Roy Shuvro, Fu Katherine, Ryan Timothy E, Bordelon Yvette, Flippen Charles C, Keener Adrienne M
From the Department of Neurology (S.R.), Johns Hopkins University, Baltimore, MD; Department of Neurology (S.R., K.F., T.E.R., Y.B., C.C.F., A.M.K.), UCLA, Los Angeles, CA; and Department of Neurology (T.E.R.), Cedars Sinai Medical Center, Los Angeles, CA.
Neurol Educ. 2022 Nov 18;1(2):e200017. doi: 10.1212/NE9.0000000000200017. eCollection 2022 Dec.
There is a need for earlier outpatient exposure in neurology training. In 2017, 56% of residents on the American Academy of Neurology (AAN) Graduating Resident Survey reported that they felt that the fellowship process started too early, and 46% felt that they did not have adequate outpatient exposure before making a fellowship decision. In addition, the traditional front-loaded resident schedule may contribute to high rates of burnout due to greater work hours and heavier inpatient load, as was suggested in the findings of a 2016 AAN survey comparing burnout among residents and fellows.
We created an X + Y model within the UCLA Neurology Residency Program in the 2020-2021 academic year with the goal of increasing outpatient exposure earlier in training. We used a preintervention/postintervention design assessing measures of resident satisfaction, outpatient clinic exposure, number of inpatient handoffs, resident work hours, and scores on the resident in-training examination (RITE). We hypothesized that outpatient clinic exposure would increase, handoffs would diminish, work hours would be reduced, measures of resident satisfaction with inpatient care, outpatient care, and well-being would improve, and that RITE scores would improve. Work hours, handoffs, and number of clinic days were compared across each year via analysis of the resident schedule. Resident perceptions were obtained via an online survey at the end of their PGY-2 year. RITE scores were compared across a variety of subspecialties.
In the postintervention year, handoffs were reduced by 6.13 (95% CI 4.73-7.54) per week. Average clinic half-days increased by 4.51 (95% CI 7.76-0.53). Resident responses regarding their outpatient experience improved from 42% to 93% satisfied and from 60% to 94% satisfied for their inpatient experience. There was no difference in average work hours per week before and after the intervention. Regarding resident well-being, responses improved from 42% satisfied in the traditional model to 96% in the X + Y model. Among the RITE subjects covering primarily outpatient subspecialties, scores improved in each category.
After implementation of an X + Y model, we observed an improvement in outpatient exposure, learning and career satisfaction, and resident education on subspecialty topics.
神经病学培训需要更早地让住院医师接触门诊工作。2017年，美国神经病学学会（AAN）毕业住院医师调查中，56%的住院医师表示他们觉得专科培训过程开始得太早，46%的人觉得在做出专科培训决定之前，他们没有足够的门诊工作经历。此外，2016年AAN一项比较住院医师和专科医师职业倦怠情况的调查结果显示，传统的前期负荷较重的住院医师日程安排，可能因工作时间更长、住院患者负担更重，导致职业倦怠率较高。
在2020 - 2021学年，我们在加州大学洛杉矶分校神经病学住院医师培训项目中创建了一个X + Y模式，目标是在培训早期增加门诊工作经历。我们采用干预前/干预后设计，评估住院医师满意度、门诊接触情况、住院患者交接次数、住院医师工作时间以及住院医师培训考试（RITE）成绩等指标。我们假设门诊接触机会将增加，交接次数将减少，工作时间将缩短，住院医师对住院治疗、门诊治疗和幸福感的满意度指标将得到改善，并假设RITE成绩将提高。通过分析住院医师日程安排，比较每年的工作时间、交接次数和门诊天数。住院医师的看法通过他们PGY - 2学年末的在线调查获得。比较了各个亚专科的RITE成绩。
在干预后的年份，每周交接次数减少了6.13次（95%置信区间4.73 - 7.54）。平均门诊半天时间增加了4.51次（95%置信区间7.76 - 0.53）。住院医师对门诊体验的满意度从42%提高到93%，对住院体验的满意度从60%提高到94%。干预前后每周平均工作时间没有差异。关于住院医师的幸福感，满意度从传统模式下的42%提高到X + Y模式下的96%。在主要涵盖门诊亚专科的RITE科目中，每个类别成绩都有所提高。
实施X + Y模式后，我们观察到门诊接触机会、学习和职业满意度以及住院医师在亚专科主题教育方面都有所改善。
