title: Evening continuity clinic: preserving primary care education in the face of duty hour limitations?
abstract: OBJECTIVE
  Residency programs with postcall afternoon continuity clinics violate the new Accreditation Council for Graduate Medical Education (ACGME) limitations on resident duty hours. We evaluated housestaff experience with a pilot intervention that replaced postcall continuity clinics with evening continuity clinics.
  
  
  METHODS
  We began this pilot program at one continuity clinic site for pediatric residents. Instead of postcall clinics, residents had evening continuity clinic added to a regular clinic day when they were neither postcall nor on call. At 5 and 11 months, we surveyed housestaff satisfaction and experience with the evening clinics, particularly in comparison to postcall clinics.
  
  
  RESULTS
  Nineteen of 23 pediatric residents participated in the pilot program. Twenty-two and 17 residents completed the 5- and 11-month follow-up surveys, respectively. A significantly greater proportion of residents rated their overall satisfaction with evening clinic as good/outstanding (16/18, 89%) compared with postcall clinic (2/19, 11%) at the 5-month survey (P<.01). Resident preference for evening clinic over postcall clinic persisted but was not statistically significant at 11 months (P =.05), and overall satisfaction with evening clinic was unchanged from the 5- and 11-month surveys (P =.64). All areas of patient care, medical education, and clinic infrastructure were better or equal in evening clinic in comparison to postcall clinic except for continuity of preceptors and access to medical services.
  
  
  CONCLUSIONS
  Housestaff had greater satisfaction and a better clinic experience with evening clinic versus postcall clinic. Evening continuity clinic is a viable solution to meeting the ACGME work hour limitations while preserving housestaff primary care education.
authors.affiliation: Department of Pediatrics, San Francisco General Hospital and University of California, 94110, USA. akuo@itsa.ucsf.edu
authors.forename: Anda K
authors.initials: AK
authors.lastname: Kuo
authors.forename: Christine T
authors.initials: CT
authors.lastname: Ma
authors.forename: Robert K
authors.initials: RK
authors.lastname: Kamei
mesh_terms: D003153:Community Health Services; D003266:Continuity of Patient Care; D006801:Humans; D007396:Internship and Residency; D007588:Job Satisfaction; D010372:Pediatrics / Q000193:education*; D010561:Personnel Staffing and Scheduling; D010865:Pilot Projects; D012495:San Francisco