The VA Center of Excellence in Primary Care Education (CoE) Medical Home Pathway is a unique pathway within the Primary Care Track of the University of Washington Internal Medicine Residency Program. Our Seattle CoE is part of VA Puget Sound Health Care System, and is one of five VA CoEs established and funded nationally with a mission to transform primary care education. In order to truly change the training program to enhance primary care, the CoEs require that 30% of total medicine residency training be in the primary care clinic setting. Our CoE primary care time is comprised of approximately 2/3 direct patient care in continuity clinic divided between Seattle VA Primary Care Clinic and Women's Clinic, and 1/3 in educational time with three longitudinal threads/themes. To preserve training program elective time for CoE pathway residents, there is a reduction in impatient time from 50% → 40% of total training. The added primary care time also includes two uniquely designed CoE rotations per training year.
The goals of the COE/medical home pathway include:
- Develop skills needed for primary care practice during training
- Learn team-based care in a medical home model (VA term PACT: Patient Aligned Care Teams)
- Interprofessional education (IPE) between trainees (residents and students) in medicine, nursing*, pharmacy, mental health, and other disciplines
*nursing includes nurse practitioner students in the UW Doctorate of Nursing Practice training program (DNPs), RN care managers on the panel team and our new DNP residents.
- Innovative interprofessional curriculum design and implementation, with three threads:
- Team-building with PACT members and "Meet your Colleagues" in other professions
- Panel Management (tracking clinical measures and practice and team-based efforts to improve patient care measures and outcomes); Quality improvement projects
- Clinical content multidisciplinary sessions in areas not typically taught in detail (i.e., wound care, women's health, addiction medicine, chronic pain, ophthalmology/ optometry, dermatology skin biopsy procedures
- Evaluation of the CoE by qualitative and quantitative methods
- Goal include performing resident-driven evaluation to foster growth of the resident and multidisciplinary training programs
- Develop educational program and materials sustainable and "exportable" to our program, other training programs and institutions.
- Quote from an R2 working on this website:
"As a resident, some of my favorite things about COE are the attention given to resident ideas and resident-driven projects to improve not only the COE, but also to affect change at the clinic level. COE provides the education and mentorship to help residents feel empowered to make a difference in patient care while they are trainees, so they can keep doing great things after residency."
- Quote from an R2 on the CoE leadership rotation:
“I really enjoyed this opportunity to see the decision-making that shapes my educational and working life. I interacted closely with medical leadership, and attended meetings at the clinic-, hospital-, and institution-wide levels. I hope to apply lessons learned here to improving the clinic experience throughout my career.”
These 4-week rotations are in addition to primary care track GIM immersion blocks.
- R1 year: Homeless care, Deployment health
- R2/R3 years: Leadership/Introduction to Health Administration/ Home care rotation; other electives thus far designed include: Palliative care; Group Visits, QI rotation, Rehab, Clinician-Educator rotation (one-month includes co-teaching/precepting with faculty and clinician-teacher fellows with students and residents in clinic, wards and student program sessions)
- We are open to helping develop any new themes requested by residents
- CoE rotations could include research rotations (as part of UW program process for research rotation selection)
Selection into the pathway
Information about the pathway is provided to all applicants during interview day. Selection is made after the NRMP match, in communication with newly matched primary care track R1s about career goals and continuity site assignment.
Resident Scholarly Requirement
All CoE pathway residents participate in a QI project and are encouraged to complete scholarly products. These including national presentations and workshops, national and regional meeting abstracts, and completion of a manuscript of their project(s).
- All participated in local presentations on QI project on opiate monitoring
- Two co-designing and teaching IPE Sessions (all informally co-teach in Edu sessions)
- Two participating in national ACGME presentation (2014)
- One research abstract SGIM national mtg (2014)
- All four co-authoring abstract of QI opiate monitoring project SGIM national meeting (2014)
- Participation in clinic performance improvement review and QI activities abstracts during leadership rotation.
- Two participating in longitudinal CoE all-site QI project on Emergency Department utilization of panel patients
- One conducting study of secure messaging communication with patients by residents, surveys
Residents in CoE
CoE Cohort 1 (2011-14):
Chris Chen, David Levitt, C Nick Meo, Chris Murphy
CoE Cohort 2 (2012-15):
Alisa Becker, Julie Cella, Althea Cunningham, Ximena Levander, Leah Marcott
Amy Van Nortwick
Paul “Gus” Visscher
William “Mike” Brode
Margaret “Greta” Tubbesing