Francis Maureen D, Thomas Kris, Langan Michael, Smith Amy, Drake Sean, Gwisdalla Keri Lyn, Jones Ronald R, Julian Katherine A, Nabors Christopher, Pereira Anne, Rosenblum Michael, Varney Andrew, Warm Eric, Ortiz Melchor
J Grad Med Educ. 2014 Jun;6(2):249-55. doi: 10.4300/JGME-D-13-00159.1.
Internal medicine programs are redesigning ambulatory training to improve the resident experience and answer the challenges of conflicting clinical responsibilities. However, little is known about the effect of clinic redesign on residents' satisfaction.
We assessed residents' satisfaction with different resident continuity clinic models in programs participating in the Educational Innovations Project Ambulatory Collaborative (EPAC).
A total of 713 internal medicine residents from 12 institutions in the EPAC participated in this cross-sectional study. Each program completed a detailed curriculum questionnaire and tracked practice metrics for participating residents. Residents completed a 3-part satisfaction survey based on the Veterans Affairs Learners' Perception Survey, with additional questions addressing residents' perceptions of the continuous healing relationship and conflicting duties across care settings.
THREE CLINIC MODELS WERE IDENTIFIED: traditional weekly experience, combination model with weekly experience plus concentrated ambulatory rotations, and a block model with distinct inpatient and ambulatory blocks. The satisfaction survey showed block models had less conflict between inpatient and outpatient duties than traditional and combination models. Residents' perceptions of the continuous healing relationship was higher in combination models. In secondary analyses, the continuity for physician measure was correlated with residents' perceptions of the continuous healing relationship. Panel size and workload did not have an effect on residents' overall personal experience.
Block models successfully minimize conflict across care settings without sacrificing overall resident satisfaction or resident perception of the continuous healing relationship. However, resident perception of the continuous healing relationship was higher in combination models.
内科住院医师培训项目正在重新设计门诊培训，以改善住院医师的体验，并应对临床职责冲突带来的挑战。然而，关于门诊重新设计对住院医师满意度的影响，我们知之甚少。
我们评估了参与教育创新项目门诊协作（EPAC）的住院医师对不同住院医师连续性门诊模式的满意度。
EPAC中12个机构的713名内科住院医师参与了这项横断面研究。每个项目都完成了一份详细的课程问卷，并跟踪参与住院医师的实践指标。住院医师根据退伍军人事务部学习者感知调查完成了一份三部分的满意度调查，另外还有一些问题涉及住院医师对持续治疗关系以及不同护理环境中职责冲突的看法。
确定了三种门诊模式：传统的每周体验模式、每周体验模式加集中门诊轮转的组合模式，以及有明确住院和门诊模块的模块模式。满意度调查显示，模块模式在住院和门诊职责之间的冲突比传统模式和组合模式少。组合模式下住院医师对持续治疗关系的认知更高。在二次分析中，医生连续性测量与住院医师对持续治疗关系的认知相关。小组规模和工作量对住院医师的总体个人体验没有影响。
模块模式成功地将不同护理环境之间的冲突降至最低，同时不牺牲住院医师的总体满意度或住院医师对持续治疗关系的认知。然而，组合模式下住院医师对持续治疗关系的认知更高。
