1. 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

2. 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.

3. 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

4. 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

5. 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

6. 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)

7. 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]

8. 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.

9. 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.”

10. 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