional rotations without continuity clinic sessions and 10 weeks of ambulatory experience without inpatient responsibilities. To ensure continuous resident presence in all areas, residents are divided into 5 groups, each staggered by 1 week. Evaluation We surveyed residents and faculty before and after the intervention, with questions focused on attitudes toward ambulatory medicine and training. We also conducted focus groups with independent groups of residents and faculty, designed to assess the benefits and drawbacks of the new scheduling template and to identify areas for future improvement. Results Overall, the scheduling template minimized the conflicts between inpatient and outpatient training, promoted a stronger emphasis on ambulatory education, allowed for focused practice during traditional rotations, and enhanced perceptions of team development. By creating an immersion experience in ambulatory training, the template allowed up to 180 continuity clinic sessions during 3 years of training and provided improved educational continuity and continuity of patient care. Conclusion Separating inpatient and ambulatory education allows for enhanced modeling of the evolving practice of internists and removes some of the conflict inherent in the present system.

From Volunteering to Academic Programming: A Case Example

2016 ◽  
Vol 1 (17) ◽  
pp. 7-11 ◽  
Author(s):  
Cindy Gill ◽  
Sneha Bharadwaj ◽  
Nancy Quick ◽  
Sarah Wainscott ◽  
Paula Chance
Keyword(s):  
Special Needs ◽  
Cultural Relevance ◽  
Master's Program ◽  
Speech Language Pathology ◽  
Community Based ◽  
Charitable Organization ◽  
Language Pathology ◽  
The University

A speech-language pathology master's program that grew out of a partnership between the University of Zambia and a U.S.-based charitable organization, Connective Link Among Special needs Programs (CLASP) International, has just been completed in Zambia. The review of this program is outlined according to the suggested principles for community-based partnerships, a framework which may help evaluate cultural relevance and sustainability in long-term volunteer efforts (Israel, Schulz, Parker, & Becker, 1998).

5. A needs assessment for a CanMEDS-based curriculum in ambulatory care for internal medicine residents in Canada

2007 ◽  
Vol 30 (4) ◽  
pp. 29
Author(s):  
R. Wong ◽  
S. Roff
Keyword(s):  
Internal Medicine ◽  
Ambulatory Care ◽  
Learning Outcomes ◽  
Delphi Technique ◽  
Training Programs ◽  
Internal Medicine Training ◽  
Modified Delphi ◽  
Ambulatory Training ◽  
Ambulatory Medicine ◽  
Care Training

In Canada, graduates of internal medicine training programs should be proficient in ambulatory medicine and practice. Before determining how to improve education in ambulatory care, a list of desired learning outcomes must be identified and used as the foundation for the design, implementation and evaluation of instructional events. The Delphi technique is a qualitative-research method that uses a series of questionnaires sent to a group of experts with controlled feedback provided by the researchers after each round of questions. A modified Delphi technique was used to determine the competencies required for an ambulatory care curriculum based on the CanMEDS roles. Four groups deemed to be critical stakeholders in residency education were invited to take part in this study: 1. Medical educators and planners, 2. Members of the Canadian Society of Internal Medicine (CSIM), 3. Recent Royal College certificants in internal medicine, 4. Residents currently in core internal medicine residency programs. Panelists were sent questionnaires asking them to rate learning outcomes based on their importance to residency training in ambulatory care. Four hundred and nineteen participants completed the round 1 questionnaire that was comprised of 75 topics identified through a literature search. Using predefined criteria for degree of importance and consensus, 19 items were included in the compendium and 9 were excluded after one round. Forty-two items for which the panel that did not reach consensus, as well as 3 new items suggested by the panel were included in the questionnaire for round 2. Two hundred and forty participants completed the round 2 questionnaire; consensus was reached for each of the 45 items. After two rounds, 21 items were included in the final compendium as very high priority topics (“must be able to”). An additional 26 items were identified as high priority topics (“should be able to”). The overall ratings by each of the four groups were similar and there were no differences between groups that affected the selection of items for the final compendium. To our knowledge this is the first time a Delphi-process has been used to determine the content of an ambulatory care curriculum in internal medicine in Canada. The compendium could potentially be used as the basis to structure training programs in ambulatory care. Barker LR. Curriculum for Ambulatory Care Training in Medical residency: rationale, attitudes and generic proficiencies. J Gen Intern Med 1990; 5(supp.):S3-S14. Levinsky NG. A survey of changes in the proportions of ambulatory training in internal medicine clerkships and residencies from 1986-87 to 1996-97. Acad Med 1998; 73:1114-1115. Linn LS, Brook RH, Clarke VA, Fink A, Kosecoff J. Evaluation of ambulatory care training by graduates of internal medicine residencies. J Med Educ 1986; 61:293-302.

Sustaining University-Community Partnerships in Indigenous Communities: Five Lessons from Papakōlea

2019 ◽  
Vol 16 (1-2) ◽  
pp. 35-63
Author(s):  
Robert Agres ◽  
Adrienne Dillard ◽  
Kamuela Joseph Nui Enos ◽  
Brent Kakesako ◽  
B. Puni Kekauoha ◽  
...  
Keyword(s):  
Learning Community ◽  
Ways Of Knowing ◽  
Indigenous Communities ◽  
Community Based ◽  
Urban And Regional Planning ◽  
Culture Of Learning ◽  
Community Values ◽  
University Of Hawai'i ◽  
The University

This resource paper draws lessons from a twenty-year partnership between the Native Hawaiian community of Papakōlea, the Hawai‘i Alliance for Community-Based Economic Development, and the Department of Urban and Regional Planning at the University of Hawai‘i. Key players and co-authors describe five principles for sustained partnerships: (1) building partnerships based upon community values with potential for long-term commitments; (2) privileging indigenous ways of knowing; (3) creating a culture of learning together as a co-learning community; (4) fostering reciprocity and compassion in nurturing relationships; and (5) utilizing empowering methodologies and capacity-building strategies.

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