To The Editor:
In the December issue of JGIM, Ray et al. examined several models of ambulatory training including an X + Y block schedule, a full-day clinic, and a hybrid clinic model.1 Previous studies have also examined combination continuity clinics in search of a configuration that enhances patient and resident continuity, improves outcomes, and promotes high patient satisfaction.2 , 3 In Table 2 of their article, Ray and colleagues highlight possible advantages and disadvantages of the three systems. We question two elements in this table. First, one of the purported advantages of an X + Y block schedule is “numerous long gaps in residents’ outpatient presence.” We wonder whether this was meant to be designated as a disadvantage. Second, we would question whether “residents maintain[ing] primary ownership of patients including follow up results and response to patient calls” is actually a disadvantage, particularly in light of the authors’ statement that “residents should never be completely absent from their role as primary care physicians.”
References
Ray A, Jones D, Palamara K, et al. Improving ambulatory training in internal medicine: X + Y (or why not?). J Gen Intern Med. 2016;31(12):1519–1522.
Francis MD, Warm E, Julian KA, et al. Determinants of patient satisfaction in internal medicine resident continuity clinics: findings of the Educational Innovations Project Ambulatory Collaborative. J Grad Med Educ. 2014;6(3):470–477.
Francis MD, Wieland ML, Drake S, et al. Clinic design and continuity in internal medicine resident clinics: findings of the educational innovations project ambulatory collaborative. J Grad Med Educ. 2015;7(1):36–41. doi:10.4300/JGME-D-14-00358.1.
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Andrews, R., Nardino, R.J. X + Y (or Why Not?). J GEN INTERN MED 32, 500 (2017). https://doi.org/10.1007/s11606-017-4026-x
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DOI: https://doi.org/10.1007/s11606-017-4026-x