Association between inpatient team continuity and clerkship student academic performance.

OBJECTIVE: To determine the association between inpatient team continuity, defined as the maximum number of days the same student, resident, and attending worked together on the inpatient wards, and the academic performance of students in a pediatric block clerkship. METHODS: We retrospectively identified students who rotated in the pediatric clerkship at a single institution from 2020 to 2022. We used multiple linear regression models to adjust for multiple confounders and used a one-way analysis of variance to compare adjusted outcomes across quartiles of inpatient team continuity. RESULTS: A total of 227 students were included in the analysis. Students' preceptor ratings increased by 0.04 on a scale of 0-4 (95% confidence interval [CI] 0.01-0.06; p = .001), and their final pediatric grade increased by 0.02 on a scale of 0-4 (95% CI 0.01-0.02; p < .001) with each 1-day increase in inpatient team continuity. There was no statistically significant association between team continuity and shelf exam scores or observed structured clinical examination scores. Preceptor ratings and final clerkship grades increased across quartiles of team continuity, with the greatest increase being between the second, 6-7 days of continuity, and third, 8-10 days of continuity, quartiles. CONCLUSIONS: Increased inpatient team continuity is associated with students receiving higher preceptor ratings and achieving a higher final pediatric clerkship grade. While the mechanisms driving these associations remain unknown, the results add to the literature base supporting the importance of preceptor continuity in undergraduate medical education.

Academic Performance of Clerkship Students Working on a Longitudinal Inpatient Pediatrics Team.

OBJECTIVE: To determine if the academic performance of students who worked on a longitudinal inpatient team in the pediatric clerkship differed from students on traditional teams. We hypothesized that working on the longitudinal team would be associated with improved performance. METHODS: We retrospectively identified students who rotated in the pediatric clerkship at a single institution from 2017 through 2021. We used multiple linear and multiple ordered logistic regression to examine whether working on a longitudinal inpatient team in which the majority of students work with the same senior resident and attending for the entire inpatient block and function without interns was associated with improved academic performance. RESULTS: We included data from 463 students, 316 in the longitudinal team group and 147 in the traditional team group. Working on the longitudinal team was associated with a higher inpatient preceptor rating (adjusted mean rating 3, 95% confidence interval [CI] 2.97 to 3.03 vs 2.85, 95% CI 2.81 to 2.90; P = .02; on a scale of 0 to 4) and an increased probability of achieving a higher final grade in the pediatric clerkship (adjusted probability of achieving honors 22%, 95% CI 17% to 28% vs 11%, 95% CI 6% to 16%; P = .003). These differences did not persist in the clerkship immediately after pediatrics. CONCLUSIONS: Compared with a traditional inpatient team, working on a longitudinal team was associated with achieving a higher preceptor rating and final pediatric clerkship grade. Implementing similar models within clinical clerkships may help foster optimal student performance.

The Development of an Infrastructure to Facilitate the Use of Whole Genome Sequencing for Population Health.

The clinical use of genomic analysis has expanded rapidly resulting in an increased availability and utility of genomic information in clinical care. We have developed an infrastructure utilizing informatics tools and clinical processes to facilitate the use of whole genome sequencing data for population health management across the healthcare system. Our resulting framework scaled well to multiple clinical domains in both pediatric and adult care, although there were domain specific challenges that arose. Our infrastructure was complementary to existing clinical processes and well-received by care providers and patients. Informatics solutions were critical to the successful deployment and scaling of this program. Implementation of genomics at the scale of population health utilizes complicated technologies and processes that for many health systems are not supported by current information systems or in existing clinical workflows. To scale such a system requires a substantial clinical framework backed by informatics tools to facilitate the flow and management of data. Our work represents an early model that has been successful in scaling to 29 different genes with associated genetic conditions in four clinical domains. Work is ongoing to optimize informatics tools; and to identify best practices for translation to smaller healthcare systems.