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Effects of time-in-clinic, clinic setting, and faculty supervision on the continuity clinic experience.

STUDY OBJECTIVE
To evaluate the effects of setting, type of supervision, and time in clinic on the resident continuity clinic experience.


DESIGN
Prospective cohort with preintervention and postintervention measures.


SETTINGS
Pediatric residents selected one of three clinic settings for their continuity clinic experience. These included a traditional, university-based clinic, private practice offices, and publicly funded community-based clinics.


SUBJECTS
All pediatric residents at the University of Utah Health Sciences Center, July 1985 through June 1991.


INTERVENTIONS
Using varied clinic sites, matching residents one or two to one with preceptors for their continuity clinic, increasing continuity clinic from 1 to 2 half-days per week.


MEASUREMENTS AND MAIN RESULTS
Residents in private offices had the most varied experience, seeing more patients, more acute care, and a broader age range of patients than residents at other sites. They were more likely both to be observed by their preceptors during patient visits and to observe their preceptors delivering care. Because the number of patients seen per session rose, increasing continuity clinic time from one to two half-days per week more than doubled the number of patients seen per week. Increased time away from hospital did not affect scores on the Pediatric In-Training Examination. While test scores were similar for incoming residents, those in private offices scored higher on the final Behavioral Pediatrics Examination (P < .05).


CONCLUSIONS
Clinic setting, time in clinic, and faculty supervision affect the quality of the continuity clinic experience. Increased time in clinic resulted in a broader exposure to patients. Residents placed in private offices had a more varied patient mix, were more closely supervised, and seemed to gain primary care skills more rapidly than residents at other sites.