Implementing Team-Based Care in an Internal Medicine Residency Continuity Clinic: 2 Years of Change

The association of continuity clinic teams with resident physician experience in primary care settings is incompletely understood. Prior studies have only evaluated team formation concomitant with simultaneous changes to block scheduling or medical homes. This institution's resident clinic was rated as an overall poor experience, including perception of inadequate structural support, an incomplete safety net for patient care and inconsistent faculty oversight. This study aimed to assess the impact of team formation on internal medicine resident continuity clinic experience.

A single urban academic medical centre implemented team formation in the internal medicine residency continuity clinic after the academic year 2020. This was to promote networks of learners at various stages with multidirectional learning, support and go-to faculty oversight. A pre- and post-survey assessed the clinic comparing Years 2019-2020 and 2021-2022. Twelve teams were implemented within the clinic, each composed of a lead attending and 11-12 residents.

Response rate was 74.3% (313 of 422) from 2020 to 2022. Team implementation was associated with improvement in multiple outcomes of perceived quality of patient care, support in delivering care and overall resident experience in clinic. This was in the setting of similar satisfaction with faculty physicians, nurses and medical assistants.

Team formation utilized reorganization of pre-existing resources and resulted in substantial improvement in a primary care resident continuity clinic experience separate from the benefit of block scheduling. This intervention is an option for other training clinics aiming to improve the residency outpatient experience without hiring additional faculty.