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Education-Centered Medical Home Curricular Goals

This list of Education-Centered Medical Home (ECMH) curricular goals is modified from the American College of Physicians.

Primary Care Physician

Definition: Each patient has an ongoing relationship with a primary care physician trained to provide first contact, continuous and comprehensive care.

Medical students are expected to:

  • Observe and participate in continuity in relationships with patient(s) and their families in a longitudinal fashion within practices that deliver first-contact, comprehensive, integrated, coordinated, high-quality and affordable care. (PBMR 1, PASC 1)
  • Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families and fellow professionals. (ECIS 1, ECIS 3, PBMR 3)
  • Explain the role of the primary care physician as advocate and develop and use strategies for advocating tor individual patients and groups.

Team-Based Medical Practice

Definition: The primary care physician works with a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.

Medical students are expected to:

  • Work effectively with others as a member or leader of a healthcare team or other professional group via interdisciplinary team experiences (examples may include those involving nurses, APP’s, social workers, case managers, mental health professionals, community partners, pharmacists, etc) (SATBC 2)
  • Articulate the roles, functions and working relationships of all team members (SATBC 2)
  • Participate in teams within practices as they develop a culture of learning to improve the care process and patient experience. (SATBC 2, MKS 2a)

Whole Person Orientation

Definition: The primary care physician is responsible for providing for all the patient’s healthcare needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes for all stages of life: acute care; chronic care; preventive services; and end-of-life care.

Medical students are expected to

  • Demonstrate knowledge and an appreciation of medical care in all stages of life. (MKS 1a)
  • Practice motivational interviewing and utilization of other tools to promote patient engagement, self- efficac, shared decision making and health behavior change. (CES 1)
  • Demonstrate sensitivity and responsiveness to patients’ culture, age, gender and disabilities. (CES 1, PBMR 3, PBMR 4)
  • Recognize the importance of health literacy and its impact on patient care and outcomes;(CES 2, ECIS 1, ECIS 2) 

Enhanced Access to Care

Definition: Access to care is available through systems such as team care and new options for communications between patients, their personal physician and practice staff.

Medical students are expected to:

  • Experience a variety of different encounter types such as face-to-face, telephone and electronic messaging, and home-based care. (PBMR 7)
  • Use information technology to support patient care decisions and patient education. (CLQI 3a, 3b)

Care Coordination & Systems-Based Care

Definition: Care is coordinated across all elements of the complex health system and the patient’s community. Care is facilitated by information technology and other means to assure that patients get the indicated care when and where they need it, in a culturally and linguistically appropriate manner.  (e.g. subspecialty care, hospitals, home health agencies, nursing homes). 

Medical students are expected to:

  • Discuss how the economics of healthcare systems across a community, including all settings of care, affect patient care and outcomes. (SATBC 1)
  • Demonstrate knowledge of community resources and the importance of working with non-physician partners (CES 1, 2)
  • Collaborate with specialists from various disciplines to provide patient-focused co-management of care over time. (SATBC 2)
  • Describe and discuss strategies needed to address patient transition(s) of care. (SATBC 3)

Teaching & Learning

Definition: Physicians can enhance the care of patients by teaching to and learning from faculty, peers, patients and themselves. This occurs through sharing information clearly, and counseling and educating patients and their families about health conditions and disease prevention. Teaching can be enhanced through communication skills (e.g., closed loop communication, avoiding medical jargon, teach back) and the use of teaching frameworks (e.g., teaching scripts).

Medical students are expected to:

  • Demonstrate clear patient communication, counseling and education to patients and families about health conditions and disease prevention. (ECIS-3, PCMC-6)
  • Develop and demonstrate the use of teaching scripts in to enhance patient counseling. (ECIS)3, PCMC-6)
  • Demonstrate teaching skills to facilitate patient-centered learning with faculty and peers. (MSK-4b)

Quality & Safety

Definition: Advocate for attainment of optimal, patient centered outcomes. Evidence based medicine and clinical decision support tools guide decision making.  Physicians accept accountability for quality improvement (QI) through voluntary engagement in performance measurement and improvement.

Medical students are expected to:

  • Demonstrate and practice evidence-based medicine as the standard of care. (CLQI 3a, MKS 2a)
  • Identify basic principles of population health, including how patient registries can be used to manage population health (MKS 1f)
  • Engage in opportunities to review quality data and recommend evidence-based systems changes that respond to performance measurement. (CLQI 4)

Payment & Medical Economics

Definition: Payment appropriately recognizes and values work that is done outside of face-to-face visit. It pays for care coordination, ancillary providers and community resources. Supports QI processes, e-communication, acknowledges case mix differerenes and incentivizes payments for systems improvements.

Medical students are expected to:

  • Know various physician payment methodologies (including those encompassing of past, current and future policies). (SATBC 1)
  • Assist patients in dealing with system complexities via advocacy and negotiation (SATBC 1, CES 3)