Center of Excellence in Primary Care Education

Organization Type: 
Educational Institution
Program Type: 
Curriculum/Track
Education Level: 
Graduate
Postgraduate (e.g., residency, fellowship)
Educational Elements: 
Lecture/Didactic
Independent Study
Self Reflection Activities
Experiential not including services to patients
Experiential including clinical contact with patients
Other
Other Element(s): 
Newly designed rotations (including themes in leadership, homeless care, and deployment health)
Program Description: 

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.

Evaluated: 
Yes
Targeted Professions
Physicians: 
Internal Medicine
Nursing: 
Nurse Practitioners
Registered Nurses
Pharmacy: 
Ambulatory Care
Social Work: 
Psychiatric social work
Medical social work
Psychology: 
Clinical
Additional: 
Medical Assistants
Other: 
Psychiatry, Physical Therapy, Palliative Care, Chaplains, Optometry and Opthalmology
Self-Reported Competencies
PCPCC’s Education and Training Task Force identified 16 interprofessional training competencies critical for preparing health professionals for practicing in team-based, coordinated care models such as patient-centered medical homes. Listed below are the self-reported competencies that this program has achieved, which have been organized by the five core features of a medical home as defined by the Agency for Healthcare Research and Quality
Patient-Centered Care Competencies: 
Advocacy for patient-centered integrated care
Cultural sensitivity and competence in culturally appropriate practice
Development of effective, caring relationships with patients
Patient-centered care planning, including collaborative decision-making and patient self-management
Comprehensive Care Competencies: 
Population-based approaches to health care delivery
Risk identification
Coordinated Care Competencies: 
Care coordination for comprehensive care of patient & family in the community
Health information technology, including e-communications with patients & other providers
Interprofessionalism & interdisciplinary team collaboration
Team leadership
Quality Care & Safety Competencies: 
Assessment of patient outcomes
Evidence-based practice
Quality improvement methods, including assessment of patient-experience for use in practice-based improvement efforts
Accessible Care Competencies: 
Promotion of appropriate access to care (e.g., group appointments, open scheduling)
Last updated November 15, 2013

* Please note: Information contained in this database is self-reported by representatives from each program. It does not represent an exhaustive list of education and training programs and inclusion does not constitute an endorsement from the PCPCC.

 

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