University of California San Francisco, San Francisco Veterans Affairs Medical Center, 3333 California Street, Suite 380, San Francisco, CA 94118, USA.
J Gen Intern Med. 2013 Jun;28(6):801-9. doi: 10.1007/s11606-012-2193-3. Epub 2012 Sep 21.
The U.S. faces a critical gap between residency training and clinical practice that affects the recruitment and preparation of internal medicine residents for primary care careers. The patient-centered medical home (PCMH) represents a new clinical microsystem that is being widely promoted and implemented to improve access, quality, and sustainability in primary care practice.
We address two key questions regarding the training of internal medicine residents for practice in PCMHs. First, what are the educational implications of practice transformations to primary care home models? Second, what must we do differently to prepare internal medicine residents for their futures in PCMHs?
The 2011 Society of General Internal Medicine (SGIM) PCMH Education Summit established seven work groups to address the following topics: resident workplace competencies, teamwork, continuity of care, assessment, faculty development, 'medical home builder' tools, and policy. The output from the competency work group was foundational for the work of other groups. The work group considered several educational frameworks, including developmental milestones, competencies, and entrustable professional activities (EPAs).
The competency work group defined 25 internal medicine resident PCMH EPAs. The 2011 National Committee for Quality Assurance (NCQA) PCMH standards served as an organizing framework for EPAs.
The list of PCMH EPAs has the potential to begin to transform the education of internal medicine residents for practice and leadership in the PCMH. It will guide curriculum development, learner assessment, and clinical practice redesign for academic health centers.
美国在住院医师培训与临床实践之间存在着严重的脱节，这影响了内科住院医师从事初级保健工作的招聘和准备。以患者为中心的医疗之家（PCMH）代表了一种新的临床微观系统，它正在被广泛推广和实施，以改善初级保健实践的可及性、质量和可持续性。
我们针对内科住院医师在 PCMH 实践中的培训提出了两个关键问题。首先，向初级保健家庭模式的实践转变对教育有何影响？其次，我们必须做些什么来改变，才能让内科住院医师为他们在 PCMH 的未来做好准备？
2011 年美国内科医师学会（SGIM）PCMH 教育峰会成立了七个工作组，以解决以下主题：住院医师工作场所能力、团队合作、连续性护理、评估、教师发展、“医疗之家建设者”工具和政策。能力工作组的成果为其他工作组的工作奠定了基础。工作组考虑了几种教育框架，包括发展里程碑、能力和可委托的专业活动（EPAs）。
能力工作组定义了 25 项内科住院医师 PCMH EPA。2011 年全国质量保证委员会（NCQA）PCMH 标准作为 EPA 的组织框架。
PCMH EPA 清单有可能开始改变内科住院医师在 PCMH 中的实践和领导教育。它将指导学术医疗中心的课程开发、学习者评估和临床实践设计。
