TY - JOUR
T1 - Continuity With Patients, Preceptors, and Peers Improves Primary Care Training
T2 - A Randomized Medical Education Trial
AU - Henschen, Bruce L.
AU - Liss, David T.
AU - Golden, Blair P.
AU - Cameron, Kenzie A.
AU - Bierman, Jennifer A.
AU - Ryan, Elizabeth R.
AU - Gard, Lauren A.
AU - Neilson, Eric G.
AU - Wayne, Diane B.
AU - Evans, Daniel B.
N1 - Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Purpose Infusing continuity of care into medical student clerkships may accelerate professional development, preserve patient-centered attitudes, and improve primary care training. However, prospective, randomized studies of longitudinal curricula are lacking. Method All entering Northwestern University Feinberg School of Medicine students in 2015 and 2016 were randomized to the Education Centered Medical Home (ECMH), a 4-year, team-based primary care clerkship; or a mentored individual preceptorship (IP) for 2 years followed by a traditional 4-week primary care clerkship. Students were surveyed 4 times (baseline, M1, M2, and M3 year [through 2018]); surveys included the Maslach Burnout Inventory (MBI); the Communication, Curriculum, and Culture (C3) survey assessing the hidden curriculum; and the Attitudes Toward Health Care Teams (ATHCT) scale. The authors analyzed results using an intent-to-treat approach. Results Three hundred twenty-nine students were randomized; 316 (96%) participated in surveys. Seventy percent of all respondents would recommend the ECMH to incoming first-year students. ECMH students reported a more positive learning environment (overall quality, 4.4 ECMH vs 4.0 IP, P <.001), greater team-centered attitudes (ATHCT scale, 3.2 vs 3.0, P =.007), less exposure to negative aspects of the hidden curriculum (C3 scale, 4.6 vs 4.3, P <.001), and comparable medical knowledge acquisition. ECMH students established more continuity relationships with patients (2.2 vs 0.3, P <.001) and reported significantly higher professional efficacy (MBI-PE, 4.1 vs 3.9, P =.02). Conclusions In this randomized medical education trial, the ECMH provided superior primary care training across multiple outcomes compared with a traditional clerkship-based model, including improved professional efficacy.
AB - Purpose Infusing continuity of care into medical student clerkships may accelerate professional development, preserve patient-centered attitudes, and improve primary care training. However, prospective, randomized studies of longitudinal curricula are lacking. Method All entering Northwestern University Feinberg School of Medicine students in 2015 and 2016 were randomized to the Education Centered Medical Home (ECMH), a 4-year, team-based primary care clerkship; or a mentored individual preceptorship (IP) for 2 years followed by a traditional 4-week primary care clerkship. Students were surveyed 4 times (baseline, M1, M2, and M3 year [through 2018]); surveys included the Maslach Burnout Inventory (MBI); the Communication, Curriculum, and Culture (C3) survey assessing the hidden curriculum; and the Attitudes Toward Health Care Teams (ATHCT) scale. The authors analyzed results using an intent-to-treat approach. Results Three hundred twenty-nine students were randomized; 316 (96%) participated in surveys. Seventy percent of all respondents would recommend the ECMH to incoming first-year students. ECMH students reported a more positive learning environment (overall quality, 4.4 ECMH vs 4.0 IP, P <.001), greater team-centered attitudes (ATHCT scale, 3.2 vs 3.0, P =.007), less exposure to negative aspects of the hidden curriculum (C3 scale, 4.6 vs 4.3, P <.001), and comparable medical knowledge acquisition. ECMH students established more continuity relationships with patients (2.2 vs 0.3, P <.001) and reported significantly higher professional efficacy (MBI-PE, 4.1 vs 3.9, P =.02). Conclusions In this randomized medical education trial, the ECMH provided superior primary care training across multiple outcomes compared with a traditional clerkship-based model, including improved professional efficacy.
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U2 - 10.1097/ACM.0000000000003045
DO - 10.1097/ACM.0000000000003045
M3 - Article
C2 - 31626000
AN - SCOPUS:85083877009
SN - 1040-2446
VL - 95
SP - 425
EP - 434
JO - Academic Medicine
JF - Academic Medicine
IS - 3
ER -