Abstract
Introduction
Residency programs today face new challenges in training physicians for the rapidly changing culture of quality and teamwork in medical practice. New curricular initiatives must address accreditation standards for resident education in quality improvement (QI), teamwork, and patient data review. The objective of this study was to evaluate a new curriculum for internal medicine residents which introduced the concept of a patient-centered medical home (PCMH).
Methods
We piloted a rotation for residents to experience PCMH practices in the community. The curriculum utilized experiential, didactic, and reflective sessions training residents in the PCMH tenets, QI, and interdisciplinary teamwork. We evaluated resident knowledge, attitudes, and behaviors using a single retrospective pre-post survey.
Results
Post rotation, residents felt better able to identify PCMH initiatives (47% before vs. 93% after, p < 0.01), PCMH team members in their primary care clinics (30% before vs. 83% after, p < 0.01), and expressed enhanced understanding of PCMH team members’ roles (30% before vs. 87% after, p < 0.01). Residents reported being more likely to utilize PCMH resources (52% before vs. 93% after, p < 0.01) and use patient data to improve their practice (37% before vs. 80% after, p < 0.01) after this intervention.
Conclusion
This curricular model increased resident self-reported knowledge and identification of PCMH team members in their own continuity practice. This model, which embeds trainees in an experienced PCMH practice, can be used by residency programs to prepare residents for participation in team-based, quality-driven care in other PCMH sites in which they are likely to practice in their future careers.
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Acknowledgements
The authors wish to thank Donald Raum, MD and Jonathan Swartz, MD for their assistance in the design and the coordination of the rotation.
Funding
This work was partially funded by the New York State Department of Health Hospital-Medical Homes Demonstration Project.
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Conflict of Interest
The authors declare that they have no conflicts of interest in this work.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Appendices
Appendix 1
Appendix 2: PMCH Survey
We are interested in your experience both before and after you completed the PCMH rotation.
Please check the box that best indicates how much you agree or disagree with the following statements
Strongly disagree | Disagree | Neither agree nor disagree | Agree | Strongly agree | |
1. Before the PCMH rotation, I could identify PCMH initiatives in my continuity clinic in which I was participating. | |||||
2. After the PCMH rotation, I can identify PCMH initiatives in my continuity clinic in which I am participating. | |||||
3. Before the PCMH rotation, I could list the members of the interdisciplinary PCMH team. | |||||
4. After the PCMH rotation, I can list the members of the interdisciplinary PCMH team. | |||||
5. Before the PCMH rotation, I could describe what each PCMH team member’s role is in caring for primary care patients. | |||||
6. After the PCMH rotation, I can describe what each PCMH team member’s role is in caring for primary care patients. |
We are also interested in your actions both before and after you completed the PCMH rotation.
Please check the box that best indicates how likely or unlikely you were to perform the following actions in the 2 months before the PCMH rotation and how likely or unlikely you are to perform the following actions in the next 2 months.
Very unlikely | Somewhat unlikely | Somewhat likely | Very likely | |
7. In the 2 months before your PCMH rotation, how likely were you to interact with a PCMH team member in your continuity clinic for assistance with the care of one of your primary care patients? | ||||
8. In the next 2 months, how likely are you to interact with a PCMH team member in your continuity clinic for assistance with the care of one of your primary care patients? | ||||
9. In the 2 months before your PCMH rotation, how likely were you to review data on the care of your continuity clinic patients and use it to improve their care? | ||||
10. In the next 2 months, how likely are you to review data on the care of your continuity clinic patients and use it to improve their care? |
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Morrison, J.L., Conigliaro, R.L. A Patient-Centered Medical Home (PCMH) Rotation Prepares Residentsfor Practicing in Today’s Culture of Quality and Teamwork. Med.Sci.Educ. 28, 81–87 (2018). https://doi.org/10.1007/s40670-017-0507-0
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DOI: https://doi.org/10.1007/s40670-017-0507-0