Secondary Logo

Journal Logo

Continuity with Patients, Preceptors, and Peers Improves Primary Care Training

A Randomized Medical Education Trial

Henschen, Bruce L. MD, MPH; Liss, David T. PhD; Golden, Blair P. MD; Cameron, Kenzie A. PhD, MPH; Bierman, Jennifer A. MD; Ryan, Elizabeth R. EdD; Gard, Lauren A. MPH ; Neilson, Eric G. MD; Wayne, Diane B. MD; Evans, Daniel B. MD

doi: 10.1097/ACM.0000000000003045
Research Report: PDF Only
Free
PAP

Purpose: Infusing continuity of care into medical student clerkships may accelerate professional development, preserve patient-centered attitudes, and improve primary care training. However, prospective, randomized studies of longitudinal curricula are lacking.

Method: All entering Northwestern University Feinberg School of Medicine students in 2015 and 2016 were randomized to the Education Centered Medical Home (ECMH), a 4-year, team-based primary care clerkship; or a mentored Individual Preceptorship (IP) for two years followed by a traditional 4-week primary care clerkship. Students were surveyed four times (baseline, M1, M2, and M3 year [through 2018]); surveys included the Maslach Burnout Inventory (MBI); the Communication, Curriculum, and Culture (C3) survey assessing the hidden curriculum; and the Attitudes Toward Health Care Teams (ATHCT) scale. The authors analyzed results using an intent-to-treat approach.

Results: 329 students were randomized; 316 (96%) participated in surveys. 70.1% of all respondents would recommend the ECMH to incoming first-year students. ECMH students reported a more positive learning environment (overall quality, 4.4 ECMH vs. 4.0 IP, P < .001), greater team-centered attitudes (ATHCT scale, 3.2 vs. 3.0, P = .007), less exposure to negative aspects of the hidden curriculum (C3 scale, 4.6 vs. 4.3, P < .001), and comparable medical knowledge acquisition. ECMH students established more continuity relationships with patients (2.2 vs. 0.3, P < .001) and reported significantly higher professional efficacy (MBI-PE, 4.1 vs. 3.9, P = .02).

Conclusions: In this randomized medical education trial, the ECMH provided superior primary care training across multiple outcomes compared to a traditional clerkship-based model, including improved professional efficacy.

B.L. Henschen is assistant professor, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0003-0994-9725.

D.T. Liss is research assistant professor, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0001-5505-2922.

B.P. Golden is instructor, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.0020

K.A. Cameron is research professor, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0002-3535-6459.

J.A. Bierman is associate professor, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0001-7534-8499.

E.R. Ryan, at the time of this work, was associate professor, Department of Family and Community Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Currently she is associate dean and campus director, Northwest Campus, Professor, Clinical Family Medicine, Indiana University School of Medicine – Northwest Campus, Gary, Indiana; ORCID: http://orcid.org/0000-0001-8680-3741.

L.A. Gard is research project coordinator, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

E.G. Neilson is professor and Lewis Landsberg Dean, Northwestern University Feinberg School of Medicine, Chicago, Illinois. ORCID: http://orcid.org/0000-0003-3723-8859.

D.B. Wayne is Dr. John Sherman Professor of Medicine and Medical Education, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0001-6468-0744.

D.B. Evans is assistant professor, Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Acknowledgments: The authors thank Raymond Curry, MD, John X. Thomas, PhD, and Marianne Green, MD, for their support for the ECMH and assistance in project implementation. The authors also thank the organizations that have served as ECMH sites, including PCC Community Wellness Center, Erie Family Health Center, Community Health Clinic of Chicago, Near North Health Service Corporation, and Northwestern Medical Group.

Funding/Support: Predominant funding for the ECMH was provided by the Augusta Webster Office of Medical Education at Northwestern University Feinberg School of Medicine. Additional contributions funding ECMH clinics were provided by Northwestern University’s Global Health Initiative, and Northwestern Memorial Hospital. Additional grant support specific for educational research and dissemination was provided to support authors B.L. Henschen, D.T. Liss, K.A. Cameron, E.R. Ryan, L.A. Gard, and D.B. Evans by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UH1HP29963, Academic Units for Primary Care Training and Enhancement. The information, content and conclusions expressed in this manuscript are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. REDCap is supported at FSM by the Northwestern University Clinical and Translational Science (NUCATS) Institute, Research reported in this publication was supported, in part, by the National Institutes of Health’s National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Other disclosures: None reported.

Ethical approval: Ethical approval has been granted for this study by the Northwestern University Institutional Review Board.

Correspondence should be addressed to Dr. Daniel B. Evans, 675 N. St. Clair St, Galter Pavilion, Suite 18-200, Chicago, IL 60611; telephone, (312) 695-8630; e-mail: daevans@nm.org; Twitter: @devans_at_NUmed.

© 2019 by the Association of American Medical Colleges