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X + Y (or Why Not?)
0 Rebecca Andrews , MS, MD, FACP and Robert J. Nardino, MD, FACP
1 University of Connecticut , Farmington, CT , USA
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 Compliance with Ethical Standards:
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 Bnumerous long gaps in residents’ outpatient
presence.^ We wonder whether this was meant to be
designated as a disadvantage. Second, we would question whether
Bresidents 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 Bresidents should never be completely absent from their
role as primary care physicians.^
1. 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 .
2. 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 .
3. 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.