The Road to Excellence in Primary Care Teaching Clinics (Thomas Bodenheimer MD, MPH)

Many clinics training future primary care physicians are challenged. Faculty physicians and residents spend only 1 - 2 half-days per week in clinic, undermining continuity of care for patients. Sustaining stable teams is difficult since faculty and residents are away from clinic far more than they are present. Complaining of poor access to care, patients may be unable to reach anyone in the clinic who knows them and can address their needs. A "training gap" exists between the inpatient focus of many residency programs and the reality that the majority of healthcare is occurs in the outpatient setting." Learners experiencing primary care teaching clinics may experience a disorganized environment with unhappy physicians, causing some to abandon plans for a primary care career. A major transformation in primary care teaching clinics is needed to fix these serious problems for patients, faculty, and learners. The Clinic First paradigm, derived from our observations of high-performing teaching clinics, is one model for making such a transformation. This presentation describes primary care teaching clinics that are on the road to this new patient care/teaching paradigm. In these clinics, residents learn about how to become future leaders in primary care by experiencing well-functioning clinics and by actively participating in clinic improvement, not just as a project, but throughout their years in the clinic. The principles of Clinic First are: 1. Design resident schedules tha...
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