From the Department of Medicine, Division of General Internal Medicine, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania.
Department of Internal Medicine, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
South Med J. 2024 Mar;117(3):122-127. doi: 10.14423/SMJ.0000000000001664.
Internal Medicine (IM) residents have reported dissatisfaction with continuity clinic (CC) training, which may contribute to the increasing shortage of primary care physicians. Studies show balancing inpatient and outpatient duties as a driver of dissatisfaction, but few studies have compared CC with inpatient (IP) training, following transition to an X + Y model, or assessed the impact of show rates, continuity, and telemedicine use on resident perceptions. The aim of this study was to adapt a validated survey to compare residents' perceptions of their CC with their inpatient medicine training and examine the impact of objective clinic measures on training.
This quantitative cross-sectional study included a survey that was sent to 152 residents at an academic IM program in May-June 2021. Clinic measures such as show versus no-show rates, continuity with the residents' own patients, and visit modality were obtained through the electronic health records at Veterans Affairs and non-Veterans Affairs CCs.
The survey response rate was 78% (118/152). Residents were more satisfied with inpatient general medicine rotations than their CC experience (4.5 vs 3.3 on a 5-point scale, < 0.001). Residents were more likely to pursue a profession in inpatient IM than in primary care (3.7 vs 2.3, < 0.001). No correlation was found between higher show rates, continuity with patients, or proportion of visits conducted through telemedicine and resident satisfaction with CC.
This study aligns with previous findings of IM resident dissatisfaction with CC training while adding a side-by-side comparison to inpatient training and including objective CC data. We identified new areas for improvement of CC training, including residents' medical knowledge through review of quality metrics, making CC representative of real-world practice, and mentorship from faculty.
内科住院医师报告对连续性诊所（CC）培训不满意，这可能导致初级保健医生短缺。研究表明，平衡住院和门诊职责是导致不满的一个因素，但很少有研究比较 CC 与住院（IP）培训，在过渡到 X+Y 模式后，或评估就诊率、连续性和远程医疗使用对住院医师认知的影响。本研究旨在改编一份经过验证的调查，以比较住院医师对 CC 和住院内科培训的看法，并研究客观诊所措施对培训的影响。
这项定量横断面研究包括一项调查，该调查于 2021 年 5 月至 6 月发送给一个学术内科项目的 152 名住院医师。通过退伍军人事务部和非退伍军人事务部 CC 的电子健康记录获得门诊就诊率与未就诊率、与住院医师自己的患者的连续性以及就诊方式等诊所措施。
调查的回复率为 78%（118/152）。住院医师对住院内科轮转的满意度高于 CC 体验（5 分制，4.5 分比 3.3 分，<0.001）。住院医师更倾向于从事住院内科而不是初级保健工作（3.7 比 2.3，<0.001）。就诊率较高、与患者的连续性或通过远程医疗进行的就诊比例与住院医师对 CC 的满意度之间没有相关性。
这项研究与以前内科住院医师对 CC 培训不满意的发现一致，同时对住院培训进行了并列比较，并包括了客观的 CC 数据。我们确定了改进 CC 培训的新领域，包括通过质量指标审查提高住院医师的医疗知识、使 CC 更能代表实际实践、以及教师的指导。
