EFFECTS OF TIME-IN-CLINIC, CLINIC SETTING, AND FACULTY SUPERVISION ONTHE CONTINUITY CLINIC EXPERIENCE

Study objective. To evaluate the effects of setting, type of supervisi on, and time in clinic on the resident continuity clinic experience. D esign. Prospective cohort with preintervention and postintervention me asures.Settings. Pediatric residents selected one of three clinic sett ings for their continuity clinic experience. These included a traditio nal, university-based clinic, private practice offices, and publicly f unded community-based clinics. Subjects. All pediatric residents at th e University of Utah Health Sciences Center, July 1985 through June 19 91. Interventions. Using varied clinic sites, matching residents one o r two to one with preceptors for their continuity clinic, increasing c ontinuity clinic from 1 to 2 half-days per week. Measurements and main results. Residents in private offices had the most varied experience, seeing more patients, more acute care, and a broader age range of pat ients than residents at other sites. They were more likely both to be observed by their preceptors during patient visits and to observe thei r preceptors delivering care. Because the number of patients seen per session rose, increasing continuity clinic time from one to two half-d ays per week more than doubled the number of patients seen per week. I ncreased time away from hospital did not affect scores on the Pediatri c In-Training Examination. While test scores were similar for incoming residents, those in private offices scored higher on the final Behavi oral Pediatrics Examination (P < .05). Conclusions. Clinic setting, ti me in clinic, and faculty supervision affect the quality of the contin uity clinic experience. Increased time in clinic resulted in a broader exposure to patients. Residents placed in private offices had a more varied patient mix, were more closely supervised, and seemed to gain p rimary care skills more rapidly than residents at other sites.