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

The American Academy of Family Physicians, in conjunction with the American Academy of Pediatrics, American College of Physicians and the American Osteopathic Association published Joint Principles for the Medical Education of Physicians as Preparation for Practice in the Patient Centered Medical Homefinally, payment that appropriately recognizes the value added. The corresponding educational sub-principles for each major attribute of the Patient Centered Medical Home were written describing the learning objectives for medical students and residents to learn the competencies necessary to actualize these components in the care of patients and families.

In December 2010 the Association of Departments of Family Medicine (ADFM) distributed a survey to chairs of all departments requesting information about how we teach medical students and residents about PCMH. The response rate was over 50%. Ninety-five percent of responding departments reported that they were involved in some aspect of medical student and/or resident education in PCMH. The curricular components most often listed included the utilization of EHRs, defining and implementing appropriate access, e-prescribing, implementation of group visits, care management programs, utilization of chronic disease registries, rapid cycle quality improvement methods, e-mail/other asynchronous communication, and referral tracking. Survey data revealed that 41% of departments had implemented a specific PCMH curriculum for medical students and 65% had developed a PCMH curriculum for residents. The table▶ below illustrates the utilization of different PCMH topics and methods. Curricular teaching methodology revealed that didactic conferences were used much more often in the teaching of medical students when compared to residents. This difference may be because students are in departments and clerkships for a limited block period of time compared to residents’ longitudinal experience. On the other hand, curricular elements/methods utilized in resident teaching were quite varied, including didactic conferences, longitudinal projects, work with panels in population health, implementation of rapid cycle quality improvement methods, the use of group visits and specific training in team based care. Each of these content areas were mentioned with nearly equal frequency.

Table t1.

PCMH Curricular Components

	Medical Students	Residents
Didactic conferences	26	39
Longitudinal projects	11	33
Work with panels/population health	9	33
Specific training in team based care	15	32
HIT innovations to improve care	17	34
Use of disease registries	9	33
Group visits	9	34
Rapid quality improvement	8	36
Other

The majority of respondents also indicated a willingness to share their curriculum with others either in a presentation format at meetings or in a shared publishable form.

ADFM plans to develop and share a compendium of well-defined curricula that teach the education principles elucidated in the joint principles document. Other family medicine organizations will be contacted regarding those residency programs that are not administered by departments in order to learn what kinds of PCMH curricula and teaching may occur in these programs. The evolution of the Patient Centered Medical Home must move beyond practice redesign into curricular redesign, so that we can most effectively train the family physicians of the future. This will be a significant component of family medicine teaching, learning and research. Sharing examples of how to manage this curricular transition is an important part of our educational leadership – creating transformed practices in which students and residents can experience these innovations first hand.

Clearly this is a topic which has great interest within a broad swath of family medicine. We will work closely with other organizations in the family of family medicine and the Council of Academic Family Medicine (CAFM) to coordinate efforts in this area and disseminate materials to the widest possible group.