Since July 2019, Woodwinds Hospital Family Medicine Residency Program Director Dr. Casey Martin has scheduled physicians using a Set Day Schedule model at M Health Fairview Clinic - Bethesda. With this innovative model, half the residents and faculty physicians are consistently in clinic on Monday/Thursday/Friday and the other half on Tuesday/Wednesday/Friday. Dr. Martin has also prioritized scheduling residents for all-day clinic to decrease midday transitions. Prior to the set day model, residents’ clinic shifts were scheduled around their rotation and were unpredictable.

The shift from a rotation-based model to the set day model was prompted by the department’s “Clinic as Curriculum” initiative led by Vice Chair for Clinical Affairs Dr. Pita Adam. One of the aims of Clinic as Curriculum is to prioritize and improve residents’ continuity clinic experience. For residents at the Bethesda clinic, the set day clinic model had an almost immediate impact. Here are some quotes from a focus group conducted with Bethesda residents in early 2020:

"Now that we've changed to a more regular schedule it's much easier to predict when you're going to be in clinic and so it's easier for your patients to follow up now that they know you're in clinic." —PGY3 resident

"I think that one thing that's made clinic easier this year for me is that we've gone to working in clinic on typical days. So I feel that I'm seeing patients, I guess like not seeing new patients all the time, and I'm actually following up with people, which has made a big difference and reduced my stress. And I think it's also helped me to pre-visit plan…So I think that's been a positive change this year." —PGY3 resident

An equally important aim of Clinic as Curriculum is to improve physicians’ continuity with their patients. Patients who consistently see their primary care provider have improved outcomes and lower healthcare costs. Listening to residents, it appeared that the predictability of set days in clinic also improved continuity:

"Yeah, and it guarantees that you're going to be in clinic, another full day that week. So like, I wanted to see them in two days I'm more likely to have a slot open for them if I'm there all day, versus before it used to be a lot of half days intermittent throughout the week. And naturally those slots just filled up with a bunch of random people usually. So when you have a full day open to fill in and it just tends to have more regular patients within that day." —PGY3 resident

To understand if continuity actually changed for Bethesda clinic physicians after implementation of the set day clinic model, Drs. Adam and Martin reached out to the Research Services Hub for support. Dr. Kristen Klemenhagen (data and statistical analyst) and Derek Hersch (research support manager) helped develop and conduct a research project that evaluated the impact of the set day clinic model. The project compared continuity during a six-month period (October-March) in 2021/2022, to the same months in 2018/2019, when the schedule was rotation-driven. They found that PGY3 residents had significantly higher continuity during the set day clinic period, and PGY2 residents had modest improvement in continuity. Bethesda physicians were also asked to complete a brief survey in June 2022 regarding their perceptions of the set day clinic model. Resident and faculty respondents overwhelmingly reported that the set day clinic model improved their experience in clinic and their ability to schedule follow-up visits. Moreover, residents and faculty did not believe that the set day clinic model interfered with their rotational learning and teaching/scholarly activities, respectively. This project was recently presented as a poster at the North American Primary Care Research Group (NAPCRG) Annual Meeting, and manuscript preparations are underway.