Training Tomorrow's Comprehensive Primary Care Internists: A Way Forward for Internal Medicine Education

Lee, Patrick T.; Friedberg, Mark W.; Bowen, Judith L.; Day, Susan; Kilo, Charles M.; Sinsky, Christine A.

doi:10.4300/jgme-d-12-00134.1

Cited by 7 publications

(8 citation statements)

References 28 publications

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“…The access barriers cited by residents present opportunities for innovation in resident clinic schedules and further community-based creativity in addressing social determinants of health and patientcentered research on alternative forms of outreach and connection. 24 Residents cited difficulty with patient engagement as limiting their success in improving their patients' health; further panel management curricular work could include measuring patient engagement and resident education in tools and techniques, such as motivational interviewing to better equip residents. 25 We plan to incorporate assessment of resident knowledge and behavior change as we study ongoing iterations of our curriculum.…”

Section: Discussionmentioning

confidence: 99%

Internal Medicine Resident Experiences With a 5-Month Ambulatory Panel Management Curriculum

Strout

Landrey

MacLean

et al. 2018

Journal of Graduate Medical Education

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Background Panel management is emphasized as a subcompetency in internal medicine graduate medical education. Despite its importance, there are few published curricula on population medicine in internal medicine residency programs.Objective We explored resident experiences and clinical outcomes of a 5-month diabetes and obesity ambulatory panel management curriculum.Methods From August through December 2016, internal medicine residents at the University of Vermont Medical Center reviewed registries of their patients with diabetes, prediabetes, and obesity; completed learning modules; coordinated patient outreach; and updated gaps in care. Resident worksheets, surveys, and reflections were analyzed using descriptive and thematic analyses. Before and after mean hemoglobin A1c results were obtained for patients in the diabetic group.Results Most residents completed the worksheet, survey, and reflection (93%-98%, N¼42). The worksheets showed 70% of participants in the diabetic group had appointments scheduled after outreach, 42% were offered referrals to the Community Health Team, and 69% had overdue laboratory tests ordered. Residents reported they worked well with staff (95%), were successful in coordinating outreach (67%), and increased their sense of patient care ownership (66%). In reflections, identified successes were improved patient care, teamwork, and relationship with patients, while barriers included difficulty ensuring follow-up, competing patient priorities, and difficulty with patient engagement. Precurricular mean hemoglobin A1c was 7.7%, and postcurricular was 7.6% (P ¼ .41). ConclusionsThe curriculum offered a feasible, longitudinal model to introduce residents to population health skills and interdisciplinary care coordination. Although mean hemoglobin A1c did not change, residents reported improved patient care. Identified barriers present opportunities for resident education in patient engagement.

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Section: Discussionmentioning

confidence: 99%

Internal Medicine Resident Experiences With a 5-Month Ambulatory Panel Management Curriculum

Strout

Landrey

MacLean

et al. 2018

Journal of Graduate Medical Education

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“…When the same group added a PCMH block rotation and didactic curriculum, the intervention group reported improved PCMH knowledge, skills, and experience from ‘basic’ to ‘intermediate’ level [30]. Lee recommended including education in care management, teamwork, and community resources in training residents for careers in new practice models [31]. …”

Section: Discussionmentioning

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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“…13 Despite lack of consensus about best practices, the ubiquity of team-based comprehensive care has brought requests for graduate medical education to emphasize related experiences for trainees. 14 …”

Section: Introductionmentioning

confidence: 99%

Reducing ER use through a trainee-designed, interprofessional care group for high-utilizing chronically ill patients: A pilot program

Schuttner

Zhang

Kuo

2017

Journal of Interprofessional Education & Practice

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Background Healthcare utilization is skewed to a subset of high-need, high-use patients, but optimal models of care are not known. Purpose To reduce emergency room (ER) use and hospital readmissions, trainees designed an innovative model of care delivery for chronically ill, high-utilizing adult patients. Methods Enrolled patients (N = 65) joined an interprofessional care program (nutrition, behavioral health, pharmacy, and care coordination), located in a single ambulatory clinic with extended hours. Results Evaluated by generalized linear mixed-effects models, the primary outcome of all-cause ER visits showed a significant decreasing trend after enrollment, from an increasing odds of ER visits (OR 1.07) in the 12-months prior to the program, compared to a decreasing trend post-enrollment (OR 0.88). Implementation and completion of the program was cost neutral. Discussion and Conclusions This pilot supports team-based ambulatory care models that address the diverse needs of chronically ill patients, with a focus on improving select health services utilization.

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Training Tomorrow's Comprehensive Primary Care Internists: A Way Forward for Internal Medicine Education

Cited by 7 publications

References 28 publications

Internal Medicine Resident Experiences With a 5-Month Ambulatory Panel Management Curriculum

Internal Medicine Resident Experiences With a 5-Month Ambulatory Panel Management Curriculum

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

Reducing ER use through a trainee-designed, interprofessional care group for high-utilizing chronically ill patients: A pilot program

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