206 - Pediatric Residents Value Continuity with Patients: Results of an Institutional Survey

Publication Number: 206.6488

Ryan M. Breaud, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Paul M. Darden, University of Oklahoma College of Medicine, Oklahoma City, OK, United States; Michael Garbe, Oklahoma Childrens Hospital at OU Health, Oklahoma City, OK, United States; Devin Cook, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Sowmya Patil, University of Arkansas for Medical Sciences College of Medicine, LR, AR, United States; Natalie Bishop, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Christopher E. Smith, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States

Background: The ACGME requires that residents foster continuous relationships with their patients. To achieve continuity, residents must be identified as primary care providers, a panel of patients empaneled to them, scheduling must be continuity-driven, and residents must be engaged. In December 2023, an internally controlled PCP field was added to the EMR, and patient empanelment to residents based on prior patient visits. An update occurred in July 2024, and our current survey on resident engagement was completed in September 2024.

Objective: To evaluate residents’ perceptions of continuity, its importance, and factors to enhance patient continuity.

Design/Methods: A cross-sectional survey was distributed to 95 residents (74 Categorical Pediatric, 19 Medicine-Pediatric, and 2 Child Neurology). One child neurology response was combined with categorical pediatrics due to similar schedules. Attitudinal questions utilized a 5-point Likert scale (Strongly Agree to Strongly Disagree), while estimated practices used a 4-point scale (> 75% to < 25%). Statistical analyses compared responses using Chi-square. Open-ended responses were coded for key themes.

Results: We received 79 evaluable responses (83.2%) from 85 total responses (89.5%). No significant differences were noted between Categorical and Medicine-Pediatrics. Residents endorsed the importance of patient continuity (68% Strongly Agree); there was no difference by training level. Perceived continuity varied by training level (27% PGY-1 to 60% PGY-3 Strongly Agree/Agree, P = .05). Resident review of assigned internal PCPs varied (33% to 77%; P = .01). Residents adding their name to scheduling instructions varied (30% PGY-1 to 64% PGY-3; P = .03) (Figure 1). Residents reporting good continuity (Strongly Agree/Agree vs Neutral to Strongly Disagree) were more likely to endorse the importance of continuity (85% Strongly Agree vs 55%; P < .01) (Table 1). Qualitative analysis (Table 2) revealed that proactive EMR use and the specification of resident names in scheduling orders could enhance continuity. A scheduler decision tree prioritizing continuity and consistent resident scheduling in the continuity clinic were identified as crucial system processes. Positive outcomes of continuity were increased humanism, improved comprehensive patient care, and efficiency.

Conclusion(s): Residents value continuity of care with their patients and possess insights for improvement. Engaging residents in evaluating and addressing continuity challenges can foster ownership and engagement of residents and increase resident and patient continuity.

Figure 1: Perceptions of Continuity and Factors Supporting Continuity
*Not included in level comparisons due to small sample size.

Table 1: Perceived Continuity and Continuity Importance


Table 2: Qualitative Analysis
*Social determinants of health were not directly mentioned but would impact both humanism and outcomes sections.