• Kathleen Heist, Mary Guese, Michelle Nikels, Rachel Swigris, and Karen Chacko.
• Department of Medicine, Division of General Internal Medicine, University of Colorado Denver, 1635 Aurora Court, F 729 Aurora, Denver, CO, 80045, USA, Kathleen.heist@ucdenver.edu.
• J Gen Intern Med. 2014 Aug 1; 29 (8): 119511991195-9.

BackgroundLeaders in medical education have called for redesign of internal medicine training to improve ambulatory care training. 4 + 1 block scheduling is one innovative approach to enhance ambulatory education.AimTo determine the impact of 4 + 1 scheduling on resident clinic continuity.SettingResident continuity clinic in traditional scheduling in which clinics are scheduled intermittently one-half day per week, compared to 4 + 1 in which residents alternate 1 week of clinic with 4 weeks of an inpatient rotation or elective.ParticipantsFirst-year internal medicine residents.Program DescriptionWe measured patient-provider visit continuity, phone triage encounter continuity, and lab follow-up continuity.Program EvaluationIn traditional scheduling as opposed to 4 + 1 scheduling, patients saw their primary resident provider a greater percentage; 71.7% vs. 63.0% (p = 0.008). In the 4 + 1 model, residents saw their own patients a greater percentage; 52.1% vs. 37.1% (p = 0.0001). Residents addressed their own labs more often in 4 + 1 model; 90.7% vs. 75.6% (p = 0.001). There was no significant difference in handling of triage encounters; 42.3% vs. 35.8% (p = 0.12).Discussion4 + 1 schedule improves visit continuity from a resident perspective, and may compromise visit continuity from the patient perspective, but allows for improved laboratory follow-up, which we pose should be part of an emerging modern definition of continuity.

10 keywords...

hide…