Association Between Teaching Clinic Structure and the Readiness of Ophthalmology Residents to Enter Independent Practice

Our objective is to determine if the structure of Graduate Medical Education teaching clinics is associated with how well ophthalmology residents are prepared to meet the workload demands of independent clinical practice. Resident preparedness to enter independent practice was measured by the Readiness Index. Part of the Department of Veterans Affairs’ new Workload-based Resident Academic Performance measures (WRAP), resident readiness is computed from electronic health records for residents by clinic and service-date. The index compares resident productivity net of supervision and adjusted for care quality to the average productivity of non-supervising ophthalmologists. Readiness comprises a Workload component (ratio of resident gross productivity to the average productivity of non-supervising ophthalmologists) and Supervision component (ratio of resident net of supervision to gross productivity). Teaching clinic factors include resident postgraduate-year level, resident-to-physician staff ratios, patient care complexity, and program size. Covariates include time into the academic year, facility quality ranking and complexity rating, and attending physician productivity rate. Study setting is 109 ophthalmology outpatient clinics from the United States Department of Veterans Affairs and its 1,300 annual ophthalmology resident positions rotating on 84,600 ophthalmology clinic-days during academic years from July 1, 2015, through June 30, 2019. An average 2.6 residents at a second-year or higher saw 25.0 patients requiring 93.6 relative value units (RVUs) of workload. Senior ophthalmology residents from clinics with higher resident-to-physician ratios had greater practice readiness than their counterparts primarily from having greater progressive autonomy from supervision. Residents from larger programs treating more complex patients had only slightly greater practice readiness than their counterparts primarily from having greater workload productivity. The readiness of ophthalmology residents to enter independent practice is associated with their academic level and resident-to-physician staff ratios, and to a lesser extent care complexity and program size. •Ophthalmology residents progressed over time towards independent clinical practice.•Resident progress was associated with clinics with larger resident-to-physician staff ratios.•Resident progress was associated with treating more complex cases.•Resident progress was associated with clinics supporting a l