Department of Family and Community Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way ML0582, Medical Sciences Building 4453C, Cincinnati, OH, 45267, USA.
Department of Physician Assistant Studies, Mount St. Joseph University, Cincinnati, OH, USA.
BMC Med Educ. 2024 May 21;24(1):556. doi: 10.1186/s12909-024-05559-z.
Primary care in the US faces challenges with clinician recruitment, retention, and burnout, with further workforce shortages predicted in the next decade. Team-based care can be protective against clinician burnout, and opportunities for interprofessional education (IPE) on professional development and leadership could encourage primary care transformation. Despite an increasingly important role in the primary care workforce, IPE initiatives training physician assistants (PAs) alongside physicians are rare. We describe the design, curriculum, and outcomes from an interprofessional primary care transformation fellowship for community-based primary care physicians and PAs.
The Community Primary Care Champions (CPCC) Fellowship was a one-year, part-time fellowship which trained nine PAs, fourteen physicians, and a behavioralist with at least two years of post-graduate clinical experience in six content pillars: quality improvement (QI), wellness and burnout, mental health, social determinants of health, medical education, and substance use disorders. The fellowship included a recurring schedule of monthly activities in self-study, lectures, mentoring, and community expert evening discussions. Evaluation of the fellowship included pre, post, and one-year follow-up self-assessments of knowledge, attitudes, and confidence in the six content areas, pre- and post- wellness surveys, lecture and discussion evaluations, and midpoint and exit focus groups.
Fellows showed significant improvement in 24 of 28 self-assessment items across all content areas post-fellowship, and in 16 of 18 items one-year post-fellowship. They demonstrated reductions in emotional exhaustion and depersonalization post-fellowship and increased confidence in working in interprofessional teams post-fellowship which persisted on one-year follow-up assessments. All fellows completed QI projects and four presented their work at national conferences. Focus group data showed that fellows experienced collaborative, meaningful professional development that was relevant to their clinical work. They appreciated the flexible format and inclusion of interprofessional community experts in evening discussions.
The CPCC fellowship fostered an interprofessional community of practice that provided an effective IPE experience for physicians and PAs. The learning activities, and particularly the community expert discussions, allowed for a flexible, relevant experience, resulting in personal and professional growth along with increased confidence working within interprofessional teams.
美国的初级保健面临着临床医生招聘、保留和倦怠的挑战，预计未来十年劳动力短缺将进一步加剧。团队式护理可以预防临床医生倦怠，而提供专业发展和领导力方面的跨专业教育（IPE）机会可以鼓励初级保健转型。尽管在初级保健劳动力中扮演着越来越重要的角色，但培训医师助理（PA）和医生一起进行 IPE 的举措却很少。我们描述了一项针对社区初级保健医生和 PA 的跨专业初级保健转型研究员的设计、课程和结果。
社区初级保健冠军（CPCC）研究员是一项为期一年的兼职研究员，培训了 9 名 PA、14 名医生和 1 名行为学家，他们在六个内容支柱方面至少有两年的研究生临床经验：质量改进（QI）、健康和倦怠、心理健康、健康的社会决定因素、医学教育和物质使用障碍。该研究员包括自我学习、讲座、指导和社区专家晚间讨论的月度活动计划。对研究员的评估包括在六个内容领域中进行知识、态度和信心的预、后和一年随访自我评估、预和后健康调查、讲座和讨论评估以及中点和退出焦点小组。
研究员在所有内容领域的 28 项自我评估项目中，有 24 项在研究员后显著改善，在 18 项中的 16 项在研究员后一年显著改善。他们在研究员后减少了情绪衰竭和去人性化，在研究员后增加了在跨专业团队中工作的信心，这一信心在一年后的随访评估中仍然存在。所有研究员都完成了 QI 项目，其中 4 人在全国会议上介绍了他们的工作。焦点小组数据显示，研究员们经历了协作、有意义的专业发展，这与他们的临床工作相关。他们赞赏灵活的格式和包括社区跨专业专家的晚间讨论。
CPCC 研究员培养了一个跨专业的实践社区，为医生和 PA 提供了有效的 IPE 体验。学习活动，特别是社区专家讨论，提供了一个灵活、相关的体验，使个人和专业得到成长，同时在跨专业团队中工作的信心也得到了提高。
