BY LESLIE CHAMPLIN
Bring together about 20 patients with diabetes. Add two family medicine residents. Provide clinical and educational goals. Mix for several months.
Then watch everyone learn.
That's the goal of combining group medical visits and residency training, said Sean Gaskie, M.D., associate clinical professor of family medicine at the University of California, San Francisco, and faculty supervisor for group visits at Sutter Medical Center Family Practice Residency Program.
Family medicine residency programs, such as Sutter and the Duluth (Minn.) Family Practice Residency Program, are beginning to experiment with group visits, which are part of residents'rotations.
A pioneer in pairing group visits with residency training, Gaskie said the combination sparks enthusiasm among participants, broadens residents' clinical skills and enhances the quality of patient care.
Patient-centered focus
Group visits can occur monthly or bimonthly and last up to two hours. They include a brief social time, a presentation on a health topic of interest to the group and review of patients' action plans. Some incorporate one-on-one physician encounters during group time, while others offer individual visits after the meeting.
Research shows that key elements of group visits -- social support, self-management, health education and routine primary care -- provide significant benefit to patients with chronic conditions such as diabetes. However, said Gaskie, those elements also require attitudes that differ dramatically from those learned in medical school.
"The group medical visit puts the patient first and makes the doctor secondary," said Gaskie. "These visits recognize that patients are more expert at coping with their illness than the doctors are."
William Byrd, M.D., a resident at the Duluth program, agreed. Commenting on a recent group visit for patients with diabetes, he said, "The most important thing that I walked away with in regard to that meeting was that each person did not feel alone and was more candid about their health issues.They exchanged ideas that could be useful in maintenance of their diabetic control."
In-depth preparation, active listening
In contrast to the grab-and-read chart reviews and jam-packed 15-minute encounters of traditional one-on-one patient visits, group medical visits require more preparation.
"If you're not prepared to address the patients' medical condition, you can't take care of them," said Gaskie.
Residents must review charts for up to 20 patients and order preliminary lab work. During the meeting, residents must facilitate discussion among participants. Success depends on developing active listening and negotiation skills, said Gaskie.
Brian Niskanen, M.D., a resident with the Duluth program, said most physicians come to group visits with strong examination and diagnostic skills. However, he added, "What has improved considerably is my ability to communicate the complexities of diabetes and facilitate group discussion. The topics presented have increased my understanding of the physiology of diabetes and its complications. This understanding has certainly improved my clinical decision-making skills."
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Copyright © 2004 by
American Academy of Family Physicians.