Block versus Longitudinal Scheduling of Emergency Medicine Residents' Rotation in an Independent Children’s Hospital: Pediatric Emergency Medicine Attending Faculty's Perspective

Abstract

Introduction For many emergency medicine (EM) residency programs, pediatric education takes place at independent pediatric emergency departments (PEDs). Residency programs are charged with selecting a scheduling model for their residents' clinical experience at these PEDs. The main advantage of block scheduling is that it immerses the residents in pediatric care for a period of time and provides continuity of work with the same PED attending faculty. The longitudinal model offers residents continuous pediatrics experience throughout their training and allows them to treat illnesses related to the seasons (seasonal variation). The purpose of this project was to evaluate a shift from block to longitudinal scheduling through the eyes of the PED attending faculty members. Methods A questionnaire was designed by a committee to obtain attending faculty's opinions about resident scheduling, seasonality, and the factors they would consider to make decisions about resident autonomy in patient care. The questionnaire was reviewed by a survey expert and piloted; they were then delivered electronically to 60 faculty members at our affiliated children's hospital emergency department (ED). Results The survey return rate was 63%. Most attending faculty expressed a preference for longitudinal over block scheduling because it eliminated the negative impact of seasonality on resident education. Others expressed positive features, including more sustained experience with pediatrics throughout training, and an experience that was more representative of day-to-day emergency medicine practice. A few attending faculty expressed concern that longitudinal scheduling would jeopardize attending faculty's familiarity with residents, making it difficult for residents to be entrusted to work autonomously. Most of the attending faculty suggested that their familiarity with a resident was a key factor in how they made decisions about the resident's participation in procedures or resident autonomy; however, very few were concerned that longitudinal scheduling would impact their ability to "get to know a resident." Conclusion Attending faculty mostly thought that longitudinal scheduling was better than block scheduling. While they acknowledged that their familiarity with the resident was the driver of faculty entrustment in the PED, they did not express any concern that the scheduling change would affect their ability to get to know the residents. Other solutions, including a mixed scheduling model to address both issues, are also proposed.