Comparison of continuity clinic experience by practice setting and postgraduate level
T. D. Rice, S. E. Holmes and J. E. Drutz
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
OBJECTIVE: To compare continuity clinic experiences by practice setting and
postgraduate level. DESIGN: Mailed questionnaire. SETTING: Baylor College
of Medicine pediatric residents selected 1 of 3 continuity practice
settings, including community-based private offices (n = 35) and
university-based clinics in a private (n = 71) and a public (n = 12)
hospital. SUBJECTS: One hundred eighteen pediatric residents, May 1993.
OUTCOME MEASURES: Patient volume, continuity of care, type of patient
visit, and faculty supervision. RESULTS: The response rate was 77%
(91/118). Pediatric residents in community-based private offices reported
seeing more patients per session than those in the university-based private
and public clinics (88%, 10%, and 0% residents in the respective practice
settings reported > or = 4 patients per session), but were less likely
to see patients repeatedly (6%, 68%, and 40% residents in the respective
practice settings had seen more than half their patients > 2 times).
Residents in private offices provided a smaller percentage of well child
care (16%, 61%, and 90% residents in the respective practice settings
reported > 50% patients were well) and more acute care (68%, 15% and 0%
residents in the respective practice settings reported > 25% patients
were acutely ill). Residents in private offices reported a higher
percentage of time spent observing only (33%, 0%, and 0% residents in the
respective practice settings observed > 25% of the time) and less time
managing patients independently (93%, 59%, and 40% residents, respectively,
managed < or = 25% of the time). No significant differences among
postgraduate levels were found for these variables. CONCLUSIONS: Patient
volume, continuity of care, type of patient visit, and faculty supervision
were significantly different among continuity practice settings.
Postgraduate level of training did not affect significantly these measures
of continuity clinic experience. These differences need to be considered in
curriculum development.
