RESIDENT AND FAMILY CONTINUITY IN PEDIATRIC CONTINUITY CLINIC - 9 YEARS OF OBSERVATION

Objective. To assess resident, patient, and family continuity. Backgro und. Continuity clinic is the principal longitudinal primary care expe rience for pediatric residents. Although it has been a recommendation of the Residency Review Committee for pediatric training for more than 10 years and has been a requirement of the Accreditation Council of G raduate Medical Education since 1989, the extent to which continuity i s achieved in this setting has not been reported. Methods. Nine years (1984-1993) of residents' continuity clinic experience in a community hospital affiliate of a university training program were reviewed. Con tinuity was defined by recurring visits between the same patient/provi der pair. The analysis from 57 different residents includes 48 intern (R1) years, 45 level two (R2) years, and 40 level three (R3) years; 32 of these residents completed all 3 years of training (3-year cohort) in the program during the study period. Observations included 89 952 v isits by 11 009 patients in 7130 families. Continuity was determined f or the resident, patient, and family. Results. Residents saw an annual average of 93, 136, and 144 visits as Rls, R2s, and R3s. Residents sa w 60% of their patients fewer than 3 times and nearly 40% only once. I n the final year for those in the 3-year cohort, residents saw an aver age of 149 visits; 53% of the time these R3s had seen their patients o nce or twice over 3 years. Thirty percent of the patients never saw th eir primary care physician (PCP) and 72% of patients had fewer than 3 visits with their PCP. One quarter of the families never saw their con tinuity resident, and 62% saw their continuity resident fewer than 3 t imes. Conclusions. These data demonstrate a remarkable lack of both re sident and patient continuity in the principal clinical activity affor ding longitudinal primary care experiences during residency training. If more continuity is essential for both primary care of patients and Education in general pediatrics, change in the structure of continuity experience is required.