A ‘firm’ system for graduate training in general internal medicine

An Organizational Innovation: The Yale Primary Care Residency Program's Experience With a Firm System

“…[1][2][3][4][5][6][7][8][9][10][11][12] Although demonstrating measurable educational and patient care advantages, these firm structures are not generalizable to multisite residency programs. [1][2][3][4][5][6][7][8][9][10][11][12] Although demonstrating measurable educational and patient care advantages, these firm structures are not generalizable to multisite residency programs.…”

The Use of Physical Restraints and the Absence of Kindness

“…Furthermore, much of the bedside care and management has been taught to medical students and first year residents in training by a second year resident. There are some exceptions to this usual training pattern where third year residents guide the clinical care and attending physicians are actively involved in clinical decision‐making 9 . In general, however, senior and seasoned attending physicians have had little direct influence on the provision of clinical care in academic teaching hospitals.…”

The state of science surrounding the clinical microsystem: a hedgehog or a fox?

“…We did not actually call it microsystems at that time, but called it ‘panel management.’6 The overarching concepts put forth then formed the foundation that can be found in current microsystem research and practice:There is a disconnect between the preoccupations of the front offices and the daily work of caring for patients at the front lines.The language between the two is common (improve access to care, improve quality and safety, improve patient satisfaction) but the translation is different for senior leaders versus front-line providers.A model based on Quinn's ‘smallest replicable unit’7 and academic firms8 9 provides a framework for frontline providers to use in understanding and improving the care provided to individuals patients as well as to a defined population of patients.…”

“…A model based on Quinn's ‘smallest replicable unit’7 and academic firms8 9 provides a framework for frontline providers to use in understanding and improving the care provided to individuals patients as well as to a defined population of patients.…”