Center of Excellence in Primary Care Education

The VA Center of Excellence at the Seattle Division of VA Puget Sound Health Care System hosts residents and doctoral students in a partnership with the University of Washington’s School of Medicine and School of Nursing.  During this shared three-year interprofessional education program,  internal medicine residents in the primary care track and nursing students in the Doctorate of Nursing Practice (DNP) program provide team-based care for patients  in the Seattle VA Primary Care Clinic and the Women's Clinic. The program includes educational workshops on communication and team building using nationally recognized curricula as well as seminars on the learning process of primary care.  Study measures include numerous patient care outcomes and trainee outcomes.  The program’s overarching goals are to instruct trainees in primary care during training and to help prepare trainees to enter primary care careers. 

This program features the following key innovations in education:

1. Shared Decision Making: Trainees will demonstrate effective listening skills, utilize motivational interviewing techniques to facilitate patient interactions, promote health behaviors and self-management, and utilize patient’s preferences in determining health intervention. Evaluation:  Standardized patients will be utilized for teaching and evaluation; patient satisfaction survey (Consumer Assessment of Healthcare Providers and Systems - CAHPS); skills will also be assessed by preceptors observing clinic patient interviews.
2. Sustained Relationships:  Residents and DNPs are paired on the same teams with doctors and nurse practitioner faculty preceptors for one to three years, with each trainee having an individual patient panel. They cross-cover each other’s patients for urgent care when primary care is unavailable, with a focus on safe hand-offs.  An important aspect of shared patient care involves cultural transformation from separate training experiences and traditional individual panel responsibility with physician leadership to recognition and respect for complimentary skills of DNP and physician providers. Evaluation:  Continuity tool (Starfield, Magelniecki, et al); measures to assess access of care, frequency of visits with primary care providers and care team providers; patient survey of perceptions of continuity and coordination of care (CAHPS, Office of Quality Performance - OQP, Survey of Healthcare Experiences of Patients - SHEP).
3. Interprofessional Collaboration: Trainees will demonstrate effective team communication skills, understand and value the contributions of each team member, and demonstrate effective collaboration.  Evaluation:  The University of Washington School of Nursing Macy Project will use assessment tools to measure effectiveness of interpersonal training and huddle participation. 
4. Performance Improvement:  Trainees will learn panel management and data analysis via a series of didactics with faculty guidance to track clinical performance measures, develop interventions, and study results. Evaluation: Accreditation Council for Graduate Medical Education (ACGME) residency competencies; newly designed DNP competency tool; comparison data between trainee cohorts and trainees vs. non-center residents.

Clinician-educator faculty will participate in team-building curriculum, including “train the trainer” skills to conduct future activities.  All educational seminars and workshops will be evaluated with on-going improvements and modifications incorporated as needed.