Coletti Daniel J, Yalakkishettar Pratiksha, Alexandri Maya, Block Lauren, Martinez Johanna, Fornari Alice, Conigliaro Joseph
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
Department of Medicine, Northwell Health Division of General Internal Medicine, Great Neck, New York.
J Eval Clin Pract. 2020 Aug;26(4):1162-1170. doi: 10.1111/jep.13283. Epub 2019 Oct 16.
RATIONALE, AIMS, AND OBJECTIVES: Providing high-quality primary care in patient-centred medical homes (PCMHa) requires competencies that can only be provided by interprofessional (IP) education. The benefits of collaborative training have been documented for learners, but less is known about the perceptions of the clinical professionals who train the learners or the patients receiving IP primary care. This investigation compared stakeholder attitudes about IP education, training, and providing collaborative care prior to developing a new IP training programme.
We conducted five focus groups at a large general internal medicine training practice. Learner and faculty groups included participants from medicine, psychology, pharmacy, and physician assistant professions; three patient groups were held to obtain perspectives on receiving health care from IP trainees. We used inductive analysis to identify themes across the three stakeholder groups.
We identified seven convergent themes across all three stakeholder groups: (a) team engagement, (b) technology in care delivery, (c) cost of care, (d) involving patients in learning, (e) time constraints, (f) scope of practice, and (g) autonomy/interdependence. Each group emphasized the need to define and communicate team members' roles. Learners anticipated high-quality IP interactions, and patients noted the benefits of receiving care from well-supervised trainees. Faculty struggled to navigate the training needs of diverse learner groups and to integrate PCMH mandates focused on documentation with authentic patient-centred care.
This is the first reported data comparing perceptions about IP training and care across these three stakeholder groups. Results suggest the need to clarify scope of practice, define professional roles, and bridge gaps between teaching PCMH principles and subsequently providing high-quality health care. Results inform faculty development needs in learning ways to train learners across professions and outline ways to structure interactions with patients.
原理、目的和目标：在以患者为中心的医疗之家（PCMHa）提供高质量的初级护理需要跨专业（IP）教育才能具备的能力。协作培训对学习者的益处已有文献记载，但对于培训学习者的临床专业人员或接受IP初级护理的患者的看法了解较少。在制定新的IP培训计划之前，本调查比较了利益相关者对IP教育、培训和提供协作护理的态度。
我们在一个大型普通内科培训机构开展了五个焦点小组。学习者和教员小组包括来自医学、心理学、药学和医师助理专业的参与者；举行了三个患者小组以获取对接受IP实习生提供医疗服务的看法。我们采用归纳分析来确定三个利益相关者群体中的主题。
我们在所有三个利益相关者群体中确定了七个趋同主题：（a）团队参与，（b）护理交付中的技术，（c）护理成本，（d）让患者参与学习，（e）时间限制，（f）执业范围，以及（g）自主性/相互依存性。每个群体都强调了定义和沟通团队成员角色的必要性。学习者期望高质量的IP互动，患者指出接受受过良好监督的实习生护理的益处。教员在应对不同学习者群体的培训需求以及将专注于文档记录的PCMH要求与真正以患者为中心的护理相结合方面面临困难。
这是首次报告的比较这三个利益相关者群体对IP培训和护理看法的数据。结果表明需要明确执业范围、定义专业角色，并弥合教授PCMH原则与随后提供高质量医疗保健之间的差距。结果为教员在学习跨专业培训学习者的方法方面的发展需求提供了信息，并概述了构建与患者互动的方式。
