Pediatric residents' continuity clinics: how are we really doing?

The Accreditation Council for Graduate Medical Education (ACGME) established guidelines in 1989 requiring pediatric residents to attend a continuity clinic (CC) one half-day per week. OBJECTIVE. To assess pediatric residents' CCs, with an emphasis on those factors potentially affecting house staff education and patient care. DESIGN AND PARTICIPANTS. A multi-item questionnaire designed to assess the educational, administrative, and clinical components of CCs was distributed to all US CC directors. RESULTS. Responses were received from 164 programs (74.9%), which represented more than 90% of all house staff in accredited US pediatric programs. Fifty-five percent of programs acknowledged non-ACGME-approved exemptions from attendance, and 64% changed CC schedules dependent on in-patient rotation assignment. Less than half of the programs had core curricula or didactic conferences. Most programs (76%) were located in hospital clinics. Clinic resources and equipment were often limited; faculty preceptors and nursing and clerical support staff were frequently insufficient in number. On average, PL1s saw four patients per session, whereas PL2s and PL3s saw five. Continuity of care for the patient for phone calls, acute and after-hours visits, and hospitalization was limited. Directors' perceived support for CCs' educational programs ranged from a high of 87% by generalists to a low of 33% by intensivists. CONCLUSIONS. Despite the ACGME directives, many residency programs have not provided the required priority, protected time, or adequate resources for CCs. The recent emphasis on health care reform and primary care medical education highlights the prominent role the CC should play as an important site in our teaching of longitudinal and ambulatory medicine. Departmental support and committed resources necessary to enhance the experience and to meet the educational challenge successfully will be required.