title: Disruptions and satisfaction in internal medicine resident continuity clinic differ between inpatient and outpatient rotations.
abstract: BACKGROUND
  Little is known about whether assignment to simultaneous inpatient and outpatient clinical duties causes disruptions during internal medicine resident continuity clinic and impacts trainee satisfaction.
  
  
  OBJECTIVE
  Our purpose was to determine whether dual inpatient and continuity clinic responsibilities impact resident stress and document the number, type, and immediacy of interruptions in continuity clinics.
  
  
  METHODS
  Methods included a prospective 2-residency survey of 70 internal medicine residents performing 240 half-day continuity clinic sessions.
  
  
  RESULTS
  More than half (52%) of trainees on inpatient rotations felt pressured to return to their ward duties. Half (50%) of residents thought clinic increased work hours, and the majority (70%) did not think continuity clinic detracted from their education on inpatient or elective rotations. Disturbances were more likely to occur on inpatient rotations (odds ratio 4.52, 95% confidence interval = 2.298.92) than on outpatient rotations. The time required to address an interruption was 3.9 +/- 4.51 min. Residents thought many (46%) problems addressed during clinic could have waited until clinic completion.
  
  
  CONCLUSIONS
  Residents on inpatient rotations who were commonly interrupted in clinic felt pressured to return to ward duties and unable to focus on their clinic patients. Internal medicine faculty should modify curriculum to minimize the interference of other duties in resident clinics.
authors.affiliation: Department of Medicine, Tripler Army Medical Center, Honolulu, Hawaii 96859, USA. stephen.salerno@us.army.mil
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Salerno
authors.forename: Paul M
authors.initials: PM
authors.lastname: Faestel
authors.forename: Timothy
authors.initials: T
authors.lastname: Mulligan
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rosenblum
mesh_terms: D002983:Clinical Competence; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007388:Internal Medicine; D007396:Internship and Residency; D007588:Job Satisfaction; D008297:Male; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D013315:Stress, Psychological; D013997:Time Factors; D014481:United States; D016526:Workload / Q000706:statistics & numerical data