The Academy and three other primary care professional organizations have promulgated a new policy to guide the education of physicians who will be graduating from U.S. medical schools in an era of health care reform that promotes preventive health services and a greater reliance on primary care.
The policy, known as the Joint Principles for the Medical Education of Physicians as Preparation for Practice in the Patient-Centered Medical Home(12 page PDF), builds on the Joint Principles of the Patient-Centered Medical Home, or PCMH, which the groups adopted three years ago.
In addition to the AAFP, the new educational principles have been approved by the American Academy of Pediatrics, the American College of Physicians and the American Osteopathic Association. The principles now will be forwarded to the Patient-Centered Primary Care Collaborative(www.pcpcc.net), which will consider them for endorsement.
Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education, said the new principles are an important guide to medical schools because, in the new health care reform environment, the emphasis is on prevention and the need for increasing access to primary care.
"Training for PCMH practice has been embraced by the graduate medical education community, but at the medical school level, the response has been less -- hence, the development of these principles to guide development at the medical school level of training," said Pugno.
The original PCMH joint principles, which were adopted in February 2007, comprise seven components:
- the concept of the personal physician,
- a physician-directed, team-based approach to medical practice,
- a whole-person orientation,
- coordinated and integrated care,
- quality and safety,
- enhanced access, and
- an appropriate payment framework.
The new medical education principles relate each of these PCMH components to the pertinent Accreditation Council for Graduate Medical Education/American Board of Medical Specialties core competencies and describe the corresponding education subprinciples.
For example, the personal physician component of the PCMH joint principles calls for each patient to have an ongoing relationship with a personal physician trained to provide first-contact, continuous and comprehensive care. The related attributes/competencies for students say that medical students should demonstrate knowledge about the definition of patient-centeredness and must be able to demonstrate the ability to provide patient-centered care in their clinical encounters.
The corresponding education subprinciples say that medical students are expected to experience continuity in relationships with patients in a longitudinal fashion within practices that deliver first-contact, comprehensive, integrated, coordinated, high-quality and affordable care. In addition, students are expected to communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families and fellow professionals.
Student attributes/competencies related to physician-directed, team-based practice say that medical students should be able to demonstrate collaborative care via leadership skills that result in effective information exchange and teaming with patients, their patients' families and professional associates.
The corresponding education subprinciples call for medical students able to work effectively with others as a member or leader of a health care team; articulate the roles, functions and working relationships of all members of the team; and apply knowledge of leadership development, quality improvement, change management and conflict management.
The new joint principles acknowledge that integrating these features into undergraduate medical education will require additional resources. In some cases, students simply can be incorporated into existing patient-care and practice-based activities. In other cases, however, additional faculty -- such as those with expertise in economics, health policy or business administration -- and staff will be needed to create and oversee new experiences for the students.
It's important for medical schools to recognize the need to invest in the future to provide these educational opportunities, Pugno said.
"We know that the current model of health care isn't financially sustainable," said Pugno. "We need at least some medical schools and their academic medical centers to show leadership and make some difficult choices -- and change how they do business. In the short term, it will cost, but the dividends will come in the future."
The medical education principles also point out that preparing faculty for health reform changes as a prerequisite to training medical students in both primary and specialty care is an "unmet need." Accordingly, the principles call for demonstration projects to help inform decisions about faculty development methods, as well as the development of assessment tools and outcomes measures. They also state that resident physicians will be "integral components" of medical student education in PCMH concepts.
According to Pugno, medical schools have had mixed results in preparing physicians to practice in the new environment.
"I believe the nation's medical schools are making a valiant effort to respond to all of the competing needs for training tomorrow's physicians," he said. "Some seem to be doing better than others. But many are still rooted in the old, narrow specialty and hospital-centric model of care.
"The joint principles were created to assist schools in evolving their curricula forward to meet future needs."