278 - Improved Resident Satisfaction in Continuity Clinic Through a Systemic and Faculty Focus on Education

Poster Number: 278
Publication Number: 278.420

Grace E. Black, University of Rochester, Rochester, NY, United States; Andrea Milne Wenderlich, URMC, Rochester, NY, United States; Constance D. Baldwin, University of Rochester School of Medicine and Dentistry, Mendon, NY, United States; Caren Gellin, Golisano Children's Hospital at The University of Rochester Medical Center, Rochester, NY, United States

Background:

Background: Primary care (PC) education of pediatric residents at the University of Rochester includes weekly continuity clinic and an outpatient illness rotation at the Golisano Children’s Hospital Pediatric Practice (GCHPP). Of >14,000 urban patients, many live in poverty and a high percentage have medical complexities. Prior to the study period, from 2016-17 to 2020-2021, residents gave low ratings to these PC experiences. Therefore, several educational enhancements were implemented.

Objective: To assess, over a 5-year period, the relation between educational improvements in PC training at the GCHPP and changes in pediatric residents’ evaluations of these experiences.

Design/Methods: During the assessment period, continuity and illness clinic rotations were periodically evaluated by residents, who rated overall educational value of the rotations and their perception of the ratio of service to education. Ratings were compared year by year using Chi Square analysis, and data were also examined over time by the Cochran-Mantel-Haenszel statistic. Figure 1 summarizes the educational enhancements that were implemented over these five years. We also assessed written comments of residents to help identify which PC educational innovations were most often reported to be positive changes.

Results: From 2017-2021, the percent of residents indicating they strongly agree/agree that "The educational component of the rotation exceeded the service component” improved significantly (from 47% in 2017-18 to >90% in 2020-21, p < 0.001). Over time, ratings of the educational value of both the continuity and illness clinic rotations as “very good” or “excellent” increased significantly (p < 0.001) (see Figure 2). The longitudinal relationship between evaluation year and residents’ agreement with these statements was confirmed using the Cochran-Mantel-Haenszel statistic (p < 0.0001). Residents’ written comments (n=528) about their PC experiences helped to identify several educational enhancements that they felt were valuable (Table 1).Conclusion(s): With implementation of educational enhancements over a 5 year period, residents’ evaluations of PC experiences significantly improved, along with their assessment of the ratio of service to education in these settings. Written comments suggest particular value in the changes in faculty size and composition, and improvements in residents’ patient schedules and clinic workflow. These findings suggest the potential for targeted changes to improve resident educational experiences in a busy PC settings that cares for high-risk urban youth.
Figure 1: Educational enhancements over 5 years that were designed to improve resident learning in primary care
Figure 2: Percent of Residents Reporting that the Overall Educational Value of the Rotation Was Very Good/Excellent