Teaching Chronic Illness Care to Clerkship Students within the Patient-Centered Medical Home Beat Steiner, MD, MPH Lisa Slatt, MEd University of North Carolina at Chapel Hill

Background for PCMH Exercise Takes place in the 6 week UNC Family Medicine Clerkship, an outpatient experience with weekly “Day Backs” Counts 15% of final grade Started this academic year (77 students have completed exercise so far) Objective: integrate teaching about PCMH with teaching about common chronic illnesses.

Components of the Patient Centered Medical Home Systems Based Approach to Quality and Safety Patient Centered Care Ensuring Access to Care Providing Comprehensive Care Coordinating Care

Components of the Patient Centered Medical Home Systems Based Approach to Quality and Safety Patient Centered Care Ensuring Access to Care Providing Comprehensive Care Coordinating Care

Specific Objectives of PCMH Exercise Systems Based Approach to Quality and Safety Be able to apply the guidelines for common chronic illnesses Understand and suggest improvements in systems of care in the practice (related to chronic illnesses) Patient Centered Care Refine interview skills with patients with chronic illnesses Exercise does not integrate other aspects of the PCMH such as Ensuring Access to Care, Providing Comprehensive Care & Coordinated Care but introduced in Orientation

Components of the PCMH Exercise -focusing on assigned chronic illness Use evidence based resources to concisely present guidelines (10 min) Use PCMH interview guide to explore systems of care in practice and present current status and areas of improvement (10 minutes) Tape interview of patient with Flip recorder and present key sequences (15 minutes)

Evaluation of Student Below Meets Exceeds Does not meet Below Meets Exceeds 50 70 75 80 85 90 95 100 How well did the student demonstrate awareness of current management guidelines for this chronic condition? How well did student demonstrate an understanding of systems issues in the practice that influence care? [PCMH] How well did student demonstrate application of guidelines to unique situation of patient? [Flip recording]

Student Feedback [n=55] 72% response rate Survey Items % Agree % Disagree Preparing presentation was time well spent. 89 11 Listening to others present guidelines was time well spent. 98 2 Reviewing my own Flip recording helped me improve my interview skills. 87 13 Watching others presents their Flip recording helped me improve my interview skills. 58 42 I knew about PCMH prior to the FM Clerkship. 36 64 Knowing about systems of care related to PCME will be useful to my future career.

Student Comments “PCMH portion and the Flip recording were the most interesting and valuable parts of the assignment.” “Preparing the guidelines was a great way to learn about my chronic illness and have the knowledge stick.” “Videotaping myself ….was very stressful.” “This assignment was a great change of pace from lectures and personal reading.” “I could pick up things I wanted to change about my interviewing style.”

Faculty Feedback Strengths of exercise Students sharpen their thinking by focusing on what is clinically relevant and how to teach their peers Learn search strategies Introduction to PCMH; providing a framework for discussion with preceptor