A novel, team based, four-year longitudinal primary care clerkship focused preparing medical students to best understand healthcare disparities in the communities where they serve.
In the following video, Daniel Evans, MD, General Internal Medicine and Geriatrics, and director of the Education-Centered Medical Home at Feinberg School of Medicine, speaks about the value of the program and what it teaches medical students about social determinants of health.
Primary care practitioners feel strongly that all patients should have an ongoing relationship with a personal physician and practice-based team trained to provide first contact, continuous and comprehensive care. If continuity is the foundation of primary care, then one would presume that medical students considering a career in primary care would have the opportunity to experience first-hand what it feels like to be a continuity provider early on in training (under the supervision of a trusted primary care role model). If a student never has the chance to build patient rapport and follow patients over time - then how can they possibly make a well informed decision about the pros and cons of a primary care career?
To address this issue, Northwestern Feinberg School of Medicine has created the Education-Centered Medical Home (ECMH) program. The ECMH is a team-based, longitudinal primary care clerkship founded on the principle of continuity and focused on teaching the educational principles of the Patient-Centered Medical Home (PCMH). The ECMH embeds medical student teams into primary care clinics to care for an authentic panel of complex patients over time. The four-year structure with stable relationships among patients, preceptors, and peers allows trainees to see the natural history of chronic illness and, therefore, appreciate the profound impacts of social determinants of health on patient outcomes over time. Gone are the "one-visit-and-done," superficial encounters which tend to be the norm in traditional family medicine or primary care clerkships. Instead, students meet patients struggling with diabetes or asthma during their first year and are tasked to fulfill the role of health coach and patients advocate for the next four years. The ECMH also fosters a culture of accountability and improvement by having clinics track their outcomes, and to design and implement annual quality improvement projects. Prior work shows that our ECMH model is feasible, highly rated by students, mitigates the negative effects of the hidden curriculum, improves perceptions of their primary care training experience and increases students' measures of patient-centeredness compared to students in the traditional curriculum. Intriguingly, preliminary data show that patients in one ECMH clinic were more engaged and had better chronic disease management metrics after working with student coaches compared to historic controls. The specific aims of this project are to:
- Evaluate the impact of the ECMH longitudinal primary care model on student attitudes, medical knowledge and clinical skills.
- Evaluate the impact of the ECMH longitudinal primary care model on student attitudes towards primary care, and ultimate career choice.
- Formalize the ECMH curriculum, disseminate course materials to other interested academic institutions, ultimately we aim to make the ECMH model a "national best-practice care education," which other institutions can implement or adopt.
Lauren Gard, MPH