The Ambulatory Long-Block: An Accreditation Council for Graduate Medical Education (ACGME) Educational Innovations Project (EIP)
- 381 Downloads
Historical bias toward service-oriented inpatient graduate medical education experiences has hindered both resident education and care of patients in the ambulatory setting.
Describe and evaluate a residency redesign intended to improve the ambulatory experience for residents and patients.
Categorical Internal Medicine resident ambulatory practice at the University of Cincinnati Academic Health Center.
We created a year-long continuous ambulatory group-practice experience separated from traditional inpatient responsibilities called the long block as an Accreditation Council for Graduate Medical Education Educational Innovations Project. The practice adopted the Chronic Care Model and residents received extensive instruction in quality improvement and interprofessional teams.
The long block was associated with significant increases in resident and patient satisfaction as well as improvement in multiple quality process and outcome measures. Continuity and no-show rates also improved.
An ambulatory long block can be associated with improvements in resident and patient satisfaction, quality measures, and no-show rates. Future research should be done to determine effects of the long block on education and patient care in the long term, and elucidate which aspects of the long block most contribute to improvement.
KEY WORDSambulatory education clinic residency training chronic care model
The authors have no acknowledgements to report.
Conflict of Interest
- 1.Association of Program Directors in Internal Medicine, Fitzgibbons JP, Bordley D, Berkowitz L, Miller BW, Henderson MC. Redesigning residency education in internal medicine: a position paper from the association of program directors in internal medicine. Ann Intern Med. 2006;144:920–6.PubMedGoogle Scholar
- 6.The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; Available at: http://www.ihi.org/IHI/Results/WhitePapers/TheBreakthroughSeriesIHIsCollaborativeModelforAchieving+BreakthroughImprovement.htm. Accessed June 26, 2007.
- 7.American College of Physicians. The Impending Collapse of Primary Care Medicine and Its Implications for the State of the Nation’s Health Care: Report from the American College of Physicians. Available at: http://www.acponline.org/hpp/statehc06_1.pdf. Accessed August 16, 2008.
- 11.Residency Review Committee for Internal Medicine. Educational Innovation Project; 2005. Available at: http://www.acgme.org/acWebsite/RRC_140/140_EIPindex.asp. Accessed June 26, 2007.
- 18.Langley GL, Nolan KM, Nolan TW, et al. The Improvement Guide: a Practical Approach to Enhancing Organizational Performance. San Francisco, CA: Jossey-Bass Publishers, 1996.Google Scholar