Elsevier

Ambulatory Pediatrics

Volume 7, Issue 5, September 2007, Pages 348-353
Ambulatory Pediatrics

Commentary
Pediatric Education
Pediatric Residents’ and Continuity Clinic Preceptors’ Perceptions of the Effects of Restricted Work Hours on Their Learning Relationship

https://doi.org/10.1016/j.ambp.2006.05.001Get rights and content

Objective

The effects of the Work Hour Standard (WHS) on continuity of care and quality of education has stimulated much discussion, yet little is known about how it affects the resident–continuity clinic preceptor (CCP) dyad, the only longitudinal learning relationship in pediatric residency. This case study explored residents’ and CCPs’ perceptions of the effects of restricted work hours on their learning relationship.

Methods

Direct observation of third-year pediatric residents (n = 10) and their CCPs (n = 10) was carried out in continuity clinic (CC) for 5 months; both groups attended clinic before and after the WHS. Semistructured, audiotaped interviews were conducted with residents before and after observation, and with CCPs after resident data were collected. Data from interview transcripts and observational notes were analyzed for major themes.

Results

To comply with the WHS, postcall clinic was eliminated and residents were rescheduled to another afternoon CC. The consequence of eliminating postcall clinic, disruption in the resident-CCP relationship, was perceived differently by residents and CCPs. From the residents’ perspective, rescheduling CC in response to the WHS benefited their learning because it exposed them to different CCPs with different practice styles. From the CCPs’ perspective, rescheduling CC frustrated their efforts to be learner-centered teachers and effective mentors.

Conclusions

Intended changes to limit excessive work hours had unintended effects that were viewed more favorably by residents than by CCPs. Understanding the shared and different perspectives of residents and preceptors regarding WHS-related changes in CC extends the discussion of the effect of restricted work hours.

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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