Teaching residents about patient and practice termination in community-based continuity settings.

BACKGROUND

The pediatric residency program at the University of Massachusetts Medical Center, Worcester, has based its continuity experience in community practices since 1988. Residents develop a relationship not only with their patients but also with the preceptors, with whom they are paired one-on-one, and with office staff.

OBJECTIVE

To describe the structure and results of an educational program that was developed to address the termination issues that arise at the end of residency. The educational program consists of four components: (1) a seminar, (2) a "mini-block" rotation, (3) office staff involvement, and (4) a resident-preceptor dinner.

RESULTS

The following issues and themes have been recurrent in the discussions during the past 4 years: (1) the importance, for patient and resident, of identifying who will be the subsequent health care provider for the patient; (2) the inability to identify which patients had strongest attachment to residents; (3) parental surprise about the resident's departure, even though all parents had been told that the resident was going to be in the practice for only a limited period; (4) the desire of residents to have follow-up on patients after termination; (5) critical aspects of the process of informing patients about the resident's departure; (6) the importance of identifying and addressing the attachment of the resident to the preceptor and office staff, as well as to patients; and (7) the affirming experience that the termination sessions with the patients can be for the residents.

CONCLUSION

Although the termination process is potentially emotionally difficult, it can be a personally and educationally valuable experience for residents.