Trial reportJournal of general internal medicine2013
Moving forward in GME reform: a 4 + 1 model of resident ambulatory training.
Trial report in Journal of general internal medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
29 citing papers in PubMed, 2 syntheses or guidelines pooled it, 50 citations in OpenAlex.
- The Impact of Block Ambulatory Scheduling on Internal Medicine Residencies: a Systematic Review.Journal of general internal medicine · 2019Pooled it
- Factors Affecting Resident Satisfaction in Continuity Clinic-a Systematic Review.Journal of general internal medicine · 2018Pooled it
- Implementing Night Float Systems for Nephrology Fellows: A National Survey of Nephrology Training Program Directors.Kidney medicine · 2026Article
- Firsthand Accounts of Practicing Generalists-Internal Medicine Residency and the 'Leap of Faith' into Primary Care.Journal of general internal medicine · 2026Article
- Optimal outpatient training for resident physicians' general medicine in-training examination score: a cross-sectional study.BMC medical education · 2025Article
- Resident Perceptions of Ambulatory Block Handoffs in the X + Y Block Scheduling Model.Journal of general internal medicine · 2025Article
- Impact of Ambulatory Blocks on Pulmonary Critical Care Fellow Outpatient Training Experience.ATS scholar · 2024Article
- The Impact of Changing From a 6+2 to a 3+1 Residency Block Schedule on Patient Access and Other Outcomes.Journal of graduate medical education · 2024Article
- Impact of Set-Day Clinic on Physician Continuity in a Family Medicine Residency Clinic.Family medicine · 2023Article
- X+Y Scheduling in Psychiatry Training.Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry · 2022Article
- A narrative review of ambulatory care education in Canadian internal medicine.Canadian medical education journal · 2020Review
- Residency Practice Transformation: Implementation of Team-Based Care in an Academic Continuity Clinic.Journal of graduate medical education · 2020Article
- A National Survey of Internal Medicine Primary Care Residency Program Directors.Journal of general internal medicine · 2019Article
- A Decade of Teaching and Learning in Internal Medicine Ambulatory Education: A Scoping Review.Journal of graduate medical education · 2019Article
- Restoration of resident sleep and wellness with block scheduling.Medical education · 2017Observational
- An Interactive Ambulatory Nephrology Curriculum for Internal Medicine Interns: Design, Implementation, and Participant Feedback.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2017Article
- Resident and Preceptor Perceptions of Preceptor Integration Into Resident Clinic Scheduling Templates.Journal of graduate medical education · 2017Article
- Why Aren't More Primary Care Residents Going into Primary Care? A Qualitative Study.Journal of general internal medicine · 2016Article
- Fulfilling outpatient medicine responsibilities during internal medicine residency: a quantitative study of housestaff participation with between visit tasks.BMC medical education · 2016Article
- Use of Team-Based Learning Pedagogy for Internal Medicine Ambulatory Resident Teaching.Journal of graduate medical education · 2015Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTraditional ambulatory training models have limitations in important domains, including opportunities for residents to learn, fragmentation of care delivery experience, and satisfaction with ambulatory experiences. New models of ambulatory training are needed.
aimTo compare the impact of a traditional ambulatory training model with a templated 4 + 1 model.
settingA large university-based internal medicine residency using three different training sites: a patient-centered medical home, a hospital-based ambulatory clinic, and community private practices.
participantsResidents, faculty, and administrative staff. PROGRAM DESCRIPTION: Development of a templated 4 + 1 model of residency where trainees do not attend to inpatient and outpatient responsibilities simultaneously. PROGRAM EVALUATION: A mixed-methods analysis of survey and nominal group data measuring three primary outcomes: 1) Perception of learning opportunities and quality of faculty teaching; 2) Reported fragmentation of care delivery experience; 3) Satisfaction with ambulatory experiences. Self-reported empanelment was a secondary outcome. Residents' learning opportunities increased (p = 0.007) but quality of faculty teaching was unchanged. Participants reported less fragmentation in the care residents provide patients in the inpatient and outpatient setting (p < 0.0001). Satisfaction with ambulatory training improved (p < 0.0001). Self-reported empanelment also increased (p < 0.0001). Results held true for residents, faculty, and staff at all three ambulatory training sites (p < 0.0001). DISCUSSION: A 4 + 1 model increased resident time in ambulatory continuity clinic, enhanced learning opportunities, reduced fragmentation of care residents provide, and improved satisfaction with ambulatory experiences. More studies of similar models are needed to evaluate effects on additional trainee and patient outcomes.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.