Residency Training in Primary Care

Summary: The purpose ofthis project is to develop and implement an innovative practice based learning and improvement (PBLI) curriculum that aims to develop clinical leaders in the primary care workforce who are able to demonstrate competence in Patient Centered Medical Home (PCMH) elements and applications and quality and safety improvement principles and strategies. This curriculum will teach resident physicians the broad skill set required for quality primary care practice including care for vulnerable populations, working in underserved communities, population health, and team based care. Need: The PCMH is the leading framework for achieving healthcare transformation in the 21 st century. Family medicine residency programs must train their graduates to incorporate principles ofthe PCMH into their practices to better prepare them to meet the needs ofthe changing healthcare system; however, best practices to accomplish this continue to be investigated. Currently, most residencies teaching PCMH focus on teaching the model elements and place less emphasis on the aspect of quality improvement applied in a real clinical setting. We propose an alternate strategy to teach PCMH principles by de-emphasizing the model and instead teaching the elements through a practice based learning and improvement curriculum focused on quality and safety improvement, which are hallmarks ofthe PCMH. Methodology: Our Quality Health Care Curriculum will provide the content necessary for the residents to understand and lead clinical change and move toward a PCMH. Strategies will include formal quality and safety improvement training, longitudinal competency based didactics, web-based training modules, and a resident learning collaborative. The primary teaching method will be experiential learning through resident led multidisciplinary quality and safety improvement initiatives in the clinical setting or "living learning lab". Objectives: 1) Develop, implement, and evaluate an innovative Quality Health Care Curriculum grounded in the PCMH that specifically teaches the knowledge, skills, and attitudes necessary for residents to: a) participate effectively in and lead collaborative health care teams and b) facilitate quality and safety improvements in care and 2) Train primary care resident physicians to plan, lead, and implement practice improvement processes through collaborative quality improvement teams that lead to safe, effective, timely, efficient, equitable, and quality patient-centered care for underserved and vulnerable populations. Evaluation: A rigorous mixed-method evaluation strategy will be used, including formative and surnmative evaluations using qualitative and quantitative methods. Quality and safety improvement initiatives will be evaluated based on nationally recognized quality outcome measures. Program completers will be surveyed in years one and five post graduation to identify the nature of their practice and the population they serve and to evaluate the impact ofthe curriculum.