Thursday, December 2, 2010

Incorporating PCMH/Patient-Centered Medical Education During Non-Clinical Years

Medical education, although increasing in price, is evolving to meet the demands of the Patient Protection and Affordable Care Act. The model most frequently referenced in the law to effectively carry out this legislation is a concept known as the Patient-Centered Medical Home - a model that is not a new concept. The PCMH was introduced by the American Academy of Pediatrics in 1967 and eventually reinvigorated in the past decade by the AAP, the American Academy of Family Physicians through TransforMED, and the American College of Physician as the Advanced Medical Home model. What does this mean for medical students?

Is this possible? Don't we already have enough to learn about during medical school?

The Pennsylvania State University College of Medicine at Hershey received a $1.46 million grant to incorporate PCMH training during the 3rd year of medical school. Other schools receiving grants to incorporate PCMH into clinical education include Tulane and Alpert Medical School of Brown University. When reading the details of these grants, it seems like they are going to implement a majority of PCMH training into the last 2 years of medical school.

Enter EVMS. They also received a grant, though their vision seems a bit different. The grant of $2.1 million over 5 years is intended to develop a project called Predoctoral Education for Advancing Community Health (PEACH). They plan to "create a simulated community-health center where medical students will learn how to manage complicated cases effectively within a busy practice."
The goal is to teach not just primary-care medicine, but to teach primary-care practice systems that are necessary to achieve success for the patients. Every week they're going to be going to their simulated medical office and taking care of patients as if they were interns in a family-medicine residency.

It's getting them ready for 21st-century primary care. If they go into primary care, they'll be better prepared. If they go into a specialty, they'll be better prepared to interact with the primary-care physicians that are in their community
A curriculum that allows for longitudinal training while incorporating the use of the PCMH seems like a no-brainer. Having a panel of patients of all ages, male and female, with a wide variety of biopsychosocial issues to "take care of" and coordinate care for during non-clinical years would really bring the basic science foundations learned concurrently to life. Providing clinical relevance is something that most medical students enjoy during the non-clinical years.

Imagine sitting in lecture during your first year of medical school and receiving an email from one of your "patients" from your longitudinal panel of patients asking for your opinion on an acute or chronic condition. Should they go to the hospital or see you at their "medical home" that is conveniently open after they are finished with work. Between lecture, you log onto your medical home's EMR and access your patient's information to figure out what should be done and promptly email them back to see you in the office. Later that day, a standardized patient is waiting for you at the clinical skills center to discuss their current issue. You are unsure about a few things during that patient encounter, so you "tweet" a question to your professors and classmates that follow you on your professional Twitter account. Later that evening, you also receive a video with commentary by faculty about your encounter....

Imagine setting up a video-chat with other students in nursing, physician assistant, nutrition, behavioral health, and future social workers that are part of your medical home to discuss your patient panel's coordination of care.

Suppose one of your patients were to have a procedure or surgery - the student would go to their school's simulation center to learn how to "drive the camera" and use other laparascopic tools as well as learn how to suture. Maybe one of your patients are in labor? - Back to the simulation center for a simulated birth. You then see the standardized patient for follow-up care with their "simulated newborn" to learn the newborn well-child exam.

The possibilities of revolutionizing medical education are endless. By learning how to use the PCMH concept with simulation centers, standardized patients, EMR, social media, and coordinating with other future members of our medical homes, we will develop the communication and coordination of care necessary to breed quality physicians. This does not only help our future primary care physicians, but also those who specialize, so that they understand the amount of communication and coordination they will also need to have with their primary care counterparts to improve the care of our patients.


  1. A very thought provoking post. Students may have to lead the way around the sludge of old fashioned medical education. These grants about PCMH for student training will allow students freedom to inspire faculty with the "next vision" for medical education. Patients should be the winners.

  2. What an innovative program! Sounds like an exciting opportunity to allow medical students to understand longitudinal issues in patient-centered care. That definitely meets some of the goals of the FFM project. Great post!


  3. I love the focus on primary care systems... Any more news on progress?