Journal de recherche et de développement en éducation à la santé

Perceptions of Becoming Personal Physicians within a Patient-Centered Medical Home

Abstract

Patricia A Carney, Elizabeth Jacob-Files, Susan J Rosenkranz, Deborah J Cohen, Larry Green, Samuel Jones, Colleen T Fogarty, Elaine Waller and M Patrice Eiff

Objective: Residency training is transforming how to teach residents about practicing as a personal physician in a Patient Centered Medical Home [PCMH], but little is known about how trainees experience these responsibilities. Methods: This study used an online survey with open-ended questions to assess residents experiences with curricular innovations as part of learning to practice as physicians in a PCMH. The survey questions were distributed every six to 12 months. This analysis focuses on responses to a single question administered once, “What does being a personal physician working in a medical home mean to you?” Two independent researchers analyzed text responses using an immersion-crystallization approach. The full research team met to discuss emerging themes. Principal findings: Sixty-two residents representing 78.6% of participating training programs responded to the online survey question that is the focus of this analysis. Overwhelmingly, resident respondents reported finding meaning in the humanistic and interpersonal aspects of medicine. In particular, residents reported that being a personal physician in a PCMH meant being the go-to person for patients’ healthcare needs. This included delivering patient-centered, continuous care in the context of a physician-patient relationship that broke down the traditional physician-patient hierarchy. Being a personal physician also included an important role for the physician and clinical team members in orchestrating the referral and care coordination process. To accomplish this, residents recognized that personal physicians needed to learn the art of practice. Conclusion: Physicians trained in newly redesigned residencies understand and embrace their role and relationships with patients and health care teams that emerge as part of the PCMH. Residency redesign efforts can inculcate new family physicians with key practice ideals and knowledge about how to achieve these in practice.