Teaching Health Center: Team-Based Care Curriculum

This database is no longer actively maintained and is here for archival purposes only

Organization Type: 
Not For Profit
Program Type: 
Education Level: 
Postgraduate (e.g., residency, fellowship)
Continuing Education
Technical certificate programs or certificate training programs
Educational Elements: 
Experiential including clinical contact with patients
Other Element(s): 
Complexity team-based care; accountability; professionalism and self-awareness; crucial conversations; team empanelment review and collaborative communication on patient panels and care plans.
Program Description: 

Northwestern University’s School of Medicine offers a Family Medicine Residency Program based on a team-based care curriculum that specifically addresses educational gaps in team-based care and team management strategies.  There is a growing need to promote interdisciplinary collaboration and team management training for the next generation of primary care leaders and administrators. As one of the inaugural 11 Federal Teaching Health Centers, this training program has a unique focus in training primary care physicians to develop leadership roles in a community-based primary care venue. One of its primary goals is to train the next generation of primary care providers – including physicians, nurses, medical assistants, and behavioral health providers, in team communication and team-based care.

Specifically, this program has incorporated a team-based educational curriculum and re-designed its clinical practice model into a multidisciplinary team of providers (attending physicians, residents, mid-level providers, nurses, medical assistants, pharmacists, case-managers, health care educators, behavioral health, and other ancillary personnel). Leadership roles have been organized within the team, including training all residents in chief administrative roles, communication skills among the team, and help members work at their optimal levels of training.

This program offers a developmental curriculum designed to enhance team-based care by addressing knowledge, skills, and professional attitudes in the following areas:

  1. Defining and describing team-based care models such as patient-centered medical homes (PCMH) and Accountable Care Organizations (ACO)
  2. Assessing and understanding  individual and team members’ styles, roles and responsibilities
  3. Developing communication pathways (e.g., huddles, meetings, learning lunches)
  4. Implementing Plan-Do-Study-Act (PDSA) cycles, shared care plans, and complexity care for quality improvement processes (i.e., cycle time and health outcomes)
  5. Developing conflict resolution, problem solving and accountability team processes and strategies

Participants include resident physicians (lead), attending physicians, nurses, medical assistants, pharmacists, case-managers, health care educators, behavioral health and other ancillary personnel.

Upon utilizing these resources, participants will be able to:

  1. Create a primary care interdisciplinary team-based curriculum that is integrated into a primary care residency program
  2. Apply a team-based model approach within a community-based primary care health center and residency training program
  3. Identify opportunities and challenges with the curriculum through a systematic process-oriented evaluation
  4. Gain practical knowledge and skills in interdisciplinary collaborative teaching and patient care

The curriculum can be adapted to a diverse group of healthcare settings and is not limited to primary care family medicine clinical practices.  While designed for primary care team members and issues, this program’s foundational structure can be adapted to other healthcare teams in outpatient (e.g., internal medicine, pediatrics, obstetrics and gynecology) and inpatient settings.

Program Results: 

Effective teamwork requires monitoring and evaluation of how the group is communicating, managing responsibilities, and handling differences.  Systematic evaluation and monitoring of the team’s interaction is an added feature in this training curriculum.  Tri-annually, teams use evaluation tools of their team work, which is shared with the team and used as a springboard for sustaining effective relationships.  Changes in patient health outcomes are also used as an indicator of effective team work.  No results reported.  

Targeted Professions
Family Medicine
Registered Nurses
Licensed Practical Nurses
Medical Assistants
Patient Educators
Licensed Clinical Social Workers, Law Students
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: 
Patient-centered care planning, including collaborative decision-making and patient self-management
Comprehensive Care Competencies: 
Risk identification
Coordinated Care Competencies: 
Care coordination for comprehensive care of patient & family in the community
Interprofessionalism & interdisciplinary team collaboration
Team leadership
Quality Care & Safety Competencies: 
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.


Go to top