Measuring Greater Patient-Provider Continuity in a Clinic-First Family Medicine Residency Curriculum

Area of Science:

• Medical Education
• Primary Care Research
• Health Systems Science

Background:

• Patient continuity is crucial for high-value care and satisfaction.
• Achieving continuity in residency training presents significant challenges.
• Traditional residency schedules often impede consistent patient-provider relationships.

Purpose of the Study:

• To evaluate the impact of a clinic-first curriculum on continuity measures in a family medicine residency.
• To compare continuity outcomes before and after curriculum redesign.

Main Methods:

• A retrospective analysis compared a traditional block curriculum with a clinic-first curriculum over seven years (July 2011-June 2018).
• Key metrics included resident panel size, clinic time, patient visits, and resident/patient-sided continuity.
• A novel measure, "familiar faces" (patients seen ≥3 times), assessed longitudinal continuity.

Main Results:

• The clinic-first model increased resident panel size, clinic time for junior residents, and total visits with paneled patients.
• Resident-sided continuity improved across all training levels.
• Patient-sided continuity showed improvement for first-year residents and remained stable for others.
• Longitudinal continuity, measured by "familiar faces," nearly doubled.

Conclusions:

• Redesigning the family medicine residency curriculum to a clinic-first approach demonstrably enhanced resident continuity.
• This curriculum shift positively impacts key aspects of patient care continuity within a training setting.