Transforming Primary Care Training—Patient-Centered Medical Home Entrustable Professional Activities for Internal Medicine Residents
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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
We thank Karen Hauer, H. Carrie Chen, Patricia O’Sullivan, and C. Seth Landefeld for their thoughtful reviews of the manuscript.
Josiah Macy Jr. Foundation supported the Education Summit. Additional financial support for the Summit was provided by the United Health Foundation. The American College of Physicians, Primary Care Progress, and the Veterans Health Administration office of Academic Affiliations provided in-kind support.
The paper has not been presented. The list of EPAs from this Education Summit was presented at a workshop during the 2011 Annual Meeting of the Society of General Internal Medicine
Conflict of Interest
The authors declare that they do not have a conflict of interest.
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