Unmasking a Vulnerable Patient Care Process: A Qualitative Study Describing the Current State of Resident Continuity Clinic in a Nationwide Cohort of Internal Medicine Residency Programs.

Background: Residents serve as access points to the health care system for the most vulnerable patients in the United States. Two large academic medical centers have identified performance gaps between resident and faculty physicians. Our intent in this study was to measure the scope of resident-faculty performance gaps in a nationwide sample and identify potential targets for intervention.

Methods: This is a qualitative study of 12 residency programs representing 4 out of 5 US regions. Main measures include perceptions of population health performance in resident versus faculty populations, description of precepting model employed, perceptions of differences between resident and faculty patients, and handoff processes at the time of graduation.

Results: Of the 8 programs that routinely compare resident and faculty performance, half had confirmed the presence of outcome disparities on routine population health metrics. Seven out of 12 programs employ a 1:1 preceptor:resident comanagement structure. Ten of the 12 programs perceived that resident panels were more psychosocially complex; 2 had a formal process to measure this. Four of the 12 programs had a process to monitor patient loss to follow-up after resident transition.

Conclusions: Resident-faculty performance disparities may be a widespread problem nationally. Potential targets for intervention include increased preceptor engagement, improving access for empanelment in the faculty practice for vulnerable patient populations, and employing more robust handoff practices. Integrating a culture of quality improvement to continuously monitor important educational metrics such as outcome disparities, panel demographics, educational continuity, and patient loss in the resident panel should be a routine practice for academic health centers.