Improving Fellow Continuity Clinic With Multiple Subspecialties: A Quality Improvement Initiative

Area of Science:

• Medical Education
• Healthcare Management
• Pediatric Hematology/Oncology

Background:

• Continuity clinics are essential for graduate medical training but face challenges impacting learning.
• Fellows in pediatric hematology/oncology reported dissatisfaction with clinic structure and workflow.
• Current clinic setup involved multiple subspecialty clinics, potentially fragmenting the educational experience.

Purpose of the Study:

• To enhance fellow satisfaction with education and workflow in a subspecialty continuity clinic.
• To improve satisfaction scores from a baseline of 2.3 (education) and 1.8 (workflow) to a target of 3.5.
• To identify and implement effective interventions within the clinic setting.

Main Methods:

• A multidisciplinary team developed and implemented five key interventions.
• Interventions included a clinical mentor, defined clinical team roles, adjusted patient visits, a schedule template, and panel management.
• Plan-do-study-act cycles were used for iterative refinement, with satisfaction surveys conducted regularly.

Main Results:

• Fellow satisfaction with the educational experience significantly increased from 2.3 to 4.1.
• Fellow satisfaction with clinic workflow significantly increased from 1.8 to 3.5.
• Faculty and staff satisfaction remained stable, indicating no negative impact on other stakeholders.

Conclusions:

• Multidisciplinary interventions effectively improved fellow satisfaction in continuity clinics.
• Sustained improvements in both educational experience and workflow were achieved.
• The implemented strategies offer a model for enhancing similar training programs.