Education of Students and Residents in Patient Centered Medical Home (PCMH): Preparing the Way

David, Alan K.; Baxley, Libby; Adfm,

doi:10.1370/afm.1272

Cited by 11 publications

(9 citation statements)

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“…23 As Hochman et al showed, moving toward a PCMH model in a safety-net clinic staffed by residents improved the satisfaction of both residents and patients. 7 Achieving the goals of the PCMH model may be especially relevant for resident clinics, 24,25 as clinical practice redesign may positively impact resident training and satisfaction with their clinical experience. Residents who had spent time in higher functioning primary care clinics, which included PCMHs, valued the exposure to these types of practice models.…”

Section: Discussionmentioning

confidence: 99%

Why Aren’t More Primary Care Residents Going into Primary Care? A Qualitative Study

et al. 2016

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BACKGROUND:Workforce projections indicate a potential shortage of up to 31,000 adult primary care providers by the year 2025. Approximately 80 % of internal medicine residents and nearly two-thirds of primary care internal medicine residents do not plan to have a career in primary care or general internal medicine. OBJECTIVE: We aimed to explore contextual and programmatic factors within primary care residency training environments that may influence career choices. DESIGN: This was a qualitative study based on semistructured, in-person interviews. PARTICIPANTS: Three primary care internal medicine residency programs were purposefully selected to represent a diversity of training environments. Second and third year residents were interviewed. APPROACH: We used a survey guide developed from pilot interviews and existing literature. Three members of the research team independently coded the transcripts and developed the code structure based on the constant comparative method. The research team identified emerging themes and refined codes. ATLAS.ti was used for the analysis. KEY RESULTS: We completed 24 interviews (12 secondyear residents, and 12 third-year residents). The age range was 27-39 years. Four recurrent themes characterized contextual and programmatic factors contributing to residents' decision-making: resident expectations of a career in primary care, navigation of the boundary between social needs and medical needs, mentorship and perceptions of primary care, and structural features of the training program. CONCLUSIONS: Addressing aspects of training that may discourage residents from careers in primary care such as lack of diversity in outpatient experiences and resident frustration with their inability to address social needs of patients, and strengthening aspects of training that may encourage interests in careers in primary care such as mentorship and protected time away from inpatient responsibilities during primary care rotations, may increase the proportion of residents enrolled in primary care training programs who pursue a career in primary care.

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Section: Discussionmentioning

confidence: 99%

Why Aren’t More Primary Care Residents Going into Primary Care? A Qualitative Study

et al. 2016

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“…The preliminary results from pilot programs designed to incorporate the medical home model in their resident education clinics have shown that such interventions can lead to highly satisfied patients, fewer emergency department visits, and less hospital and urgent care use. 11 Lieberman et al 12 propose the development of ''education homes'' envisioned as ''ambulatory sites with a stable practice staff and patient population where a student or resident receives the bulk of his or her clinical training over several years.'' It remains to be seen what the long-term outcomes of such programs are and how they may affect trainees' knowledge and skills and patient outcomes.…”

Section: Patient-centered Medical Homementioning

confidence: 99%

Redesigning Medical Education to Improve Health Care Delivery and Outcomes

Alexandraki

Mooradian

2013

The Health Care Manager

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The need to improve the health of individuals and populations by providing high-quality health care has become a priority and has led to the implementation of various quality indicators to measure performance and outcomes. However, significant disparities exist in the health care delivery and outcomes among individuals that can only intensify, considering the future projections for an aging and increasingly diverse population. This article provides the authors' perspectives on how these issues can be addressed and overcome by redesigning medical education so the future generations of physicians have the necessary knowledge, skills, and attitudes to provide high-quality, patient-centered, and culturally sensitive care.

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“…Residents are commonly trained in ambulatory settings which incorporate PCMH principles and in NCQA-certified medical home practices [8]. Several professional organizations including the Alliance for Academic Internal Medicine advocate a move to training based on patient-centered care [9].…”

Section: Introductionmentioning

confidence: 99%

Do medical residents perform patient-centered medical home tasks? A mixed-methods study

Block

LaVine

Verbsky

et al. 2017

Medical Education Online

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Background: Increasingly, residents are being trained in Patient-centered Medical Home (PCMH) settings. A set of PCMH entrustable professional activities (EPAs) for residents has been defined but not evaluated in practice. Objective: To understand whether residents trained at PCMH sites reported higher likelihood of engaging in PCMH tasks than those training in non-PCMH sites. Design: Survey and nominal group data from post-graduate trainees at three residency programs. Results: A total of 179 residents responded (80% response). Over half (52%) cared for patients at PCMH sites. Residents at PCMH sites were more likely to report engaging in tasks in the NCQA domains of enhancing access and continuity (p < 0.01 for 4/11 tasks), planning and managing care (p < 0.01 for 3/4 tasks), providing self-care and community support (p < 0.01 for 3/5 tasks), and identifying and managing patient populations (p < 0.01 for 1/6 tasks), but were not more likely to report tracking and coordinating care or measuring and improving performance. Residents at PCMH sites were more likely to report working with medical assistants (p < 0.01), but not other healthcare professionals. Qualitative data showed staff teamwork and continuity of care as facilitators of patient-centered care, and technological problems and office inefficiencies as barriers to care. Conclusions: Residents trained at PCMH sites were more likely to engage in tasks in several NCQA domains, but not care coordination and quality assessment. Similar facilitators and barriers to trainee provision of patient-centered care were cited regardless of PCMH status. Curricula on PCMH principles and workflows that foster continuity and communication may help to inform residents on PCMH tenets and incorporate residents into team-based care. Abbreviations: EPA: Entrustable professional activity; GIM: General Internal Medicine; NCQA: National Center for Quality Assurance; PCMH: Patient-centered medical home

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Education of Students and Residents in Patient Centered Medical Home (PCMH): Preparing the Way

Cited by 11 publications

References 0 publications

Why Aren’t More Primary Care Residents Going into Primary Care? A Qualitative Study

Why Aren’t More Primary Care Residents Going into Primary Care? A Qualitative Study

Redesigning Medical Education to Improve Health Care Delivery and Outcomes

Do medical residents perform patient-centered medical home tasks? A mixed-methods study

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