Table 2.
Effect of Block Scheduling on Residency-Related Outcomes
| Study | Block schedule type | Outcomes of interest | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Resident satisfaction (n = 7) | Inpatient-outpatient conflict (n = 5) | Care continuity | Ambulatory training time (n = 5) | Patient satisfaction (n = 3) | Patient health outcomes (n = 3) | |||||
| Physician (n = 4) | Patient (n = 4) | |||||||||
| Effect size* (absolute change) | Effect size* (absolute change) | Percent change† | Percent change‡ | Number of added clinic sessions | Percent change§ | Percent changeǁ | Various measures | |||
| “Short” ambulatory blocks (1 week) | ||||||||||
| Chaudry et al., 201324 | 4 + 1 | 0.9 (+ 1.0) | 1.4 (+ 3.4) | + 60 (in 9 months) | + 66.7% | |||||
| Harrison et al., 201425‡‡ | 3 + 1 | 0.7 (+ 0.6) | 2.6 (+ 2.5) | |||||||
| Heist et al., 201426 | 4 + 1 | − 15.0% | − 8.7% | + 6 (in 10 months) | + 32.3% | |||||
| Mariotti et al., 201027‡‡ | 4 + 1 | 0.7 (+ 0.8) | + 72 (in 7 months) | + 66.7% | ||||||
| Other ambulatory block designs | ||||||||||
| Bates et al., 2016 23 | 3 + 3 | NA¶ | NA# | + 14.0% | NA (in 12 months) | + 11.0% | ||||
| Francis et al. | June 201417 | Various: 4 + 4 8 + 4 8 + 8 “Long” |
0.0 (+ 0.0) | 0.3 (+ 0.5) | ||||||
| Sept 201418 | + 1.1 | |||||||||
| 201519 | − 10.2% | + 35.5% | − 7 (in 12 months) | − 13.9% | ||||||
| 201620 | See text | |||||||||
| Warm et al., 200828 | 1 year | NA** (+ 0.9) | NA** (+ 1.6) | + 14.0% | + 3.5% | See text | ||||
| Wieland et al., 201329 | 4 + 4 | − 0.3 (− 0.1)†† | − 14.8% | − 10.2% | + 0.2%** | See text | ||||
IM internal medicine, NA not available
*Effect size = absolute change in outcome between intervention and control groups/standard deviation. Effect size of ≥ 0.2 small magnitude of change, ≥ 0.5 medium magnitude of change, ≥ 0.8 large magnitude of change. Negative values denote a change for the worse (i.e., worsened resident satisfaction or worsened perception of inpatient-outpatient conflict). An effect size of 0 indicates no difference. All values were statistically significant unless otherwise noted
†Calculated as the change in the percentage of visits that a resident physician saw his or her assigned primary care patients with the transition to block scheduling. A negative value denotes worse continuity after implementation of block scheduling. All values were statistically significant unless otherwise noted
‡Calculated as the change in the percentage of visits a patient was seen by his or her assigned resident physician after transition to block scheduling. A negative value denotes worse continuity after implementation of block scheduling
§Calculated as the percent change in resident continuity clinic sessions with block scheduling compared to traditional scheduling. A positive value denotes an increase in number of clinic sessions after implementation of block scheduling, whereas a negative value denotes a decrease
ǁCalculated as the percent change in self-reported patient satisfaction scores after transition to block scheduling. A positive value denotes an increase in patient satisfaction
¶Reported as proportion of residents with “positive” responses (i.e., score of 4 or 5 on a 5-point Likert scale). Reported increase from 75 to 81% proportion of positive responses after implementation of block scheduling. Mean values for resident satisfaction scores not reported
#Reported as proportion of residents with “positive” responses (i.e., score of 4 or 5 on a 5-point Likert scale). Reported increase from 16 to 98% proportion of positive responses after implementation of block scheduling. Mean values for resident-perceived conflict scores not reported
**Standard deviation not available for calculation of effect size
††Change was not statistically significant
‡‡These two studies evaluated continuity qualitatively with resident perspective of their continuity discussed during focus groups. There was no quantitative data to report