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Open Access Research article

A web-based simulation of a longitudinal clinic used in a 4-week ambulatory rotation: a cohort study

Rene WG Wong1* and Heather A Lochnan2

Author affiliations

1 Department of Medicine, Division of Endocrinology, University Health Network – Toronto General Hospital, 200 Elizabeth Street, 12-EN-211, Toronto, Canada

2 Department of Medicine, Division of Endocrinology, The Ottawa Hospital, 1967 Riverside Drive, 4th floor, Ottawa, Canada

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Citation and License

BMC Medical Education 2009, 9:8  doi:10.1186/1472-6920-9-8

Published: 2 February 2009



Residency training takes place primarily on inpatient wards. In the absence of a resident continuity clinic, internal medicine residents rely on block rotations to learn about continuity of care. Alternate methods to introduce continuity of care are needed.


A web-based tool, Continuity of Care Online Simulations (COCOS), was designed for use in a one-month, postgraduate clinical rotation in endocrinology. It is an interactive tool that simulates the continuing care of any patient with a chronic endocrine disease. Twenty-three residents in internal medicine participated in a study to investigate the effects of using COCOS during a clinical rotation in endocrinology on pre-post knowledge test scores and self-assessment of confidence.


Compared to residents who did the rotation alone, residents who used COCOS during the rotation had significantly higher improvements in test scores (% increase in pre-post test scores +21.6 [standard deviation, SD, 8.0] vs. +5.9 [SD 6.8]; p < .001). Test score improvements were most pronounced for less commonly seen conditions. There were no significant differences in changes in confidence. Residents rated COCOS very highly, recommending its use as a standard part of the rotation and throughout residency.


A stand-alone web-based tool can be incorporated into an existing clinical rotation to help residents learn about continuity of care. It has the most potential to teach residents about topics that are less commonly seen during a clinical rotation. The adaptable, web-based format allows the creation of cases for most chronic medical conditions.