Transforming Primary Care Training—Patient-Centered Medical Home Entrustable Professional Activities for Internal Medicine Residents
The U.S. faces a critical gap between residency training and clinical practice that affects the recruitment and preparation of internal medicine residents for primary care careers. The patient-centered medical home (PCMH) represents a new clinical microsystem that is being widely promoted and implemented to improve access, quality, and sustainability in primary care practice.
We address two key questions regarding the training of internal medicine residents for practice in PCMHs. First, what are the educational implications of practice transformations to primary care home models? Second, what must we do differently to prepare internal medicine residents for their futures in PCMHs?
The 2011 Society of General Internal Medicine (SGIM) PCMH Education Summit established seven work groups to address the following topics: resident workplace competencies, teamwork, continuity of care, assessment, faculty development, ‘medical home builder’ tools, and policy. The output from the competency work group was foundational for the work of other groups. The work group considered several educational frameworks, including developmental milestones, competencies, and entrustable professional activities (EPAs).
The competency work group defined 25 internal medicine resident PCMH EPAs. The 2011 National Committee for Quality Assurance (NCQA) PCMH standards served as an organizing framework for EPAs.
The list of PCMH EPAs has the potential to begin to transform the education of internal medicine residents for practice and leadership in the PCMH. It will guide curriculum development, learner assessment, and clinical practice redesign for academic health centers.
KEY WORDSpatient-centered medical home entrustable professional activities graduate medical education internal medicine primary care
- 3.Julian K, Riegels NS, Baron RB. Perspective: creating the next generation of general internists: a call for medical education reform. Acad Med. 2011;86(11):1443–7.Google Scholar
- 8.American Academy of Family Physicians. Joint principles of the patient-centered medical home. Del Med J. 2008;80(1):21–22.Google Scholar
- 11.Jaen CR, Ferrer RL, Miller WL, Palmer RF, Wood R, Davila M, et al. Patient outcomes at 26 months in the patient-centered medical home national demonstration project. Ann Fam Med. 2010;8 Suppl 1:S57,67; S92.Google Scholar
- 12.Maeng DD, Graf TR, Davis DE, Tomcavage J, Bloom FJ, Jr. Can a patient-centered medical home lead to better patient outcomes? The quality implications of geisinger’s ProvenHealth navigator. Am J Med Qual. 27(3):210–6.Google Scholar
- 15.Association of Program Directors in Internal Medicine, Fitzgibbons JP, Bordley DR, Berkowitz LR, Miller BW, Henderson MC. Redesigning residency education in internal medicine: a position paper from the association of program directors in internal medicine. Ann Intern Med. 2006;144(12):920–926. Jun 20.PubMedCrossRefGoogle Scholar
- 20.Nadkarni M, Reddy S, Bates CK, Fosburgh B, Babbott S, Holmboe E. Ambulatory-based education in internal medicine: current organization and implications for transformation. results of a national survey of resident continuity clinic directors. J Gen Intern Med. 2011;26(1):16–20.PubMedCrossRefGoogle Scholar
- 23.Health Resources and Services Administration Primary Care Residency Expansion Initiative, (HRSA-10-277, 2010).Google Scholar
- 24.VA centers of excellence in primary care education [Internet]. 810 Vermont Avenue, NW - Washington, DC 20420: U.S. Department of Veterans Affairs. Available from: http://www.va.gov/oaa/rfp_coe.asp. Accessed June 22, 2012.
- 26.American college of physicians medical home builder [Internet]. 190 North Independence Mall West, Philadelphia, PA 19106–1572: American College of Physicians; 2011. Available from: https://www.medicalhomebuilder.org/home. Accessed June 22, 2012.
- 27.ACGME outcomes project [Internet]. 515 N. State Street Suite 2000 Chicago, Il 60654: ACGME; 2011. Available from: http://www.acgme.org/acWebsite/home/home.asp. Accessed June 22, 2012.
- 28.Royal College of Physicians and Surgeons of Canada CanMEDS [Internet]: Royal College of Physicians and Surgeons of Canada; 2011. Available from: http://www.royalcollege.ca/public/resources/aboutcanmeds. Accessed June 22, 2012.
- 38.National committee for quality assurance patient centered medical home 2011 [Internet]. 1100 13th Street, NW, Suite 1000, Washington, DC 20005: National Committee for Quality Assurance; 2011. Available from: http://www.ncqa.org/tabid/631/default.aspx. Accessed June 22, 2012.
- 39.Joint principles for the medical education of physicians as preparation for practice in the patient-centered medical home. American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP), American Osteopathic Association (AOA); 2010. Available at www.aafp.org/online/etc/medialib/aafp_org/documents/news_pubs/ann/joint-principles-for-med-ed.Par/