Academic Medicine. 2008 Nov;83(11):1064-70.
Two decades of Title VII support of a primary care residency: process and outcomes.
Lipkin M, Zabar SR, Kalet AL, Laponis R, Kachur E, Anderson M, Gillespie CC.
Primary Care Internal Medicine Residency Education Program, Division of General Internal Medicine, Department of Medicine, New York University School of Medicine, New York, New York 10016, USA. mack.lipkin@med.nyu.edu
Significance:
Two Decades of Title VII Support of a Primary Care Residency: Process and Outcomes presents the outcomes of the first 23 years of the New York University/Bellevue Primary Care Internal Medicine Residency Program, assessed through a comprehensive, quantitative and qualitative survey of 122 reachable graduates from the first 20 graduating classes.
By crafting and deploying an educational, training model that is comprehensive in scope and focused on top priorities, and relentlessly humanistic in specific, planned ways, with methods to achieve high, measured skill levels in graduates, the Bellevue/NYU PC Program has produced high numbers of primary care physicians who are actively engaged in scholarship, demonstrate burnout rates one third of their peers and high career satisfaction, who are enormously successful in the field, and who are engaging in the type of medicine that is the top national priority.
This program represents a different and more evolved paradigm of education from usual residency training with a strong emphasis on the psychosocial aspects of medicine, clinical epidemiology, health policy, and mastery of the core skills needed to deal with the full bio-psychosocial range of primary care problems.
Abstract:
PURPOSE: To assess 23 years of Health Resources and Services Administration (HRSA) Title VII Training in Primary Care Medicine and Dentistry funding to the New York University School of Medicine/Bellevue Primary Care Internal Medicine Residency Program. The program, begun in 1983 within a traditional, inner-city, subspecialty-oriented internal medicine program, evolved into a crucible of systematic innovation, catalyzed and made feasible by initiatives funded by the HRSA. The curriculum stressed three pillars of generalism: psychosocial medicine, clinical epidemiology, and health policy. It developed tight, objectives-driven, effective, nonmedical specialty blocks and five weekly primary care activities that created a paradigm-driven, community-based, role-modeling matrix. Innovation was built in. Every block and activity was evaluated immediately and in an annual, program-wide retreat. Evaluation evolved from behavioral checklists of taped interviews to performance-based, systematic, annual objective structured clinical examinations.
METHOD: The authors reviewed eight grant proposals, project reports, and curriculum and program evaluations. They also quantitatively and qualitatively surveyed the 122 reachable graduates from the first 20 graduating classes of the program.
RESULTS: Analysis of program documents revealed recurring emphases on the use of proven educational models, strategic innovation, and assessment and evaluation to design and refine the program. There were 104 respondents (85%) to the survey. A total of 87% of the graduates practice as primary care physicians, 83% teach, and 90% work with the underserved; 54% do research, 36% actively advocate on health issues for their patients, programs, and other constituencies, and 30% publish. Graduates cited work in the community and faculty excitement and energy as essential elements of the program's impact; overall, graduates reported high personal and career satisfaction and low burnout.
CONCLUSIONS: With HRSA support, a focused, innovative program evolved which has already met each of the six recommendations for future innovation of the Alliance for Academic Internal Medicine Education Redesign Task Force. This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.
PMID: 18971659
