Hofstra University Northwell School of Medicine launched a primary care track called IMPACcT (Improving Patient Access, Cost and Care through Training) last June. Today on the blog, we learn all about the program through a Q&A with the IMPACcT program’s leadership: (clockwise from top left) Dr. Lauren Block, Dr. Alice Fornari, Dr. Joseph Conigliaro, and Dr. Nancy LaVine.
What was the state of primary care training at Northwell Health before?
Like many institutions across the country, Northwell Health had few trainees entering primary care careers. Over the past five years, about five to 15 percent of graduates from our residency program have entered primary care, less than the national average of 20 percent reported in JAMA. Much as in programs elsewhere, our trainees reported that lifestyle, salary, and negative residency clinic experiences contributed to their decisions to pursue specialty and hospital medicine careers.
What prompted this curriculum at Hofstra Northwell SOM? Who was involved? What role did students play and what input did they provide?
Our new medical school, which opened in 2011, has had strong input from general internists. Our dean, chief medical officer, several associate deans, chair of medicine, and designated institutional officer for graduate medical education are all dedicated general internists. As a result, strong primary care training is a focus of our students’ early clinical experiences. In the first few weeks of medical school, all students become part of the local community through a nine-week Emergency Medical Technician (EMT) training, and upon completion are certified EMTs, skilled in the core skills of history taking and physical exam. This prepares them for their early primary care experiences. These experiences are supported by an integrated curriculum consisting of communication skills, physical diagnosis, clinical reasoning, and professionalism to support core skills in clinical settings. Diverse student-led interest groups focus on primary care careers by introducing role models to the students early in their education. Hofstra Northwell SOM supports a student-run clinic providing hands-on experience and responsibility for the care of a group of underserved patients. Each of these opportunities ensures that role models in primary care will be available to students at a critical point in their education.
Bolstered by the support of general internists throughout our institution, the Division of General Internal Medicine was awarded a five-year Health Services Resource Administration (HRSA) Primary Care Enhancement Award to establish an interprofessional clinic experience we call IMPACcT. This new primary care educational and clinical program includes trainees from our internal medicine residency program, medical school, pharmacy school, psychology training program, and PA school. Adding to the momentum generated from this award, we teamed up with colleagues in family medicine and pediatrics to apply for and take part in the national PACER (Professionals Accelerating Clinical and Educational Redesign) program, which is jointly funded by the Josiah Macy Jr. Foundation, the American Board of Family Medicine, the American Board of Internal Medicine, the American Board of Pediatrics and the Accreditation Council for Graduate Medical Education. The PACER program has brought together the primary care specialties throughout our institution to work on collaborative projects and share best practices.
From this increasingly pro-primary care environment at Northwell Health, our Primary Care Progress chapter has blossomed. Originating from our medical school’s internal medicine interest group, our PCP chapter started in 2014 and sent its first representatives to the PCP Leadership Summit this summer. Students returned to tell the newly initiated IMPACcT clinic program about the conference and share skills and strategies learned from other chapters. PCP’s founder Andrew Morris-Singer presented at our Department of Medicine grand rounds and toured our clinical program in November, which focused attention on our PCP chapter and on the incredible resources available through PCP.
Who is enrolled in IMPACcT? What will they learn?
IMPACcT accepted ten residents, 31 students, two psychology externs, 12 pharmacy students, and eight PA students for its inaugural year. IMPACcT features a team-based approach to care in a clinic-within-a-clinic model as well as longitudinal mentoring and an interprofessional educational curriculum. Students are encouraged to take a hands-on approach to primary care as key members of the patient-centered medical home team and work alongside trainees from other disciplines. Core principles of our clinical program include a focus on continuous quality improvement, continuity of care and expanded access, all using a team-based approach. Key educational topics include health disparities, quality improvement, behavioral health, medication management, team leadership, and PCMH principles.
What do you hope to gain from the new primary care track?
Our goal is to deliver the highest quality care to our patients while providing our students with excellent clinical and educational experiences and longitudinal mentoring to encourage primary care careers across several clinical care disciplines.
How will IMPACcT affect your PCP chapter? How will chapter members be involved in implementation?
Our PCP chapter leaders are key participants in the IMPACcT program, where they find a community of like-minded individuals. We support their work to advocate for primary care nationally as we work with our colleagues to promote primary care at our institution and beyond. By inviting our PCP chapter leaders to speak at IMPACcT events and advertising PCP events to our IMPACcT trainees, we hope to achieve success together. We feel incredibly fortunate to have had Dr. Morris-Singer speak at our institution, generating support for national primary care advocacy while spreading the word on PCP’s mission and events. In the future, we hope to leverage our partnership with PCP to offer workshops in relational leadership to our trainees and faculty.How do the students and trainees like the program so far?
Here's some of the things they've told us:
- “I would totally want to be an IMPACcT patient because you all do the best comprehensive care.”
- “I appreciate the patience and dedication from everyone in furthering my education and clinical skills. I will leave today as a more confident provider solely because of all your efforts.”
- “Everyone has challenged me and has helped me build so much confidence in myself. I will take everything I have learned onto my next rotations.”