1.  Checking In on Check-Out: Perceptions and Expectations of Residents during the Continuity Clinic Check-Out Process
Yvonne Covin, M.D., Shannon Scielzo, Lynne Kirk, M.D., Blake Barker, M.D. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
INTRODUCTION
RESULTS
DISCUSSION
The limited efficacy of ambulatory graduate medical education training in general has been well established. Two predominant contributors to the lack of pedagogical value in this area of training have been proposed: resident frustration with healthcare delivery issues (e.g., multi-level bottle necks in work flow, overwhelmed schedules, under preparation to work with diverse populations) and dissatisfaction with supervision (i.e., teaching and feedback).
Despite calls for increasing the quality of ambulatory graduate medical education training sites, few studies to date have examined resident and preceptor perceptions of specific teaching components of patient management during case discussions (i.e., the “check-out” process) as a first step in faculty development.
In this study, we set out to compare preceptor and resident perceptions of learning priorities during check-out in primary care continuity clinics. Specifically, we wanted to identify areas of deficiency in training from the residents’ perspective, to examine the correlation of resident and preceptor perceptions, and to explore the impact of preceptor clinical experience to the correspondence of priorities.
Effective teaching in the ambulatory setting is a complex responsibility.
Survey participants agreed preceptors should prioritize clinical decision making.
Unexpectedly, we did not see improvements in agreement of important check-out discussions with increasing years of preceptor clinical practice.
Limitations: Our study, although among two residency programs across three continuity clinics, was a single-center study. Although perceptions should be diverse, they may not be generalizable. The potential for selection bias should be considered given the low resident response rate despite no incentive for survey completion.  
Due to a high number of ambulatory preceptor volunteers, we recognize the limitation of few enduring interactions between preceptor-resident pairs throughout training to develop individualized check-out priorities.  
METHODS
CONCLUSIONS
Survey participants : Categorical Internal Medicine and Family Medicine residents and 22 primary care preceptors
Study sites: Two safety-net primary care clinics at a tertiary care  hospital, and one Veteran’s Health Administration primary care clinic.
Tool: Anonymous, electronic survey distributed to all residents and preceptors in the clinics
5-point Likert questionnaire to assess priorities (1 = very unimportant, 3 = no opinion, 5 = very important) and practices (1 = very rarely or never, 3 = about half the time, 5 = always).
Participation was voluntary and not incentivized.
Completed survey response rates among preceptors and residents were 61% (n=22) and 48% (n=82), respectively.
Residents desire more patient management education.
Preceptors mold resident perception of outpatient clinical competence through agreement of priorities in learning.
Preceptors must manage the responsibility of goal-setting for check-out with residents with whom relationships may be brief.
Our results should serve as permission to capture time in the “teachable moment” whether in the patient room for physical examination demonstration or even in the reassuring moment before offering input.
Future work should focus on faculty development activities for ambulatory clinician-educators focused on teaching content valued by learners in the continuity clinic setting.
Copyright Colin Purrington (