Continuity with Patients, Preceptors, and Peers Improves Primary Care Training: A Randomized Medical Education Trial. (15th October 2019)

• Record Type: Journal Article
• Authors: Henschen, Bruce L.; Liss, David T.; Golden, Blair P.; Cameron, Kenzie A.; Bierman, Jennifer A.; Ryan, Elizabeth R.; Gard, Lauren A.; Neilson, Eric G.; Wayne, Diane B.; Evans, Daniel B.
• Is Part Of: Academic medicine. Volume 95:Number 4(2020)
• Publication Date: 2019-10-15
• Subjects: Medical education -- Periodicals; Medical policy -- Periodicals; Medical personnel -- Periodicals; Periodicals; 610.711
• DOI: 10.1097/ACM.0000000000003045
• Languages: English
• ISSNs: 1040-2446

Abstract

Abstract : Purpose: Infusing continuity of care into medical student clerkships may accelerate professional development, preserve patient-centered attitudes, and improve primary care training. However, prospective, randomized studies of longitudinal curricula are lacking. Method: All entering Northwestern University Feinberg School of Medicine students in 2015 and 2016 were randomized to the Education Centered Medical Home (ECMH), a 4-year, team-based primary care clerkship; or a mentored Individual Preceptorship (IP) for two years followed by a traditional 4-week primary care clerkship. Students were surveyed four times (baseline, M1, M2, and M3 year [through 2018]); surveys included the Maslach Burnout Inventory (MBI); the Communication, Curriculum, and Culture (C3) survey assessing the hidden curriculum; and the Attitudes Toward Health Care Teams (ATHCT) scale. The authors analyzed results using an intent-to-treat approach. Results: 329 students were randomized; 316 (96%) participated in surveys. 70.1% of all respondents would recommend the ECMH to incoming first-year students. ECMH students reported a more positive learning environment (overall quality, 4.4 ECMH vs. 4.0 IP, P < .001), greater team-centered attitudes (ATHCT scale, 3.2 vs. 3.0, P = .007), less exposure to negative aspects of the hidden curriculum (C3 scale, 4.6 vs. 4.3, P < .001), and comparable medical knowledge acquisition. ECMH students established more continuity relationships with patients (2.2 vs. 0.3, P < .001) and reported significantly higher professional efficacy (MBI-PE, 4.1 vs. 3.9, P = .02). Conclusions: In this randomized medical education trial, the ECMH provided superior primary care training across multiple outcomes compared to a traditional clerkship-based model, including improved professional efficacy.