title: Teaching care management in a longitudinal primary care clerkship.
abstract: BACKGROUND
  Harvard Medical School developed a longitudinal primary care clerkship as an opportunity to teach 7 themes of modern medicine: care over time, evidence-based medicine, prevention, uncertainty, cost effectiveness, teamwork, and shared decision making.
  
  
  OBJECTIVE
  To evaluate the effectiveness of the longitudinal experience.
  
  
  METHODS
  Students followed 1 patient throughout a 9-month clerkship and integrated the 7 themes into their management plans. We coded their written reports for number and duration of student-patient encounters; characteristics of students, preceptors, sites, and patients related to encounter frequency; and integration of themes into management plans.
  
  
  RESULTS
  The median number of student-patient contacts was 4.0, as was the median number of months that students maintained contact with the patients. Patients with complex diagnoses were seen more times. No characteristics of patient, student, preceptor, or site limited the number or duration of contacts. Proportions of students integrating each theme into their plans ranged from 66% (care over time) to 11% (cost effectiveness). Those who had a greater number of patient contacts integrated more themes into their plans.
  
  
  CONCLUSIONS
  Longitudinal relationships with patients can be achieved with a variety of patients and drive integration of some themes.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Office of Educational Development, Harvard Medical School, Boston, Massachusetts 02115, USA. toni_peters@hms.harvard.edu
authors.forename: Antoinette S
authors.initials: AS
authors.lastname: Peters
authors.forename: Kathleen N
authors.initials: KN
authors.lastname: Schnaidt
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Seward
authors.forename: Roy M
authors.initials: RM
authors.lastname: Rubin
authors.forename: Anita
authors.initials: A
authors.lastname: Feins
authors.forename: Robert H
authors.initials: RH
authors.lastname: Fletcher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002982:Clinical Clerkship / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management; D010817:Physician-Patient Relations; D011320:Primary Health Care; D015397:Program Evaluation; D013663:Teaching