The system, the resident, and the preceptor: a curricular approach to continuity of care training

Opportunities for experiential and shared learning more instrumental than formal curriculum

“I’ve had a lot of opportunities to experience it and I think that’s probably more valuable than sitting down in a lecture and listening about continuity”

“I don’t know if I [talk about it] explicitly but we do it just through our actions of trying to book, and basically following up with labs, consults, phone calls, things like that”

Disease evolution and “wanting to know how the story goes”

“You get feedback from subsequent visits that your clinical reasoning was correct or incorrect …. I think that the critical part to my learning in terms of integrating continuity of care was two-fold. One is sort of broadening my perspective on a person’s health problem and not having just that snapshot in time, but also developing the skills to manage a problem on an ongoing basis because that’s the key part that you need when you’re out in practice”

“So, I think, however, over the two years, you do need to see some patients over and over again, to learn how to follow up, to see the fruits of your labor, to understand what the outcomes are, what you ordered, and what the impact is”

Productive struggle promotes authentic engagement in the continuity experience

“Scheduling patients for clinic is a process that has to negotiate my schedule, the patient’s schedule, and their medical need for an appointment”

“It’s a little overwhelming for staff at a busy office with six physicians to remember which patient has seen the resident. So, what we try to do is when the patient is in the office and they need follow up, my resident will speak directly to the front staff and say, ‘please book Mr. Smith two weeks from today with me.’ So, we try to have her help facilitate it that way”

Learning by example through preceptor role modeling

“The preceptors with whom I have trained are all comprehensive family physicians and they see their role in the healthcare system and their duty to their patient as taking care of them across the full spectrum of illness. Dealing with both physical and mental health issues, dealing with social issues, dealing with the social determinants of health. You can’t deal with that stuff in just a one-off setting”

“And so, I think maybe they learn it, to a certain extent, by seeing the advantage that a doctor who has a long-standing relationship with a patient has, to be able to assess a particular complaint or connect with a patient and help them through some kind of difficulty”

Creating opportunities for reflective practice leads to different professional growth and continuous learning patterns

“I thought it was very useful to consider specific patient encounters, several weeks or months after the fact. I reflected differently on them than I did right at the start. In several cases, doing the reflective practice exercise made me realize how influential that patient encounter or series of encounters had been on what I’m doing now”