Education Research: The Effect of an X + Y Schedule Model on Neurology Residency Training

There is a need for earlier outpatient exposure in neurology training. In 2017, 56% of residents on the American Academy of Neurology (AAN) Graduating Resident Survey reported that they felt that the fellowship process started too early, and 46% felt that they did not have adequate outpatient exposure before making a fellowship decision. In addition, the traditional front-loaded resident schedule may contribute to high rates of burnout due to greater work hours and heavier inpatient load, as was suggested in the findings of a 2016 AAN survey comparing burnout among residents and fellows.

We created an X + Y model within the UCLA Neurology Residency Program in the 2020-2021 academic year with the goal of increasing outpatient exposure earlier in training. We used a preintervention/postintervention design assessing measures of resident satisfaction, outpatient clinic exposure, number of inpatient handoffs, resident work hours, and scores on the resident in-training examination (RITE). We hypothesized that outpatient clinic exposure would increase, handoffs would diminish, work hours would be reduced, measures of resident satisfaction with inpatient care, outpatient care, and well-being would improve, and that RITE scores would improve. Work hours, handoffs, and number of clinic days were compared across each year via analysis of the resident schedule. Resident perceptions were obtained via an online survey at the end of their PGY-2 year. RITE scores were compared across a variety of subspecialties.

In the postintervention year, handoffs were reduced by 6.13 (95% CI 4.73-7.54) per week. Average clinic half-days increased by 4.51 (95% CI 7.76-0.53). Resident responses regarding their outpatient experience improved from 42% to 93% satisfied and from 60% to 94% satisfied for their inpatient experience. There was no difference in average work hours per week before and after the intervention. Regarding resident well-being, responses improved from 42% satisfied in the traditional model to 96% in the X + Y model. Among the RITE subjects covering primarily outpatient subspecialties, scores improved in each category.

After implementation of an X + Y model, we observed an improvement in outpatient exposure, learning and career satisfaction, and resident education on subspecialty topics.