Tuesday, August 27, 2013

Researchers Create New 'Education-Centered Medical Home' Teaching Model

August 26, 2013 02:46 pm Sheri Porter – Researchers at the Northwestern University Feinberg School of Medicine in Chicago confronted two opposing truths back in 2011. The AAFP-supported patient-centered medical home (PCMH) model of care -- a team-based model that features easily accessible, high-quality health care coordinated by a primary care physician -- was gaining popularity nationwide as a means of improving patient care and lowering health care costs, but few medical schools were introducing PCMH concepts to students via curricular changes.
As a result, researchers set out to test the feasibility of a longitudinal clerkship based on PCMH principles and anchored by PCMH educational objectives. Researchers developed a model they dubbed the "education-centered medical home" and enlisted 56 student volunteers and four faculty preceptors from the medical school to participate in a study from June 2011 to April 2012.
The overall objective, according to study authors, was to "assess the feasibility and perceptions of an education-centered medical home clerkship on students and preceptors."
At the study's conclusion, program evaluations completed by participants revealed that students gained confidence in their understanding of PCMH principles and, in particular, appreciated experiencing early clinical exposure, continuity of care with patients and peer teaching. Faculty members also responded positively. In fact, all preceptors and 39 of 42 non-graduated students said they wanted to continue participation in the education-centered medical home clinics in the 2012-13 academic year.
  • Researchers at Northwestern University Feinberg School of Medicine tested the feasibility of a longitudinal clerkship based on patient-centered medical home (PCMH) concepts and anchored by PCMH educational objectives. 
  • They created an "education-centered medical home" model and enlisted 56 volunteer medical students and four physician preceptors to participate in a study from June 2011 to April 2012. 
  • Students liked the early clinical exposure, continuity of care and peer teaching experiences; all four preceptors and 39 of 42 non-graduated medical students wanted to continue participation in the model. 
The research is summarized in an article titled "The Patient-Centered Medical Home as Curricular Model: Perceived Impact of the 'Education-Centered Medical Home'(link.springer.com)" in the August 2013 issue of the Journal of General Internal Medicine.

Program Setup

For purposes of the study, education-centered medical homes were established at four existing faculty practices. Two of the clinic sites are federally qualified health center family medicine clinics, another is an academic general internal medicine clinic, and the fourth is an academic pediatric pulmonary clinic. Student teams were formed with first-, second-, third- and fourth-year medical students on each team. High-risk patients were recruited in each setting. Clinical education was achieved via a traditional physician preceptor model with the additional component of third- and fourth-year students directly observing first- and second-year students. All students attended monthly grand rounds conferences.
Curriculum was developed with three objectives in mind. Researchers aimed to
  • maximize student continuity experiences with patients, preceptors and peers;
  • demonstrate patient-centered care principles of the PCMH model; and
  • incorporate students in the delivery of PCMH care as health coaches and coordinators.
Researchers said the implementation of the education pilot at the Feinberg School of Medicine was a success and announced plans to expand the model in the 2012-13 academic year. They also acknowledged the study's limitations. For example, the authors said establishment of an education-centered medical home "would require significant financial resources and a substantial number of preceptors to incorporate all students at an institution."

Corresponding Author Answers Questions

AAFP News Now asked corresponding author Daniel Evens, M.D., an assistant professor of medicine-general internal medicine and geriatrics at Northwestern University Feinberg School of Medicine to answer a few questions about the project.
Q. What drove your interest in giving medical students training in a PCMH setting?
A. My career path as a "hybrid" ambulatory/hospitalist physician has placed me three months per year on our inpatient teaching service and the rest of the year in the clinic as a primary care physician. As a result, I recruited a large number of medically complex patients to my panel, and I have learned the hard way how difficult it is to coordinate care for these patients with chronic illness.
I've come to appreciate that there is no way that I can do it alone, and that I need a team to help me manage these patients. I also learned that medical students are eager to have continuity with complex patients and are willing to help with service learning projects.
During our recent curriculum renewal at Feinberg, we floated the idea of merging the needs of our primary care docs (e.g., the need for care coordinators and health coaches for our complex patients) with the desires of our students (e.g., the desire to have continuity with a panel of patients and learn how to manage chronic illness) into a new educational model called the education-centered medical home.
Q. What do you make of the highly positive evaluations from participating students and preceptors?
A. The positive student reaction to our education-centered medical home was not a surprise to our steering group. We knew that the average medical student was graduating after four years having never seen a single patient back for a continuity visit, so we knew that any program focused on continuity would be well received. The major question before our steering group was whether or not we could we create a program that was feasible from the viewpoint of the preceptors, and our retention of 13 out of 13 preceptors from last year's program gives us tremendous confidence that we are on the right track.
Q. Did the findings hold any surprises for you and your colleagues?
A. We started with the model of 16 students per preceptor mainly out of convenience (it was a multiple of four, easy for organizing four classes of students) and out of necessity (our limited funding required a large student-to-preceptor ratio). However, we were delighted to learn just how impactful it was for our preclinical students to pair up and have third- and fourth-year students directly observing patient encounters as peer teachers. The peer teaching aspect of the education-centered medical home ended up being rated just as highly as the continuity aspect of the program, and this was a wonderful unintended consequence of our 16:1 preceptor formula.
Q. Can immersing students in the PCMH model via the education-centered medical home help drive students to primary care specialties?
A. It will take several years to find out if our education-centered medical home program impacts the career choice of our graduates. We certainly hope that placing students into high-functioning primary care clinics that are committed to practice transformation will inspire some students to become medical home leaders themselves. Just as important, we hope that our graduates who still choose (sub)specialty practice will have a better understanding of the scope of primary care medicine and will be better prepared to be collaborative medical neighbors in the future.
Q. What's the most important take-away message from this project?
A. There is a large appetite among our students for continuity experience and the opportunity to learn about the medical home model. Our trainees are excited to work in the PCMH environment, and medical educators need to advocate on their behalf to create opportunities to involve them in practice transformation activities. For our part, we are happy to collaborate and share teaching materials with other institutions who are considering similar programs.

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