Resident and Preceptor Perceptions of Preceptor Integration Into Resident Clinic Scheduling Templates.

BACKGROUND: Some internal medicine residency programs on X+Y schedules have modified clinic preceptor schedules to mimic those of the resident cohort (resident matched). This is in contrast to a traditional model, in which preceptors supervise on the same half-day each week. OBJECTIVE: We assessed preceptor and resident perceptions of the 2 precepting models. METHODS: We surveyed 44 preceptors and 97 residents at 3 clinic sites in 2 academic medical centers. Two clinics used the resident-matched model, and 1 used a traditional model. Surveys were completed at 6 months and 1 year. We assessed resident and preceptor perceptions in 5 domains: relationships between residents and preceptors; preceptor familiarity with complex patients; preceptor ability to assess milestone achievements; ability to follow up on results; and quality of care. RESULTS: There was no difference in perceptions of interpersonal relationships or satisfaction with patient care. Preceptors in the resident-matched schedule reported they were more familiar with complex patients at both 6 months and 1 year, and felt more comfortable evaluating residents' milestone achievements at 6 months, but not at 1 year. At 1 year, residents in the resident-matched model perceived preceptors were more familiar with complex patients than residents in the traditional model. The ability to discuss patient results between clinic weeks was low in both models. CONCLUSIONS: The resident-matched model increased resident and preceptor perceptions of familiarity with complex patients and early preceptor perceptions of comfort in assessment of milestone achievements.

The highly influential teacher: recognising our unsung heroes.

OBJECTIVES: This study was designed to investigate the roles, characteristics and contributions to the educational process of highly influential teachers described retrospectively by faculty members who were former medical students and trainees. METHODS: The authors collected 20 appreciative inquiry narratives from a convenience sample of 22 faculty members (91% collection rate) at three medical schools that had volunteered to participate in a year-long programme of faculty development in humanism in medicine. The faculty members wrote narratives in response to the prompt: 'Write about your most influential teacher.' The four authors performed qualitative analysis of the 20 narratives using the constant comparison method to identify the characteristics of influential teachers. RESULTS: Particular relational features with their learners explain the profound influences of these teachers on the professional development of their learners. All influential teachers shared qualities of excellence in teaching and nearly all were described as caring, generous and selfless in their relationships with learners. CONCLUSIONS: Highly influential teachers have no official roles, yet appear to profoundly influence the professional development of many learners at various stages of the educational process.

Impact of 4 + 1 block scheduling on patient care continuity in resident clinic.

BACKGROUND: Leaders 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. AIM: To determine the impact of 4 + 1 scheduling on resident clinic continuity. SETTING: Resident 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. PARTICIPANTS: First-year internal medicine residents. PROGRAM DESCRIPTION: We measured patient-provider visit continuity, phone triage encounter continuity, and lab follow-up continuity. PROGRAM EVALUATION: In 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). DISCUSSION: 4 + 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.