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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
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The Clinic Handbook: A Quality Improvement Project.

Success T Oyibo1, Amy Carter2

  • 1Internal Medicine, Northern Care Alliance, Manchester, GBR.

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Summary

A new Clinic Handbook improved outpatient clinic scheduling for Internal Medicine Trainees (IMTs) by addressing knowledge and system barriers. This resource enhanced scheduling ease and confidence, boosting the educational value of clinic weeks.

Keywords:
clinic organisationhandbook implementationimproving trainee experienceinternal medicine trainingquality improvement in healthcarequality improvement project (qip)quality improvement projectsquality improvement study

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Area of Science:

  • Medical Education
  • Internal Medicine Training
  • Healthcare Administration

Background:

  • Internal Medicine Trainees (IMTs) require outpatient experience but face difficulties arranging clinics due to poor communication and varied scheduling processes.
  • Barriers include lack of knowledge regarding contact persons and inconsistent scheduling procedures across institutions.

Purpose of the Study:

  • To enhance the organization and educational impact of outpatient clinic weeks for IMTs.
  • To develop and implement a user-friendly Clinic Handbook to streamline clinic scheduling.

Main Methods:

  • A pre- and post-intervention study design utilizing quantitative and qualitative analyses.
  • A baseline survey identified barriers, followed by handbook development in collaboration with administrative staff.
  • The handbook was distributed electronically, with a follow-up survey assessing its impact using Likert scales and thematic analysis within a PDSA framework.

Main Results:

  • Significant improvements were observed in ease of scheduling (2.33 to 4.33), knowing contacts (3.06 to 4.58), and planning ability (2.60 to 4.33).
  • Trainees reported increased confidence in arranging clinics, even outside their specialty.
  • All respondents found the handbook useful, indicating its effectiveness in overcoming logistical challenges.

Conclusions:

  • A trainee-developed Clinic Handbook effectively removed systemic and informational obstacles to outpatient training.
  • The handbook expanded access to specialty clinics and improved the overall training experience.
  • Sustaining these improvements requires integrating the handbook into induction and ensuring regular updates for wider application.