Three years of x+y scheduling: Longitudinal assessment of resident and faculty perceptions

PURPOSE: Five pediatric residency programs implemented true X+Y scheduling in 2018 where residents have continuity clinic in blocks rather than half-day per week experiences. We report the impact X+Y scheduling has on pediatric resident and faculty perceptions of patient care and other educational experiences over a three-year timeframe. METHODS: Electronic surveys were sent to residents and faculty of the participating programs prior to implementing X+Y scheduling and annually thereafter (2018 - 2021). Survey questions measured resident and faculty perception of continuity clinic schedule satisfaction and the impact of continuity clinic schedules on inpatient and subspecialty rotations. Data were analyzed using z-tests for proportion differences. RESULTS: 186 residents were sent the survey pre-implementation and 254-289 post-implementation with response rates ranging from 47%-69%. 378- 395 faculty members were sent the survey with response rates ranging from 26%-51%. Statistically significant (p\u3c0.05) sustained perceived improvements over three years with X+Y were seen in outpatient continuity, inpatient workflow, and time for teaching both inpatient and in continuity clinic. CONCLUSIONS: X+Y scheduling can lead to perceived improvements in various aspects of pediatric residency programs. Our study demonstrates these improvements have been sustained over three years in the participating programs. WHAT\u27S NEW: X+Y scheduling in pediatric residency programs is rather novel and there is a paucity of literature evaluating its use. We report three years of outcome data from the only ACGME-approved pilot of X+Y scheduling in pediatric residency

Impact of X+Y scheduling on pediatric resident and faculty perceptions of education and patient care

PURPOSE: Traditional half-day per week continuity clinic experiences can lead to fragmented education in both the inpatient and outpatient arenas. Five pediatric residency programs were granted the ability from the ACGME to create X+Y scheduling where residents have continuity clinic in blocks rather than half-day per week experiences. The aim of this study is to assess the impact X+Y scheduling has on pediatric resident and faculty perceptions of patient care and other educational experiences. METHODS: Electronic surveys were sent to residents and faculty of the participating programs both prior to and 12 months after implementing X+Y scheduling. Survey questions measured resident and faculty perception of continuity clinic schedule satisfaction and the impact of continuity clinic schedules on inpatient and subspecialty rotation experiences using a 5-point Likert Scale. Data were analyzed using z-tests for proportion differences for those answering Agree or Strongly Agree between baseline and post-implementation respondents. RESULTS:126 out of 186 residents (68%) responded pre-implementation and 120 out of 259 residents (47%) responded post-implementation. 384 faculty members were sent the survey with 51% response pre-implementation and 26% response at 12 months. Statistically significant (p CONCLUSIONS: From both resident and faculty perspectives, X+Y scheduling may improve several aspects of patient care and education. X+Y scheduling could be considered as a potential option by pediatric residency programs, especially if validated with more objective data

Longitudinal Assessment of Resident Performance Using Entrustable Professional Activities

Question What is the progression of performance for entrustable professional activities (EPAs) throughout pediatric residency training and at graduation? Findings This multisite cohort study of 1987 pediatric residents found that developmental growth curves can be established for EPAs. When generated to reflect the results in this study, at least 90% of trainees achieved the level of unsupervised practice at the end of residency for only 8 of the 17 EPAs studied. Meaning This study suggests that gaps exist between observed practice readiness and standards needed to produce physicians able to meet the health needs of the patient populations they serve based on the general pediatrics EPAs. Importance Entrustable professional activities (EPAs) are an emerging workplace-based, patient-oriented assessment approach with limited empirical evidence. Objective To measure the development of pediatric trainees' clinical skills over time using EPA-based assessment data. Design, Setting, and Participants Prospective cohort study of categorical pediatric residents over 3 academic years (2015-2016, 2016-2017, and 2017-2018) assessed on 17 American Board of Pediatrics EPAs. Residents in training at 23 pediatric residency programs in the Association of Pediatric Program Directors Longitudinal Educational Assessment Research Network were included. Assessment was conducted by clinical competency committee members, who made summative assessment decisions regarding levels of supervision required for each resident and each EPA. Data were collected from May 2016 to November 2018 and analyzed from November to December 2018. Interventions Longitudinal, prospective assessment using EPAs. Main Outcomes and Measures Trajectories of supervision levels by EPA during residency training and how often graduating residents were deemed ready for unsupervised practice in each EPA. Results Across the 5 data collection cycles, 1987 residents from all 3 postgraduate years in 23 residency programs were assigned 25503 supervision level reports for the 17 general pediatrics EPAs. The 4 EPAs that required the most supervision across training were EPA 14 (quality improvement) on the 5-level scale (estimated mean level at graduation, 3.7; 95% CI, 3.6-3.7) and EPAs 8 (transition to adult care; mean, 7.0; 95% CI, 7.0-7.1), 9 (behavioral and mental health; mean, 6.6; 95% CI, 6.5-6.6), and 10 (resuscitate and stabilize; mean, 6.9; 95% CI, 6.8-7.0) on the expanded 5-level scale. At the time of graduation (36 months), the percentage of trainees who were rated at a supervision level corresponding to "unsupervised practice" varied by EPA from 53% to 98%. If performance standards were set to align with 90% of trainees achieving the level of unsupervised practice, this standard would be met for only 8 of the 17 EPAs (although 89% met this standard for EPA 17, performing the common procedures of the general pediatrician). Conclusions and Relevance This study presents initial evidence for empirically derived practice readiness and sets the stage for identifying curricular gaps that contribute to discrepancy between observed practice readiness and standards needed to produce physicians able to meet the health needs of the patient populations they serve. Future work should compare these findings with postgraduation outcomes data as a means of seeking validity evidence. This cohort study measures the development of pediatric resident clinical skills using assessments based on entrustable professional activities