Pediatric Resident Continuity Clinics: 30 Years Later

This study explores changes and trends in US pediatric resident continuity clinics over the past 30 years.

A survey of clinical and educational site characteristics was sent 30 years ago to all continuity clinic directors, with results published in 1995. In 2023, the survey was expanded and sent via RedCap to all 201 categorical pediatric training programs. Data from the 1995 study were obtained for comparison. Responses were compared using chi-square, t-test, and ANOVA.

Response rate was 72% (N =157) in 1995 and 57% (N =115 with variable completion) in 2023. The majority of programs continue to have university-affiliated practices (p=0.52) but there has been an increase in private practice and federally qualified healthcare clinic-affiliated sites. While nearly all sites continue to have afternoon continuity sessions, many have expanded to morning sessions. Social work and integrated mental health support in continuity clinics increased (p<0.01). Equipment availability changed, consistent with contemporary trends. Resident care for continuity patients outside of the clinic setting decreased (p<0.01). Fewer residents are pursuing primary care (p<0.01). Continuity directors perceive diminished departmental support, although perceived support from primary care attendings has continued. Overall satisfaction with the functioning of the continuity experience has remained constant.

Changes in continuity clinic operations have paralleled changes in pediatric practice nationally. Expectations of residents regarding follow-up of continuity patient care have decreased. Fewer residents are pursuing careers in primary care. These findings have implications for improving the pediatric residency experience.