Changing Systems Curriculum

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Organization Type: 
Educational Institution
Program Type: 
Education Level: 
Postgraduate (e.g., residency, fellowship)
Educational Elements: 
Independent Study
Self Reflection Activities
Experiential not including services to patients
Program Description: 

The Changing Systems Curriculum is designed to help family medicine residents develop: 1) Leadership skills; 2) Ability to work as a part of and lead an interprofessional team; 3) Competency in carrying out quality improvement using the FOCUS-PDSA model of change; and 4) Understanding of evolving models of practice with an emphasis on the patient-centered medical home (PCMH).   The curriculum is delivered in both longitudinal and block formats.

Block Format: 

Post-Graduate Year 1 (PGY1):  During the required Outpatient Family Medicine rotation, residents read several articles on personnel management within the family medicine office, spend a half-day with nursing and front desk staff, and are given several assignments related to: defining roles of staff in the office; common issues these staff encounter, and how these issues have affected the care of the resident’s patients. Residents also attend a PCMH Steering Committee meeting and spend several sessions working with nurses in the Coumadin Clinic, where they see how nurses manage and educate patient’s on chronic anticoagulation.  During the required Essentials of Family Medicine I rotation, residents reflect on their leadership styles, and discuss their fears about taking on leadership of an inpatient ward team. Residents then discuss strategies for effective team leadership.

PGY2:  During the required Essentials of Family Medicine II rotation, residents learn about the basic principles of quality improvement using a FOCUS-PDSA model for rapid cycle change. Residents then complete, in teams, several PDSA (Plan, Do, Study, Act) cycles over the course of the month using mock data.  Residents also discuss models of team functioning and dynamics.

PGY3: During the required Essentials of Family Medicine III rotation, residents learn about and discuss different models of family medicine, including the PCMH. Residents also discuss several models of leadership, complete a leadership survey (the Q12) and discuss these results. Residents learn about different designs for effective meetings. They design, lead and participate in a meeting in order to solve a residency program issue. Residents also begin a quality improvement project, based on their clinic teams, using a metric model from the American Academy of Family Physicians.

Longitudinal:  Residents are assigned to a clinic team in the Family Medicine Center as are incoming interns, and work on this team for their entire residency. Each team consists of front-desk staff, a registered nurse, one or more licensed practice nurses, medical assistants, nurse practitioners and faculty and resident physicians. Teams meet weekly, and resident attendance is required. The teams have been trained in the Dartmouth Clinical Microsystems model of team functioning and quality improvement. All residents have the opportunity to take on different roles during team meetings (leader, facilitator, recorder, time-keeper), and participate in our quality improvement process. Residents also participate in regular all practice meetings (every 4 to 6 weeks), where teams come together and discuss their quality work. During PGY3, each resident presents at a Morbidity and Mortality conference. All residents participate in these conferences, so principles of safety and analysis of events are presented to PGY1 and PGY2 residents regularly by their PGY3 colleagues.


Program Results: 

Components of the curriculum have been evaluated, including team leadership and teaching aspects.  The team leadership curriculum has been shown to improve residents’ self-reported comfort with leading a team, as well as improvements in students’ ratings of residents as teachers.  In addition, residents have rated other components of the program highly. 

Targeted Professions
Family Medicine
Internal Medicine
Nurse Practitioners
Ambulatory Care
Social Work: 
Medical social work
Patient Educators
Physician Assistants
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
Comprehensive Care Competencies: 
Risk identification
Coordinated Care Competencies: 
Interprofessionalism & interdisciplinary team collaboration
Team leadership
Quality Care & Safety Competencies: 
Assessment of patient outcomes
Business models for patient-centered integrated care
Quality improvement methods, including assessment of patient-experience for use in practice-based improvement efforts
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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