Education Reform

Primary care training is undoubtedly one if the biggest hurdles we face along the path to a new, transformed primary care. A tremendous gap currently exists between the new skill sets required to provide team-based, coordinated, patient-centered and comprehensive primary care, and the skills being taught in our medical education institutions. Bridging this gap will require creative and proactive efforts at both the local and national level, and a lot of collective learning.

Why is education reform needed?

As patient’s health care needs have grown more complex, so has the role of the primary care provider.  Today, primary care providers must serve as members of healthcare teams in order to provide for their patients’ health care needs.  They must deliver care in nontraditional ways, maintain a whole-person and whole-population perspective, and attend to quality and safety while also considering overall costs of care. Presently, the health care education system does not focus on the skills needed to meet the demands of the primary care provider’s role. Trainees are often not educated in the basics of clinical innovation or process improvement despite the pivotal role these play in our health care delivery systems. Fixing this problem is not only important for educating trainees about new models of care delivery like the Patient Centered Medical Home – it’s also vital for attracting the best and brightest trainees to primary care careers.

Click here for more background on how people are currently trained in primary care and why reform is needed.

How can someone improve the way primary care providers are trained?

There are numerous factors that constrain efforts to reform provider training, such as antiquated models of graduate medical education financing and the predominance of inpatient ward-time over outpatient clinic work that’s so common in our training programs.  Getting past these constraints will require tapping into the creativity and resources of the local community, whether by recruiting more community primary care clinicians to serve as adjunct faculty, creating new primary care electives, informing faculty about the impact their messaging has on trainees, or starting extracurricular clinical innovation opportunities.  Building political will for change at a local institution or identifying sources for potential financial support are big goals, but we believe that the primary care community, particularly trainees, can be fantastic advocates for them.  At Primary Care Progress, we help spread these reforms by spotlighting exciting new models of provider training and those pushing these efforts forward.

What are some examples of advancing local education reform?

First, remember that academic medicine changes incredibly slowly and that there are a lot of different competing interests that want a larger piece of the curriculum. That being said there are a number of concrete steps you can take:
  1. Create an extracurricular program that supplements the traditional curriculum, and then try to establish elective credit for students and CME credit for faculty for whatever class or program you’ve created.
  2. Incorporate your issue or focus into a pre-existing, funded program that already provides credits to students. For instance, if your program has a scholarly project, provide opportunities and encouragement for students to do their projects on primary care clinical innovation.
  3. Improve upon existing courses via updated material or new faculty: Encourage fellow primary care faculty to teach in the patient-doctor course or the physiology courses, or encourage a group of students to go through the tutorial cases to edit out any misinformation about the value of primary care providers.
  4. Partner with other schools or institutions on your campus (such as Business, Policy, or Public Health) to provide an interdisciplinary experience for students.
  5. Partner with other health professional schools in your area to create an integrated and interdisciplinary approach to training where medical students, PA students, pharmacy students and nursing students can learn about team-based care together.

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