Carney Patricia A, Eiff M Patrice, Green Larry A, Carraccio Carol, Smith David Gary, Pugno Perry A, Iobst William, McGuinness Gail, Klink Kathleen, Jones Samuel M, Tucker Leslie, Holmboe Eric
P.A. Carney is professor of family medicine and of public health and preventive medicine, Oregon Health & Science University, Portland, Oregon. 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, University of Colorado, Denver, Colorado. C. Carraccio is vice president, Competency-Based Assessment Program, American Board of Pediatrics, Chapel Hill, North Carolina. D.G. Smith is director of graduate medical education, Abington Memorial Hospital, Abington, Pennsylvania, and clinical associate professor of medicine, Temple University School of Medicine, Philadelphia, Pennsylvania. P.A. Pugno is vice president for education, American Academy of Family Physicians, Leawood, Kansas. W. Iobst is vice president of academic affairs, American Board of Internal Medicine, Philadelphia, Pennsylvania. G. McGuinness is executive vice president, American Board of Pediatrics, Chapel Hill, North Carolina. K. Klink is medical director, Robert Graham Center, Washington, DC. S.M. Jones is program director, Virginia Commonwealth University-Fairfax Residency Program, Fairfax, Virginia. L. Tucker is vice president of policy, American Board of Internal Medicine, Philadelphia, Pennsylvania. E. Holmboe is senior vice president of milestone development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois.
Acad Med. 2015 Aug;90(8):1054-60. doi: 10.1097/ACM.0000000000000701.
The scope and scale of developments in health care redesign have not been sufficiently adopted in primary care residency programs.
The interdisciplinary Primary Care Faculty Development Initiative was created to teach faculty how to accelerate revisions in primary care residency training. The program focused on skill development in teamwork, change management, leadership, population management, clinical microsystems, and competency assessment. The 2013 pilot program involved 36 family medicine, internal medicine, and pediatric faculty members from 12 residencies in four locations.
The percentage of participants rating intention to implement what was learned as "very likely to" or "absolutely will" was 16/32 (50%) for leadership, 24/33 (72.7%) for change management, 23/33 (69.7%) for systems thinking, 25/32 (75.8%) for population management, 28/33 (84.9%) for teamwork, 29/33 (87.8%) for competency assessment, and 30/31 (96.7%) for patient centeredness.Content analysis revealed five key themes: leadership skills are key drivers of change, but program faculty face big challenges in changing culture and engaging stakeholders; access to data from electronic health records for population management is a universal challenge; readiness to change varies among the three disciplines and among residencies within each discipline; focusing on patients and their needs galvanizes collaborative efforts across disciplines and within residencies; and collaboration among disciplines to develop and use shared measures of residency programs and learner outcomes can guide and inspire program changes and urgently needed educational research.
Revise and reevaluate this rapidly evolving program toward widespread engagement with family medicine, internal medicine, and pediatric residencies.
医疗保健重新设计的发展范围和规模在基层医疗住院医师培训项目中尚未得到充分应用。
创建了跨学科的基层医疗教师发展倡议，以教导教师如何加速基层医疗住院医师培训的修订。该项目侧重于团队合作、变革管理、领导力、人群管理、临床微系统和能力评估方面的技能发展。2013年的试点项目涉及来自四个地点12个住院医师培训项目的36名家庭医学、内科和儿科教师。
将所学内容付诸实施的意愿评为“非常可能”或“肯定会”的参与者比例，领导力方面为16/32（50%），变革管理方面为24/33（72.7%），系统思维方面为23/33（69.7%），人群管理方面为25/32（75.8%），团队合作方面为28/33（84.9%），能力评估方面为29/33（87.8%），以患者为中心方面为30/31（96.7%）。内容分析揭示了五个关键主题：领导技能是变革的关键驱动力，但项目教师在改变文化和吸引利益相关者方面面临巨大挑战；获取电子健康记录中的数据用于人群管理是一个普遍挑战；三个学科以及每个学科内的住院医师培训项目在变革准备方面存在差异；关注患者及其需求可促进跨学科和住院医师培训项目内部的协作努力；学科间合作开发和使用住院医师培训项目及学习者成果的共享指标，可指导和激励项目变革以及迫切需要的教育研究。
修订并重新评估这个快速发展的项目，以使其与家庭医学、内科和儿科住院医师培训项目广泛接轨。
