VA Center of Excellence in Primary Care Education: A patient-centered, interprofessional, team-based medical home training pathway
"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 create 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."
The Seattle VA Center of Excellence (CoE) in Primary Care Education is a unique pathway within the Primary Care Track of the University of Washington Internal Medicine Residency Program. Our CoE is one of five legacy VA CoEs nationwide established and funded with a mission to transform primary care education and to foster interprofessional education and collaborative practice.
To optimize the primary care training experience, the CoEs require that at least 30% of total medicine residency training be in the primary care setting. To preserve primary care training time for our CoE pathway residents, inpatient rotations are reduced from 50% to 40% of total training. Our CoE primary care educational experience is comprised of approximately 2/3 time in direct patient care in the Seattle VA Primary Care and Women's Clinics, and 1/3 time in uniquely designed interprofessional didactics.
COE PATHWAY GOALS
In the CoE pathway, we strive for:
Teaching our trainees to work in and lead teams: delivering high quality, patient centered, team-based primary care with a focus on interprofessional collaboration, leadership, and scholarship.
Moving graduate medical education out of silos by creating interprofessional didactic and direct patient care experiences among internal medicine residents, nurse practitioner residents and students, registered nurse residents, pharmacy residents, psychology fellows, and social work interns.
Innovating interprofessional curriculum with three longitudinal threads:
Team-building with Patient Aligned Care Team (PACT) members (primary care-based RN care managers, LPNs, administrative assistants, pharmacists, psychologists and social workers) and "Meet your Colleagues" sessions with other professions/specialists
Panel Management: Learn population health management skills including accessing clinical data and advancing clinical care for panel patients between provider visits. Themes include Diabetes, HTN, ED utilization, tobacco, and opioid monitoring.
Interprofessional, multidisciplinary, clinically focused didactic sessions in areas not covered in detail elsewhere in internal medicine residency training (e.g, wound care, women's health, addiction medicine, insomnia, chronic pain, ophthalmology/ optometry, urology
Evaluating our CoE by qualitative and quantitative methods focused on trainee feedback to foster growth and innovation in both the resident and our training programs.
Developing educational curricula that are sustainable and exportable to our larger residency program and other training programs and institutions nationwide.
UNIQUE COE BLOCKS
These novel COE rotations strive to supplement areas not otherwise covered in typical internal medicine residency training, and our COE trainees attend these in addition to two general primary care track immersion blocks each year of residency training.
Quote from a resident 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."
Homeless Health Care
(with 2 additional elective blocks, see below)
Leadership/Introduction to Health Administration
Home Based Primary Care
Selected examples of elective blocks (with ample opportunity to create new electives):
Non-internal medicine specialties relevant to primary care training:
Physical medicine and rehabilitation
Wound care clinic
Physical and occupational therapy
Internal medicine subspecialties
Innovative care delivery
COE QI AND SCHOLARSHIP OPPORTUNITIES
All CoE pathway residents participate in interprofessional QI projects and are encouraged to complete scholarly products. The trainee QI projects to date have been very successful, directly benefitting patient care and clinic operations.
Our trainees also have the opportunity to present at our monthly QI works in progress and journal club lunch sessions.
To date, there have been more than 100 combined national presentations and workshops, meeting abstracts, and published manuscripts by our CoE trainees.
Graduates of our CoE have gone on to diverse and successful professional careers, with about 75% choosing to work in the primary care setting. A Examples of leadership positions accepted by our graduates include clinic directors, residency program leadership, and leadership positions in telemedicine and Patient Safety/QI.
SELECTION INTO THE COE PATHWAY
Information about the CoE pathway is provided to all applicants during interview day.
Selection into the CoE is made after the NRMP match, by communicating with newly matched primary care track trainees about career goals and continuity site/pathway preferences
Joyce Wipf, MD
Professor of Medicine,
Division of General Internal Medicine, Department of Medicine