A Structural and Educational Intervention to Improve Inter-Visit Care in an Internal Medicine Residency Clinic: A Multimethod Evaluation.

Abstract

Inter-visit care (IVC), including test result management and asynchronous patient communication, is a growing component of ambulatory practice. Despite its clinical importance, IVC is inconsistently taught, supervised, and assessed in residency programs. Prior interventions address either educational or structural aspects of IVC in isolation, limiting understanding of how integrated approaches support both learning and patient care. To evaluate the educational and clinical impact of an integrated curricular and structural intervention to improve IVC practices in an internal medicine residency clinic. Multimethod evaluation using a retrospective pre-post survey of educational outcomes and chart review of matched resident cohorts before and after implementation for patient communication outcomes. Thirty-two internal medicine residents in an academic continuity clinic during the 2023-2024 academic year. A combined intervention consisting of (1) a firm-based inbox coverage system to ensure continuity of test result follow-up and supervision and (2) a longitudinal IVC curriculum addressing electronic health record efficiency, clinical reasoning in inter-visit decision-making, and professional responsibility. Educational sessions were aligned with clinical supervision through shared faculty oversight and inbox office hours. The primary educational outcome was residents' self-reported confidence in IVC-related skills. Clinical outcomes included clinic-level and resident-level rates and timeliness of test result communication before and after the intervention. Survey results showed improvements in residents' perceived confidence across IVC skill domains. Clinic-wide, the proportion of test results communicated increased from 57 to 76% (p < 0.01), and mean time to communication decreased from 18.7 to 8.5 days (p < 0.01). Resident-level analysis showed variable patterns of change across baseline communication tertiles and training level. An integrated curricular and structural intervention was associated with improvements in resident-reported skills and clinic-level outcomes. These findings support treating IVC as a multidimensional clinical domain that benefits from alignment between educational objectives and clinical systems. Not applicable.