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A Model for Catalyzing Educational and Clinical Transformation in Primary Care: Outcomes from A Partnership Among Family Medicine, Internal Medicine, And Pediatrics

Authors: 
Eiff MP, Green LA, Holmboe E, McDonald F, Klink K, Smith, DG, Carraccio C, Harding R, Dexter E, Marino M, Jones SM, Carney PA
Year: 
2016
Journal: 
Academic Medicine
Pub Med #: 
Abstract: 

Purpose
To report findings from a national effort initiated by three primary care certifying boards to catalyze change in primary care training.

Method
In this mixed-method pilot study (2012–2014), 36 faculty in 12 primary care residencies (family medicine, internal medicine, pediatrics) from four institutions participated in a professional development program designed to prepare faculty to accelerate change in primary care residency training by uniting them in a common mission to create effective ambulatory clinical learning environments. Surveys administered at baseline and 12 months after initial training measured changes in faculty members’ confidence and skills, continuity clinics, and residency training programs. Feasibility evaluation involved assessing participation. The authors compared quantitative data using Wilcoxon signed-rank and Bhapkar tests. Observational field notes underwent narrative analysis.

Results
Most participants attended two in-person training sessions (92% and 72%, respectively). Between baseline and 12 months, faculty members’ confidence in leadership improved significantly for 15/19 (79%) variables assessed; their self-assessed skills improved significantly for 21/22 (95%) competencies. Two medical home domains (“Continuity of Care,” “Support/Care Coordination”) improved significantly (P < .05) between the two time periods. Analyses of qualitative data revealed that interdisciplinary learning communities formed during the program and served to catalyze transformational change.

Conclusions
Results suggest that improvements in faculty perceptions of confidence and skills occurred and that the creation of interdisciplinary learning communities catalyzed transformation. Lengthening the intervention period, engaging other professions involved in training the primary care workforce, and a more discriminating evaluation design are needed to scale this model nationally.