Resident-run urology clinics: A tool for use in competency-based medical education for teaching and assessing transition-to-practice skills
Introduction: In a competency-based approach to resident education, a component of training should focus on skills needed for the transition from residency to independent practice. The ability to run an outpatient clinic represents one such skill. Resident-run clinics (RRC) have been implemented in family medicine programs to allow residents to practice this skill and have enhanced learning while providing excellent patient satisfaction. To date, there has been little experience with RRCs in surgical residency programs. We describe a urology RRC and report assessments of both resident performance and patient satisfaction.
Methods: The RRC was run independently by a senior urology resident. All cases were reviewed with faculty at the end of the day and an evaluation form assessing resident performance was completed. Residents also completed a brief self-assessment. All patients completed an anonymous survey to assess aspects of patient satisfaction.
Results: Overall, resident performance was excellent, with changes to the management plan in 6% (3/47) of cases after faculty review. All clinics finished within 30 minutes of planned end time. Residents reported confidence in their ability to manage the clinic (8.25/10). Forty-three patient surveys were completed. On a five-point scale, patient ratings of wait time, clinic environment, and appointment duration were 3.91, 4.23, and 4.12, respectively. Patient ratings of resident skills (communication, sensitivity, treatment options, and answering questions) were 4.30, 4.35, 4.40, and 4.42, respectively. Overall, confidence in residents was 9.07/10 and 100% of patients would recommend the RRC.
Conclusions: Based on our ongoing experience, RRCs provide well-received, safe patient care and serve as a learning tool for residents as they prepare for independent practice. Given these results, residency programs could consider inclusion of a RRC as a component of the transition-to-practice training within a competency-based curriculum.
Aggarwal R, Moorthy K, Darzi A. Laparoscopic skills training and assessment. Br J Surg 2004; 91:1549-58.
Aggarwal R, Grantcharov TP, Eriksen JR, et al. An evidence-based virtual reality training program for novice laparoscopic surgeons. Ann Surg 2006; 244:310.
Long DM. Competency-based residency training: the next advance in graduate medical education. Acad Med 2000; 75:1178-83.
Scheele F, Teunissen P, Luijk SV, et al. Introducing competency-based postgraduate medical education in the Netherlands. Med Teach 2008; 30:248-53
Frank JR, Snell LS, Cate OT,et al. Competency-based medical education: theory to practice. Med Teach 2010; 32:638-45.
RoyalCollege.ca. Ottawa: Royal College of Physicians and Surgeons of Canada; c2008. http://www.royalcollege.ca/rcsite/documents/cbd/cbd-competence-continuum-diagram-legal-e.pdf Accessed October 12, 2018.
Serwint JR, Thoma KA, Dabrow SM, et al. Comparing patients seen in pediatric resident continuity clinics and national ambulatory medical care survey practices: a study from the continuity research network. Pediatrics 2006; 118:849-58.
Yancy WS, Macpherson DS, Hanusa BH, et al. Patient satisfaction in resident and attending ambulatory care clinics. J Gen Intern Med 2001; 16:755-62.
Day KM, Zoog ES, Kluemper CT, et al. Progressive surgical autonomy observed in a hand surgery resident clinic model. J Surg Educ 2018; 75:450-7.
Weissler JM, Carney MJ, Yan C, et al. The value of a resident aesthetic clinic: a 7-year institutional review and survey of the chief resident experience. Aesthet Surg J 2017; 37:1188–98.
Ingargiola MJ, Molina Burbano F, Yao A, et al. Plastic surgery resident-run cosmetic clinics: a survey of current practices. Aesthet Surg J 2018; 38:793-9.
Pyle JW, Angobaldo JO, Bryant AK, et al. Outcomes analysis of a resident cosmetic clinic: safety and feasibility after 7 years. Ann Plast Surg 2010; 64:270-4.
Wojcik BM, Fong ZV, Patel MS, et al. The resident-run minor surgery clinic: a pilot study to safely increase operative autonomy. J Surg Educ 2016; 73:142-9.
Recker M, Lam CH, McCullough HK, et al. Resident education spotlight: A blueprint for forming a resident run interventional radiology clinic. J Vasc Interv Radiol 2011; 22:S136.
Smith SD, Marrone L, Gomez A, et al. Clinical outcomes of diabetic patients at a student-run free clinic project. Fam Med 2014; 46:198-203.
Frank JR, Danoff D. The CanMEDS initiative: implementing an outcomes-based framework of physician competencies. Med Teach 2007; 29:642-7.
Kish L. Survey Sampling. New York: John Wiley & Sons Inc.; 1995.
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