Miller William L, Cohen-Katz Joanne
Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA, USA.
Fam Syst Health. 2010 Dec;28(4):334-47. doi: 10.1037/a0022001.
The renewal of primary care waits just ahead. The patient-centered medical home (PCMH) movement and a refreshing breeze of collaboration signal its arrival with demonstration projects and pilots appearing across the country. An early message from this work suggests that the development of collaborative, cross-disciplinary teams may be essential for the success of the PCMH. Our focus in this article is on training existing health care professionals toward being thriving members of this transformed clinical care team in a relationship-centered PCMH. Our description of the optimal conditions for collaborative training begins with delineating three types of teams and how they relate to levels of collaboration. We then describe how to create a supportive, safe learning environment for this type of training, using a different model of professional socialization, and tools for building culture. Critical skills related to practice development and the cross-disciplinary collaborative processes are also included. Despite significant obstacles in readying current clinicians to be members of thriving collaborative teams, a few next steps toward implementing collaborative training programs for existing professionals are possible using competency-based and adult learning approaches. Grasping the long awaited arrival of collaborative primary health care will also require delivery system and payment reform. Until that happens, there is an abundance of work to be done envisioning new collaborative training programs and initiating a nation-wide effort to motivate and reeducate our colleagues.
初级保健的复兴即将到来。以患者为中心的医疗之家（PCMH）运动以及一股合作的清新之风预示着它的到来，全国各地都出现了示范项目和试点。这项工作传递的一个早期信息表明，协作性跨学科团队的发展可能是PCMH取得成功的关键。本文的重点是培训现有的医疗保健专业人员，使其成为以关系为中心的PCMH中转型临床护理团队的活跃成员。我们对协作培训最佳条件的描述首先要界定三种类型的团队以及它们与协作水平的关系。然后，我们将描述如何使用不同的专业社会化模式和文化建设工具，为这类培训创造一个支持性、安全的学习环境。还包括与实践发展和跨学科协作过程相关的关键技能。尽管让当前的临床医生成为活跃协作团队的成员存在重大障碍，但利用基于能力和成人学习的方法，为现有专业人员实施协作培训项目仍有一些后续步骤可行。要迎接期待已久的协作式初级卫生保健的到来，还需要进行交付系统和支付改革。在此之前，设想新的协作培训项目并发起全国性努力来激励和再培训我们的同事，还有大量工作要做。
