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Table 3 Medical student education: Strategies addressing PCMH principles pre- and post-transformation

From: Healthcare workforce transformation: implementing patient-centered medical home standards in an academic medical center

Former Curricular Activity Current State in Pre-Clinical Training Current State in Clinical Training
1. Team-Based Care
• Periodic team-based activities were integrated across the medical student curriculum. • Team based learning case studies integrated into each pre-clinical course.
• Team-based standardized patient encounters in all system-based courses, which include group history taking, examination, diagnosis and treatment.
• Clinical students participate in weekly “Family Centered Rounds” with a wide variety of healthcare professionals and their patient’s family to gather information and plan next steps.
• Students are required to complete “translational pillars” in between clerkships in which groups work together to solve clinical problems.
2. Patient-Centered Access
• Foundations in Clinical Practice course provided occasional lectures by patient speakers. • “Meet the Patient” seminars to increase student exposure to the patient perspective.
• Periodic one-on-one standardized patient encounters with a focus on patient care, integrated with feedback from the patient, preceptors, and self-auditing using interactive video capture.
• Students work in both in-patient and out-patient centers that are geographically dispersed in order to facilitate sociodemographic understanding.
• Students rotating through the newborn nursery are tasked with extensive parental education to provide experience in patient instruction.
3. Population Health Management/ Knowing and Managing Your Patients
• Students were introduced to basic concepts within epidemiology and public health in the Foundations in Clinical Practice course. • “Themes in Medical Education” (TIME) course in the first and second year with structured interactive learning activities focused on epidemiology as well as systemic, state, and community support programs. • In collaboration with institutional initiatives, students are afforded experiential opportunities to learn about critical public health issues in their local communities.
4. Care Management and Support
• Education in care management and support was reserved for clinical students during “discharge rounds”. • Standardized patient encounters focused on gauging patient health literacy and delivering patient education during the TIME course. • Students in the Internal Medicine clerkship participate in weekly “multi-disciplinary care management” rounds.
• Students are assessed on their ability to be active participants on patient rounds to encourage care management competency.
5. Care Coordination and Care Transitions
• Students gained skills in care coordination and care transitions through active participation in clinical clerkships. • Students gain exposure to multi-disciplinary care through visits to varied community health sites through the TIME course- during which students meet social workers, dietitians, nurses, and other healthcare team members. • Phase III students are evaluated heavily on their ability to transition from reporter/interpreters of information to managers and educators.
6. Performance Measurement and Quality Improvement
• Students discussed performance measurement and quality improvement in unstructured activities with both clinical and pre-clinical preceptors. • Activities targeting hospital quality improvement during the TIME course.
• Patient-led discussions surrounding care improvement and critique during the TIME course.
• Clinical students participate in structured chart reviews to assess practice performance.
• Students are required to complete a one-time evaluation of medical school tenets about quality improvement measures and a medical error protocol.