Investigating Continuity of Care in Residency Training through Education Scholarship

Oct 30, 2017

Studies have shown that when a patient continues to see the same family medicine physician over time and develops a patient-provider relationship based on effective communication and trust, patients have improved health outcomes.

When a North York General Hospital (NYGH) resident noted to faculty member Dr. Allyson Merbaum, the Postgraduate Program’s Hospital Site Director, that residents might benefit from more exposure and understanding of continuity of care, Merbaum decided to investigate how residents are exposed to the concept of continuity of care at NYGH and other residency training programs.Stock Photo of Student in ClassTwo cohorts of residents received a preceptor-based training model.

Working with the Office of Education Scholarship (OES) at DFCM, including our Vice-Chair of Education Dr. Risa Freeman, NYGH Faculty Development Site Director Lead Dr. Rebecca Stoller, and Mahan Kulasegaram, one of our Education Scientists from the Wilson Centre, Merbaum and her team developed an education scholarship project that aims to explore the factors that influence a resident’s perception regarding the provision of continuity of care during their training.

Over the space of two years, beginning in 2015, the study is following two cohorts of residents: one at NYGH and one at Michael Garron Hospital (MGH). Residents at NYGH receive a preceptor-based training model, wherein residents are immersed in their preceptors’ practices and develop a roster of patients from within the practice for whom they are responsible; whereas residents at MGH are provided with their own small roster of patients to follow over the course of their training.

At NYGH, Merbaum and her colleagues introduced educational opportunities related to continuity of care. For instance, residents now have the ability to access their patient’s electronic medical records from outside the office, which enables them to review results and provide follow-up, even if they are not in clinic.  Residents also receive an orientation session that includes a formal continuity of care workshop, as well as undergo a bi-yearly reflective exercise wherein they reflect on their experiences with continuity of care. For NYGH faculty, faculty development around continuity of care and an iterative evaluation tool for residents’ performance on continuity of care have been introduced. 

“Already, residents are talking more about continuity of care and we are seeing more recognition that family medicine is not just about office visits but also about greater patient continuity by phone and through home and hospital visits,” says Merbaum.  “So I’m really pleased with the results that we’re seeing thus far and I hope the study will indicate areas for improvement and new ideas about how we can integrate continuity of care into residency education even further.”

Beyond the results of the study itself, Merbaum says a personal result has been her own increased education and exposure to education scholarship. 

“Working with Dr. Risa Freeman, and others at OES, to help design and facilitate this study has really increased my comfort and experience with scholarship,” says Merbaum. “Their mentorship has really made me more comfortable being part of and leading education research projects and now I can mentor and support others interested in education scholarship and help it grow at NYGH.”


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