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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

Eiff, M. Patrice MD; Green, Larry A. MD; Holmboe, Eric MD; McDonald, Furman S. MD; Klink, Kathleen MD; Smith, David Gary MD; Carraccio, Carol MD; Harding, Rose; Dexter, Eve MS; Marino, Miguel PhD; Jones, Sam MD; Caverzagie, Kelly MD; Mustapha, Mumtaz MD; Carney, Patricia A. PhD

doi: 10.1097/ACM.0000000000001167
Research Reports

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.

M.P. Eiff is professor and vice chair, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.

L.A. Green is professor of family medicine, Epperson-Zorn Chair for Innovation in Family Medicine and Primary Care, University of Colorado, Denver, Colorado.

E. Holmboe is senior vice president, Milestone Development and Evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois.

F.S. McDonald is senior vice president, Academic and Medical Affairs, American Board of Internal Medicine, Philadelphia, Pennsylvania.

K. Klink is director, Medical & Dental Education, Department of Veterans Affairs Office of Academic Affiliations, Washington, DC.

D.G. Smith is director, Graduate Medical Education, Abington Memorial Hospital, Abington, Pennsylvania, and clinical associate professor of medicine, Temple University School of Medicine, Philadelphia, Pennsylvania.

C. Carraccio is vice president, Competency-Based Assessment Program, American Board of Pediatrics, Chapel Hill, North Carolina.

R. Harding is research assistant, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.

E. Dexter is biostatistician, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.

M. Marino is assistant professor, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.

S. Jones is program director, Virginia Commonwealth University–Fairfax Residency Program, Fairfax, Virginia.

K. Caverzagie is associate dean for educational strategy, University of Nebraska School of Medicine, Omaha, Nebraska.

M. Mustapha is assistant professor, Department of Internal Medicine and Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.

P.A. Carney is professor of family medicine, School of Medicine, and professor of public health, School of Public Health, Oregon Health & Science University, Portland, Oregon.

Funding/Support: The initial 18-month Primary Care Faculty Development Initiative pilot program was conducted by Oregon Health & Science University pursuant to contract HHSH250201200023C with the U.S. Department of Health and Human Services, Health Resources and Services Administration. An additional 6-month period for assessment of longer-term outcomes and further training was funded by the Josiah Macy, Jr. Foundation, the American Board of Internal Medicine, the American Board of Family Medicine Foundation, and the American Board of Pediatrics Foundation.

Other disclosures: None reported.

Ethical approval: This project, including all evaluation activities, received an exemption from Oregon Health & Science University’s institutional review board (IRB) in accordance with 45CFR46.101(b)[1] (IRB#9227). Additionally, the IRB of each of the four participating institutions also deemed the evaluation exempt.

Disclaimer: The views expressed are those of the authors and do not necessarily represent the views of the U.S. Department of Health and Human Services, including the Health Resources and Services Administration, the U.S. Department of Veterans Affairs, or the U.S. federal government.

Previous presentations: Some of the results of the Primary Care Faculty Development Initiative were presented at the 2015 Accreditation Council for Graduate Medical Education Annual Educational Conference on February 28, 2015, in San Diego, California, and the 11th Annual Association of American Medical Colleges Health Workforce Research Conference on May 1, 2015, in Alexandria, Virginia.

Correspondence should be sent to M. Patrice Eiff, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., MC: FM, Portland, OR 97239; telephone: (503) 494-6610; e-mail: eiff@ohsu.edu.

© 2016 by the Association of American Medical Colleges