Continuity in Community Medicine Training: Is It Time to Rethink the Block Rotation?

Family medicine residency training emphasizes the importance of community medicine. Recent scholarship has helped to identify important elements of community partnerships, including bidirectionality and continuity. Given the importance of continuity in family medicine and community partnerships, this study explores the relationship between continuity in community medicine curricula, partnership quality, and residents' community medicine competency.

Survey questions were included in the 2015-2016 Council of Academic Family Medicine Educational Research Alliance (CERA) Family Medicine Program Director survey that probed community medicine curricular structures, partnership quality, and outgoing resident competency in community medicine. Multivariate logistic regression was used to test the impact of continuity on the outcomes of partnership quality and residents' community medicine competency.

Respondents represented 227 of 461 family medicine programs (49%). Block rotation, used in 150 (66%) programs, was the approach most commonly used to deliver community medicine curriculum. Eighty-five (45%) programs self-reported high quality partnerships and about one-third described outgoing residents as highly proficient in community medicine competencies. Program-level continuity in community partnerships was significantly correlated to high quality partnerships (odds ratio [OR] 3.51, 95% confidence interval [CI] 1.79-6.89, P<0.001) and educational outcomes (OR 2.85, 95% CI 1.38-5.89, P=0.005), while resident-level continuity was not.

Our findings support the importance of continuity to the quality of family medicine residency community partnerships as well as resident education in community medicine. Further research is needed to understand the importance of continuity at the program level versus individual resident level.