Castro Maria Gabriela, Dicks Melanie, Fallin-Bennett Keisa, Hustedde Carol, Sacks David, Hunter Lynn Joyce, Elder William
Department of Family and Community Medicine, University of Kentucky, Lexington, KY, USA,
College of Pharmacy, University of Kentucky, Lexington, KY, USA.
Adv Med Educ Pract. 2019 Feb 5;10:47-53. doi: 10.2147/AMEP.S175413. eCollection 2019.
Transformation of care teaching is often didactic and conceptual instead of practical and operational. Clinical environments, slow to transform, limit student exposure to key experiences that characterize transformed care. We describe the design and implementation of TEAM Clinic (Teach students, Empower patients, Act collaboratively, Meet health goals) - an early clinical learning experience to address this gap.
The TEAM Clinic curriculum was based on a review of existing curricula and best practice recommendations for the transformation of care. Three key elements were selected as the focus for a low-volume, high-service clinic: patient centeredness, interprofessional collaboration and team-based care. Learners and medically and socially complex patients were recruited for voluntary participation and completed anonymous surveys about the experience during and afterward.
Nine first-year medical students, two first-year social work students and one pharmacy resident were integrated into the interprofessional team. Students were assigned roles adapted to their level and skill set; deliberate interprofessional pairing was assigned to broaden perspectives on scope and role of team members. Upon completion of this two-semester experience, 11 of the 12 learners returned surveys; all rated the experience as positive (strongly agree or agree) on the Authentic Clinical Interprofessional Experience - Evaluation of Interprofessional Site tool. Patient surveys indicated satisfaction with multiple aspects of the visit.
TEAM Clinic provided a practical example of transformation of care teaching in a not-yet-transformed environment. Logistical barriers included space, schedule and staffing. Facilitators included alignment with the goals of core curricula and faculty. Limitations included that this description of these curricula and this pilot come early in our longitudinal development of TEAM Clinic, constraining our ability to measure behavioral changes around interprofessional education, teamwork or patient centeredness. Next steps would examine the trajectory to these outcomes in the preclinical student group.
护理教学的转变往往是说教式和概念性的，而非实践性和操作性的。临床环境转变缓慢，限制了学生接触到体现护理转变的关键经验。我们描述了TEAM诊所（教导学生、赋能患者、协作行动、实现健康目标）的设计与实施——这是一种早期临床学习体验，旨在弥补这一差距。
TEAM诊所课程基于对现有课程以及护理转变的最佳实践建议的审查。选择了三个关键要素作为低量高服务诊所的重点：以患者为中心、跨专业协作和团队式护理。招募了学习者以及医疗和社会情况复杂的患者自愿参与，并在体验期间及之后完成了关于该体验的匿名调查。
九名一年级医学生、两名一年级社会工作学生和一名药学住院医师融入了跨专业团队。根据学生的水平和技能组合分配角色；安排刻意的跨专业配对以拓宽对团队成员职责范围和角色的认识。在完成这两个学期的体验后，12名学习者中有11人返回了调查问卷；在“真实临床跨专业体验——跨专业场所评估”工具上，所有人都将该体验评为积极（强烈同意或同意）。患者调查表明对就诊的多个方面感到满意。
TEAM诊所提供了在尚未转变的环境中护理教学转变的实际范例。后勤障碍包括空间、日程安排和人员配备。促进因素包括与核心课程目标和教师的契合度。局限性包括，这些课程的描述以及这个试点是在我们TEAM诊所的纵向发展早期进行的，限制了我们衡量围绕跨专业教育、团队合作或以患者为中心的行为变化的能力。下一步将研究临床前学生群体中这些结果的发展轨迹。
