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Medical Student Exposure to Components of the Patient-Centered Medical Home During Required Ambulatory Clerkship Rotations: Implications for Education

Saultz, John W. MD; O'Neill, Peggy; Gill, James M. MD, MPH; Biagioli, Frances E. MD; Blanchard, Shawn MD; O'Malley, Jean P. MPH; Brown, David; Rogers, John C. MD, MPH, MEd; Carney, Patricia A. PhD

doi: 10.1097/ACM.0b013e3181dbfa68
Primary Care

Purpose: To determine the extent to which third-year medical students are exposed to elements of the patient-centered medical home (PCMH) during required family medicine (FM) clerkships and how this exposure varies among a sample of medical schools.

Method: In 2008, the authors conducted a cross-sectional survey of 104 ambulatory teaching practices that host required third-year FM clerkship students from nine U.S. medical schools. Descriptive statistics characterized learning settings and the status of PCMH features, and generalized linear mixed models examined variation among medical schools (as the 104 clinics were nested within nine medical schools).

Results: Participating schools captured data on 104 eligible clerkship sites (44%). These practices were primarily community-based, single-specialty clinics (n = 48; 46%), and more than half (n = 55; 53%) were part of integrated health systems. Electronic health records (EHRs) were in place in 60 (58%), and no significant difference existed in EHR use according to medical school, despite up to a 10-fold variation from school to school in other PCMH features. Among sites with EHRs, 8 (14%) did not allow access to medical students. Preceptor attitudes about how practice transformation and new information technology are affecting the quality of medical education differ widely from site to site.

Conclusions: Primary care transformation toward the PCMH is already well under way in a national sample of FM teaching sites, and this transformation is having important effects on medical student education.

Dr. Saultz is professor and chair, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.

Ms. O'Neill is community outreach coordinator, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.

Dr. Gill is president, Delaware Valley Outcomes Research, Newark, Delaware, and associate professor of family and community medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.

Dr. Biagioli is associate professor of family medicine, Oregon Health & Science University, Portland, Oregon.

Dr. Blanchard is assistant professor of family medicine, Oregon Health & Science University, Portland, Oregon.

Ms. O'Malley is research associate, Biostatistics and Design Program, Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, Oregon.

Mr. Brown is senior research applications developer, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.

Dr. Rogers is professor of family and community medicine, Baylor College of Medicine, Houston, Texas.

Dr. Carney is professor of family medicine and public health and preventive medicine, Oregon Health & Science University, Portland, Oregon.

Please see the end of this article for information about the authors.

Correspondence should be addressed to Dr. Saultz, Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Mail Code: FM, Portland, OR 97239; telephone: (503) 494-6602; fax: (503) 494-4496; e-mail: saultz@ohsu.edu.

© 2010 Association of American Medical Colleges