Continuity of care is getting cookies. And not just any cookies, but homemade cookies!
Family medicine resident (K.S. and J. Kerr, unpublished data, 2009)
Continuity of care is a cornerstone of family medicine, improving physician and patient satisfaction and patient outcomes.1–4 Focus groups with residents and practising physicians highlight that long-term relationships with patients are among their key reasons for becoming family physicians (K.S. and J. Kerr, unpublished data, 2009). Given its importance, teaching about continuity of care during residency training should be thoughtfully deliberate.
Background
Hennen5 defined continuity of care as having 6 components: chronologic or longitudinal, informational, geographic, interdisciplinary, family, and interpersonal (Table 11,2,4–8). These components of continuity of care have been conceptualized as relating to each other in a hierarchy with “at least some informational continuity being required for longitudinal continuity to be present and that longitudinal continuity is required for interpersonal continuity to exist.”6 Although all aspects of continuity of care are important, it is interpersonal continuity of care that is the strongest predictor of positive physician and patient outcomes.
Teaching strategies for each of the 6 components of the continuity of care
The positive aspects of interpersonal continuity of care tend to be easily articulated. However, if we dig a little deeper, it is also obvious that continuity of care can create many difficulties: complacency, a heightened sense of responsibility with increased worry, friction between work and personal life, boundary issues, patient dependency, grief, and dealing with difficult patients.9 Many of these factors are associated with physician stress and burnout. In teaching residents about the benefits of continuity of care, therefore, it is equally important to deliberately teach about the difficult aspects of long-term therapeutic relationships and discuss coping strategies to deal with them.
Evidence from literature and best practices
Table 11,2,4–8 suggests several ways to try and enhance teaching about the various components of continuity of care, ultimately working to enhance the development of interpersonal continuity of care. Different office setups will make some suggestions more or less workable. Thinking about the underlying intent of teaching about continuity of care (ie, facilitating the development of significant therapeutic relationships between residents and patients) will hopefully allow preceptors to modify some of the suggestions that are not immediately applicable in their settings. All suggestions presume that residents are developing cohorts of patients considered “theirs” during their rotations, and that residents must follow up on investigations and management choices for these patients.
Notes
TEACHING TIPS
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Teach residents not only the benefits of continuity of care but also the difficult aspects of long-term therapeutic relationships.
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Be a role model and discuss with residents the job satisfaction from continuity of care.
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Provide opportunities for residents to get more involved in and be responsible for patient care.
CONSEILS AUX ENSEIGNANTS
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Enseignez aux résidents non seulement les bienfaits de la continuité des soins mais aussi les aspects difficiles des relations thérapeutiques à long terme.
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Agissez comme modèle à imiter et discutez avec les résidents de la satisfaction professionnelle que procure la continuité des soins.
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Donnez la possibilité aux résidents de participer davantage et d’assumer plus de responsabilités dans les soins aux patients.
Footnotes
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Competing interests
None declared
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Seminar is a new quarterly series in Canadian Family Physician, coordinated by the Section of Teachers of the College of Family Physicians of Canada. The focus is on practical topics for all teachers in family medicine, with an emphasis on evidence and best practice. Please send any ideas, requests, or submissions to Dr Allyn Walsh, Seminar Coordinator at walsha{at}mcmaster.ca.
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