The ambulatory long-block: an accreditation council for graduate medical education (ACGME) educational innovations project (EIP)

Abstract

Introduction: Historical bias toward service-oriented inpatient graduate medical education experiences has hindered both resident education and care of patients in the ambulatory setting.

Aim: Describe and evaluate a residency redesign intended to improve the ambulatory experience for residents and patients.

Setting: Categorical Internal Medicine resident ambulatory practice at the University of Cincinnati Academic Health Center.

Program description: 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.

Program evaluation: 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.

Discussion: 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.