Teaching residents about patient and practice termination in community-based continuity settings
T. G. DeWitt and K. B. Roberts
Department of Pediatrics, University of Massachusetts Medical School, Worcester, USA.
BACKGROUND: The pediatric residency program at the University of
Massachusetts Medical Center, Worcester, has based its continuity
experience in community practices since 1988. Residents develop a
relationship not only with their patients but also with the preceptors,
with whom they are paired one-on-one, and with office staff. OBJECTIVE: To
describe the structure and results of an educational program that was
developed to address the termination issues that arise at the end of
residency. The educational program consists of four components: (1) a
seminar, (2) a "mini-block" rotation, (3) office staff involvement, and (4)
a resident-preceptor dinner. RESULTS: The following issues and themes have
been recurrent in the discussions during the past 4 years: (1) the
importance, for patient and resident, of identifying who will be the
subsequent health care provider for the patient; (2) the inability to
identify which patients had strongest attachment to residents; (3) parental
surprise about the resident's departure, even though all parents had been
told that the resident was going to be in the practice for only a limited
period; (4) the desire of residents to have follow-up on patients after
termination; (5) critical aspects of the process of informing patients
about the resident's departure; (6) the importance of identifying and
addressing the attachment of the resident to the preceptor and office
staff, as well as to patients; and (7) the affirming experience that the
termination sessions with the patients can be for the residents.
CONCLUSION: Although the termination process is potentially emotionally
difficult, it can be a personally and educationally valuable experience for
residents.
