X + Y Scheduling in Pediatric Residency: Continuity, Handoffs, and Trainee Experience

Area of Science:

• Pediatric medical education
• Healthcare administration
• Clinical operations

Background:

• Many internal medicine programs use X+Y scheduling, condensing clinic time into blocks.
• Pediatric residency programs have largely not adopted this X+Y model.
• This study evaluated the X+Y schedule in a pediatric residency program.

Purpose of the Study:

• To assess if X+Y scheduling maintains or improves outpatient continuity.
• To determine if X+Y scheduling reduces inpatient handoffs.
• To evaluate resident satisfaction with the X+Y scheduling model.

Main Methods:

• Compared outpatient continuity (PCP visits) and inpatient handoffs before and after X+Y implementation.
• Analyzed resident schedules for handoff frequency.
• Surveyed residents on their experience with the X+Y schedule.

Main Results:

• Overall outpatient continuity increased from 29.5% to 31.4% (P=.004).
• Preventive visit continuity decreased from 46.2% to 43% (P=.001).
• Weekly inpatient handoffs decreased from 30 to 20 (P<.001), and 85% of residents reported a positive experience.

Conclusions:

• The X+Y schedule is a viable alternative to weekly clinics in pediatric residency.
• This model improves learner experience and reduces inpatient handoffs.
• The X+Y approach has mixed effects on outpatient continuity but is generally well-received.