title: Impact of 4 + 1 block scheduling on patient care continuity in resident clinic.
abstract: BACKGROUND
  Leaders in medical education have called for redesign of internal medicine training to improve ambulatory care training. 4 + 1 block scheduling is one innovative approach to enhance ambulatory education.
  
  
  OBJECTIVE
  To determine the impact of 4 + 1 scheduling on resident clinic continuity.
  
  
  METHODS
  Resident continuity clinic in traditional scheduling in which clinics are scheduled intermittently one-half day per week, compared to 4 + 1 in which residents alternate 1 week of clinic with 4 weeks of an inpatient rotation or elective.
  
  
  METHODS
  First-year internal medicine residents.
  
  
  METHODS
  We measured patient-provider visit continuity, phone triage encounter continuity, and lab follow-up continuity.
  
  
  RESULTS
  In traditional scheduling as opposed to 4 + 1 scheduling, patients saw their primary resident provider a greater percentage; 71.7% vs. 63.0% (p = 0.008). In the 4 + 1 model, residents saw their own patients a greater percentage; 52.1% vs. 37.1% (p = 0.0001). Residents addressed their own labs more often in 4 + 1 model; 90.7% vs. 75.6% (p = 0.001). There was no significant difference in handling of triage encounters; 42.3% vs. 35.8% (p = 0.12).
  
  
  CONCLUSIONS
  4 + 1 schedule improves visit continuity from a resident perspective, and may compromise visit continuity from the patient perspective, but allows for improved laboratory follow-up, which we pose should be part of an emerging modern definition of continuity.
authors.affiliation: Department of Medicine, Division of General Internal Medicine, University of Colorado Denver, 1635 Aurora Court, F 729 Aurora, Denver, CO, 80045, USA, Kathleen.heist@ucdenver.edu.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Heist
authors.forename: Mary
authors.initials: M
authors.lastname: Guese
authors.forename: Michelle
authors.initials: M
authors.lastname: Nikels
authors.forename: Rachel
authors.initials: R
authors.lastname: Swigris
authors.forename: Karen
authors.initials: K
authors.lastname: Chacko
mesh_terms: D000554:Ambulatory Care Facilities / Q000592:standards*; D001071:Appointments and Schedules; D003266:Continuity of Patient Care / Q000592:standards*; D005500:Follow-Up Studies; D006801:Humans; D007396:Internship and Residency / Q000379:methods* / Q000592:standards*