Journal of General Internal Medicine

, Volume 34, Issue 5, pp 731–739 | Cite as

The Impact of Block Ambulatory Scheduling on Internal Medicine Residencies: a Systematic Review

  • Ami L. DeWatersEmail author
  • Hilda Loria
  • Helen Mayo
  • Alia Chisty
  • Oanh K. Nguyen
Review Paper



Over the past decade, nearly half of internal medicine residencies have implemented block clinic scheduling; however, the effects on residency-related outcomes are unknown. The authors systematically reviewed the impact of block versus traditional ambulatory scheduling on residency-related outcomes, including (1) resident satisfaction, (2) resident-perceived conflict between inpatient and outpatient responsibilities, (3) ambulatory training time, (4) continuity of care, (5) patient satisfaction, and (6) patient health outcomes.


The authors reviewed the following databases: Ovid MEDLINE, Ovid MEDLINE InProcess, EBSCO CINAHL, EBSCO ERIC, and the Cochrane Library from inception through March 2017 and included studies of residency programs comparing block to traditional scheduling with at least one outcome of interest. Two authors independently extracted data on setting, participants, schedule design, and the outcomes of interest.


Of 8139 studies, 11 studies of fair to moderate methodologic quality were included in the final analysis. Overall, block scheduling was associated with marked improvements in resident satisfaction (n = 7 studies, effect size range − 0.3 to + 0.9), resident-perceived conflict between inpatient and outpatient responsibilities (n = 5, effect size range + 0.3 to + 2.6), and available ambulatory training time (n = 5). Larger improvements occurred in programs implementing short (1 week) ambulatory blocks. However, block scheduling may result in worse physician continuity (n = 4). Block scheduling had inconsistent effects on patient continuity (n = 4), satisfaction (n = 3), and health outcomes (n = 3).


Although block scheduling improves resident satisfaction, conflict between inpatient and outpatient responsibilities, and ambulatory training time, there may be important tradeoffs with worse care continuity.


systematic review block ambulatory scheduling X + Y 



The authors thank Lynne Kirk, MD, FACP, for her advice, input, and helpful comments on a draft of this manuscript and Anil Makam, MD, MAS, for his input on the analytic approach.


Dr. Nguyen received support from UT Southwestern KL2 Scholars Program (NIH/NCATS KL2 TR0001103). Ms. Mayo and Dr. Nguyen also received support from the AHRQ-funded UT Southwestern Center for Patient-Centered Outcomes Research (AHRQ R24 HS022418). The study sponsors had no role in study design, data analysis, drafting of the manuscript, or decision to publish these findings.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2019_4887_MOESM1_ESM.docx (27 kb)
ESM 1 Online Appendix 1 Search strategy. Online Appendix 2. Quality assessment of study methods using the Newcastle Ottawa Score for Education (NOS-E) (DOCX 26 kb)


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Ami L. DeWaters
    • 1
    Email author
  • Hilda Loria
    • 2
  • Helen Mayo
    • 3
  • Alia Chisty
    • 4
  • Oanh K. Nguyen
    • 5
  1. 1.Department of Internal Medicine Pennsylvania State Hershey Medical CenterHersheyUSA
  2. 2.Department of PediatricsUT Southwestern Medical CenterDallasUSA
  3. 3.Department of Health Sciences Digital Library and Learning CenterUT Southwestern Medical CenterDallasUSA
  4. 4.Department of Internal MedicineTemple UniversityPhiladelphiaUSA
  5. 5.Department of MedicineUniversity of CaliforniaSan FranciscoUSA

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