University of Cincinnati

Long Block (PGY 2/3)

The Long Block begins in the 17th month of residency for a total of 12 consecutive months. We chose this time because we felt it was important for residents to consolidate their inpatient skills prior to the Long Block.

In developing our model, our hypothesis was that one year of true continuity would be better for patient care and education than three years of more sporadic interactions. The results have been extremely positive.

During the Long Block, residents transition from inpatient-based rotations to an expanded outpatient experience and patient panels expand to approximately 120 patients.

Residents see patients in the ambulatory practice three half-days per week, but are required to be present in the practice or check the EPIC electronic medical record (to answer messages, etc.) at least once every day. In short, the residents act like practicing physicians.

Scheduling systems are designed to foster continuity of care. For example, each resident's daily schedule of eight appointments has two slots protected for acute patients, and every effort is made to match these patients with their assigned physician.

When not seeing patients in the practice, residents rotate on inpatient or ambulatory electives as well as research experiences with minimal overnight call (two to four weeks of inpatient night-float).

Each resident can take up to three different electives in any one field of medicine, and up to three months dedicated time for research. Residents also receive protected time to learn during the Advanced Ambulatory Practice and Board Review sessions.

During the Long Block, residents learn how to function within a highly effective Level III NCQA certified patient-centered medical home. The ambulatory group practice consists of residents, attendings, nurses (mostly RN), social worker, pharmacists, and administrators. The entire team has yearly retreat at start of Long Block focusing on quality improvement and patient-safety where residents learn basic tools, and a common approach to quality and safety problems.

The team (including all Long Block residents) meets weekly to review performance (patient care outcomes, satisfaction, throughput, financial) and residents receive monthly data reports drilled down to their specific patients with relative rankings and measurement of change over time; data is compared to team as a whole and national benchmarks. These data are also used as part of resident formative and summative evaluation.

For those interested in a more intense Quality Improvement experience, we have created the Quality Improvement Leadership Team (QuiLT). This core improvement team consisting of self-selected residents (usually about 1/3 of entire Long Block class) meets with trained quality improvement/patient-safety faculty to create and drive major improvement initiatives.
 

Sample Week on the Long Block: