Vaccination practice education: Long term modification of resident behavior

Purpose: Evaluation of the long term effects of a single behavioral intervention on residents' practice of influenza vaccination. Methods: The frequency of influenza vaccination in patients with and without indications for it was determined by retrospective outpatient chart review of 17% of the total medical clinic charts for the period Oct. 1995-Dec. 1995. The results of this review were compared with those of similar reviews in 1988, 1989, and 1990. Results: There was an increase in indicated influenza vaccinations from 4% to 46% between the 1988 and 1989 flu vaccination seasons related to the use of a protocol of focused case review by ancillary staff prior to discharge of each patient from clinic. This increase persisted through the 1990 vaccination season without reinstitution of the protocol. The 1995 review shows persistence of the 1989 improvement in vaccination practice with a 41% vaccination rate in patients with indications for influenza vaccinations. The total appropriate vaccination practice has been 65-70% since 1989. The rates of appropriate practice for PGY-I residents was noted to be the same ever since institution of study in 1989, indicating similarity of the various resident groups studied. Of note, there have been no significant changes in the teaching of vaccination practice in this program during the time interval studied. Conclusions: Persistence of modified behavior in the form of appropriate vaccination practice after a single season of enforced vaccination practice in 1989 in a unified student group of PGY I, II and III resident physicians reflects carryover of behavior, modified or otherwise, from resident group to resident group over the years. Clinical Implications: 1. Enforced rote performance of standardized practice for as little as 3 months can produce long term modifications of practice behavior. 2. In post-graduate medical education an increased focus of attention should be placed on the role of PGY II & III residents as the major teachers of the basic aspects of medical practice.