一种促进初级保健教育与临床转变的模式：家庭医学、内科和儿科学合作的成果

A Model for Catalyzing Educational and Clinical Transformation in Primary Care: Outcomes From a Partnership Among Family Medicine, Internal Medicine, and Pediatrics.

作者信息

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

机构信息

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.

出版信息

Acad Med. 2016 Sep;91(9):1293-304. doi: 10.1097/ACM.0000000000001167.

DOI:10.1097/ACM.0000000000001167

PMID:27028034

Abstract

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.

摘要

目的

报告由三个初级保健认证委员会发起的一项全国性工作的结果，以推动初级保健培训的变革。

方法

在这项混合方法的试点研究（2012 - 2014年）中，来自四个机构的12个初级保健住院医师培训项目（家庭医学、内科、儿科）的36名教员参加了一个专业发展项目，该项目旨在让教员做好准备，通过团结他们共同致力于创建有效的门诊临床学习环境来加速初级保健住院医师培训的变革。在基线和初始培训后12个月进行了调查，以测量教员在信心和技能、连续性诊所及住院医师培训项目方面的变化。可行性评估包括评估参与情况。作者使用Wilcoxon符号秩检验和Bhapkar检验比较定量数据。对观察性实地记录进行了叙事分析。

结果

大多数参与者参加了两次面对面培训课程（分别为92%和72%）。在基线和12个月之间，教员在领导力方面的信心在19个评估变量中的15个（79%）上有显著提高；他们在自我评估技能方面，在22项能力中的21项（95%）上有显著提高。两个医疗之家领域（“医疗连续性”“支持/护理协调”）在两个时间段之间有显著改善（P <.05）。定性数据分析显示，在该项目期间形成了跨学科学习社区，并有助于催化变革性变化。