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Keith L. Ponitz, MD; Robert D. Needlman, MD; Timothy J. Kilkenny, MD

Arch Pediatr Adolesc Med. 2000;154:1209-1213.

Objective  To explore residents' opinions regarding various aspects of continuity clinic in a hospital clinic vs private office, with emphasis on primary care relationships.

Design  Cross-sectional study. Residents (N = 47) who had spent time in both a clinic and an office setting were given a 49-question survey. Five-point Likert scales were used to quantify the residents' sense of quality of various aspects of training. A set of 10 statements was included to assess the degree to which residents took primary care responsibility for a cohort of patients. Residents also chose the combination of setting(s) (office, clinic, or both) that they considered optimal for their training.

Setting  Large metropolitan area. The hospital clinic, based in a freestanding children's hospital, served a primarily indigent population. The private offices (n = 20) served the surrounding suburbs and primarily middle- and upper-income families.

Hypothesis  Residents would perceive their clinic-based experience as significantly better than their office-based experience with respect to establishing primary care relationships with their patients.

Results  Residents' ratings for the primary care responsibility index were significantly higher for the clinic than for the office (mean + SD, 4.1 + 0.8 vs 2.2 + 0.9; P<.001). Residents found many aspects of the 2 settings comparable, including overall educational value and the preceptor as a positive role model. The office was rated higher for business and managed care aspects, care of school-age children, and experience with adolescents. The clinic was rated higher for care of infants and complex psychosocial and complex medical issues. Two thirds of residents chose the combined half day in office and half day in clinic as their preferred training model.

Conclusion  The opportunity for residents to take advantage of the unique strengths of both clinic- and office-based training may significantly improve their overall residency experience.

From the Department of Pediatrics, Rainbow Babies and Childrens Hospital, Case Western Reserve University, Cleveland, Ohio.

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