Changes in pediatric residents' perceptions of their continuity experience during their training: a national study.
OBJECTIVE
To determine how pediatric residents' perceptions of continuity clinic experiences vary by level of training, after controlling for the effect of continuity setting.


METHODS
Cross-sectional survey of pediatric and combined pediatric trainees in US residency programs.


RESULTS
Survey responses were received from 1355 residents in 36 training programs. Residents' continuity experiences were in hospital-based and community settings. Numbers of patients seen increased between PGY-1 and PGY-3 years, but not in the PGY-4 and PGY-5 years. Compared to PGY-1 residents, PGY-2 and PGY-3 residents were more likely to report more encounters with established patients, but were not more likely to feel like the primary care provider. There were no significant differences by training level in terms of involvement in panel patients' laboratory results, hospitalizations, or telephone calls, although nursery involvement decreased with increasing training level. Autonomy was directly related to training level. The perception of having the appropriate amount of exposure to practice management issues was low for all respondents.


CONCLUSIONS
Residents perceived that they had greater autonomy and continuity with patients as they become more senior, yet they were not more likely to feel like the primary care provider. Lack of increased involvement in key patient care and office responsibilities across training years may reflect a need for changes in resident education. These data may be helpful in formulating recommendations to program directors with regard to determining which Accreditation Council for Graduate Medical Education competencies should be emphasized and evaluated in the continuity experience.
Feigelman
Susan
S
Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA. sfeigelm@umaryland.edu
Olsson
John
J
Drutz
Jan
J
Dungy
Claibourne I
CI
Lopreiato
Joseph
J
Serwint
Janet R
JR
D000553:Ambulatory Care / Q000379:methods*; D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D006801:Humans; D007396:Internship and Residency; D010372:Pediatrics / Q000193:education* / Q000458:organization & administration; D010817:Physician-Patient Relations; D011216:Practice Management, Medical; D011231:Preceptorship / Q000592:standards / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods*; D017009:Professional Autonomy; D012941:Social Responsibility; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States