Objective:

To compare neurology residents’ experiences between a traditional weekly continuity clinic model and a newly implemented X+Y clinic structure, focusing on education, feedback, wellness, and inpatient workload.

Background:

In 2023–2024, Temple Neurology transitioned from a weekly half-day continuity clinic to an X+Y format (one full outpatient week every six weeks). This change was intended to improve protected educational time and reduce conflict with inpatient responsibilities. We evaluated perceived impact on resident wellness and training quality.

Design/Methods:

A 25-item REDCap survey was distributed to all residents (N = 30); 21 responses were analyzed (response rate = 73.3%).
Respondents: PGY-2 = 5, PGY-3 = 6, PGY-4 = 6; 12 had only X+Y experience, 9 experienced both models.
Survey items used 5-point Likert and binary scales.
Paired comparisons employed Wilcoxon signed-rank and McNemar tests.

Results:

The X+Y model showed significant improvement in:
• Interruption from inpatient calls/texts (p = 0.008)
• Work-life balance (p = 0.012)
• Exhaustion (p = 0.012)
• Exposure to diverse teaching styles (p = 0.013)
McNemar analyses demonstrated greater time for pre-charting (p = 0.005), reflective decision-making (p = 0.014), subspecialty exposure (p = 0.008), and elective flexibility (p = 0.046).
No significant differences were found in attending feedback consistency (p = 0.773), evaluation quality (p = 0.346), or supervision (p = 0.072).
Residents exposed only to X+Y and those with both experiences rated the new model similarly positively.

Conclusions:

The X+Y structure improved residents’ work-life balance, emotional well-being, and educational diversity without compromising mentorship or feedback.
Combined with a night-float schedule, this reform demonstrates that program-level scheduling innovations can enhance both trainee satisfaction and educational quality.