CommentaryPediatric EducationPediatric Residents’ and Continuity Clinic Preceptors’ Perceptions of the Effects of Restricted Work Hours on Their Learning Relationship
Section snippets
Setting and Sample
An in-depth case study was conducted in one CC affiliated with a well-established pediatric residency program. The selected site was 1 of 4 CCs housed in urban, community-based, pediatric primary care centers that were owned and staffed by the pediatric hospital that sponsored the residency program. The criterion for selection was consistently high ratings by residents of their preceptor’s teaching performance, minimizing variability among CCPs. All direct observation was conducted in the
Elimination of Postcall Clinic
As intended, the WHS limited excessive work hours by eliminating postcall clinic. Residents and CCPs agreed that abolishing what they referred to as the “painful experience” of postcall clinic was the most salient difference in CC since the implementation of the WHS. One resident recalled his experience:
The real difference in clinic was to get rid of postcall clinic, which is maybe the best thing that the whole 80 hour work week did. I remember just dreading coming to clinic.
From the
Discussion
As residency programs adapt to restricted work hours, some consequences of implementing the WHS are emerging. By drawing from both observational and interview data, we found that intended changes—that is, limiting excessive work hours—had unintended consequences for residents’ only longitudinal learning relationship. Rescheduling clinic in response to restricted work hours disrupted the resident-CCP relationship, but also exposed residents to more practice styles.
Our data suggest that the WHS
Acknowledgments
Supported in part by the Ambulatory Pediatric Association Young Investigator Grant, 2005.
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