Nurturing 21st century physician knowledge, skills and attitudes with medical home innovations: the wright center for graduate medical education teaching health center curriculum experience

Abstract

Purpose: Effect of patient centered medical home (PCMH) curriculum interventions on residents’ self-reported and demonstrated knowledge, skills and attitudes (KSA) in PCMH competency arenas is lacking in the literature. This study aimed to assess impact of PCMH curricular innovations on Internal Medicine residents’ self-reported KSA. Method: Twenty four (24) Internal Medicine residents - 12 Traditional (TR) track and 12 Teaching Health Center (THC) track - began training in academic year (AY) 2011 at the Wright Center for Graduate Medical Education (WCGME). They were followed through AY2013 covering three years of training. PCMH curricular innovations were applied beginning July 2011 until May 2012 focally to THC residents. These curricular innovations were spread program wide in May 2012. Semi-annual validated PCMH Clinician Assessments assessing PCMH competencies based on self-reported KSA were started in AY2011 and completed by all residents. Results: Mean self-reported KSA scores of TR residents were similar to THC residents at baseline for all PCMH competencies. In May 2012, mean scores of THC residents were significantly higher than 2011 and graduating 2009 TR residents for most PCMH competencies. After program wide implementation of PCMH innovations, mean scores of 2011 and 2010 TR residents for all PCMH competencies improved and most equalized to those of 2011 THC residents. Globally improved PCMH competency scores of 2011 THC and TR residents were maintained through May 2014, with majority of improvements above baseline reaching statistical significance. Conclusions: PCMH curricular innovations inspired by HRSA’s Teaching Health Center funded residency program expansion quickly and consistently improved Internal Medicine residents’ self-reported KSA of PCMH competencies and improvements were sustained.

Training Residents to Work in a Patient-Centered Medical Home: What Are the Outcomes?

“…Other studies have also shown improvement in knowledge, attitudes, and self-described skills as a result of PCMH training, 13 as well as increased resident response rates to a reminder tool for population management. Initiation of a PCMH curriculum also increased resident satisfaction with care for patients with chronic pain, 15 identified the need for faculty development, 16 and resulted in the development of tools to assess teamwork, 17 efficiency, and quality of care.…”

“…11 While concepts of the PCMH have been disseminated for several years, few studies have measured the impact of resident training in the PCMH. [12][13][14][15][16][17][18] Previous PCMH curricular evaluations have shown improvements in knowledge, attitudes, and selfdescribed behaviors. Most studies have not assessed the impact of PCMH training on observed resident behaviors and patient outcomes.…”