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Neurology: Education
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An open access peer-reviewed journal in neurologic and neuroscience education
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December 2022; 1 (2) Research ArticleOpen Access

Education Research: The Effect of an X + Y Schedule Model on Neurology Residency Training

Shuvro Roy, Katherine Fu, Timothy E. Ryan, Yvette Bordelon, Charles C. Flippen, Adrienne M. Keener
First published November 18, 2022, DOI: https://doi.org/10.1212/NE9.0000000000200017
Shuvro Roy
From the Department of Neurology (S.R.), Johns Hopkins University, Baltimore, MD; Department of Neurology (S.R., K.F., T.E.R., Y.B., C.C.F., A.M.K.), UCLA, Los Angeles, CA; and Department of Neurology (T.E.R.), Cedars Sinai Medical Center, Los Angeles, CA.
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Katherine Fu
From the Department of Neurology (S.R.), Johns Hopkins University, Baltimore, MD; Department of Neurology (S.R., K.F., T.E.R., Y.B., C.C.F., A.M.K.), UCLA, Los Angeles, CA; and Department of Neurology (T.E.R.), Cedars Sinai Medical Center, Los Angeles, CA.
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Timothy E. Ryan
From the Department of Neurology (S.R.), Johns Hopkins University, Baltimore, MD; Department of Neurology (S.R., K.F., T.E.R., Y.B., C.C.F., A.M.K.), UCLA, Los Angeles, CA; and Department of Neurology (T.E.R.), Cedars Sinai Medical Center, Los Angeles, CA.
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Yvette Bordelon
From the Department of Neurology (S.R.), Johns Hopkins University, Baltimore, MD; Department of Neurology (S.R., K.F., T.E.R., Y.B., C.C.F., A.M.K.), UCLA, Los Angeles, CA; and Department of Neurology (T.E.R.), Cedars Sinai Medical Center, Los Angeles, CA.
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Charles C. Flippen II
From the Department of Neurology (S.R.), Johns Hopkins University, Baltimore, MD; Department of Neurology (S.R., K.F., T.E.R., Y.B., C.C.F., A.M.K.), UCLA, Los Angeles, CA; and Department of Neurology (T.E.R.), Cedars Sinai Medical Center, Los Angeles, CA.
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Adrienne M. Keener
From the Department of Neurology (S.R.), Johns Hopkins University, Baltimore, MD; Department of Neurology (S.R., K.F., T.E.R., Y.B., C.C.F., A.M.K.), UCLA, Los Angeles, CA; and Department of Neurology (T.E.R.), Cedars Sinai Medical Center, Los Angeles, CA.
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Education Research: The Effect of an X + Y Schedule Model on Neurology Residency Training
Shuvro Roy, Katherine Fu, Timothy E. Ryan, Yvette Bordelon, Charles C. Flippen, Adrienne M. Keener
Neurol Edu Dec 2022, 1 (2) e200017; DOI: 10.1212/NE9.0000000000200017

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Abstract

Background and Objectives There is a need for earlier outpatient exposure in neurology training. In 2017, 56% of residents on the American Academy of Neurology (AAN) Graduating Resident Survey reported that they felt that the fellowship process started too early, and 46% felt that they did not have adequate outpatient exposure before making a fellowship decision. In addition, the traditional front-loaded resident schedule may contribute to high rates of burnout due to greater work hours and heavier inpatient load, as was suggested in the findings of a 2016 AAN survey comparing burnout among residents and fellows.

Methods We created an X + Y model within the UCLA Neurology Residency Program in the 2020–2021 academic year with the goal of increasing outpatient exposure earlier in training. We used a preintervention/postintervention design assessing measures of resident satisfaction, outpatient clinic exposure, number of inpatient handoffs, resident work hours, and scores on the resident in-training examination (RITE). We hypothesized that outpatient clinic exposure would increase, handoffs would diminish, work hours would be reduced, measures of resident satisfaction with inpatient care, outpatient care, and well-being would improve, and that RITE scores would improve. Work hours, handoffs, and number of clinic days were compared across each year via analysis of the resident schedule. Resident perceptions were obtained via an online survey at the end of their PGY-2 year. RITE scores were compared across a variety of subspecialties.

Results In the postintervention year, handoffs were reduced by 6.13 (95% CI 4.73–7.54) per week. Average clinic half-days increased by 4.51 (95% CI 7.76–0.53). Resident responses regarding their outpatient experience improved from 42% to 93% satisfied and from 60% to 94% satisfied for their inpatient experience. There was no difference in average work hours per week before and after the intervention. Regarding resident well-being, responses improved from 42% satisfied in the traditional model to 96% in the X + Y model. Among the RITE subjects covering primarily outpatient subspecialties, scores improved in each category.

Discussion After implementation of an X + Y model, we observed an improvement in outpatient exposure, learning and career satisfaction, and resident education on subspecialty topics.

Glossary

AAN=
American Academy of Neurology;
ACGME=
Accreditation Council for Graduate Medical Education;
IM=
Internal Medicine;
PGY-2=
Post-Graduate Year 2;
RITE=
resident in-training examination;
VA=
Veterans Affairs

Footnotes

  • Go to Neurology.org/NE for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Submitted and externally peer reviewed. The handling editor was Roy Strowd III, MD, Med, MS.

  • Received May 13, 2022.
  • Accepted in final form September 9, 2022.
  • © 2022 American Academy of Neurology

This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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