Medical student exposure to components of the patient-centered medical home during required ambulatory clerkship rotations: implications for education.
OBJECTIVE
To determine the extent to which third-year medical students are exposed to elements of the patient-centered medical home (PCMH) during required family medicine (FM) clerkships and how this exposure varies among a sample of medical schools.


METHODS
In 2008, the authors conducted a cross-sectional survey of 104 ambulatory teaching practices that host required third-year FM clerkship students from nine U.S. medical schools. Descriptive statistics characterized learning settings and the status of PCMH features, and generalized linear mixed models examined variation among medical schools (as the 104 clinics were nested within nine medical schools).


RESULTS
Participating schools captured data on 104 eligible clerkship sites (44%). These practices were primarily community-based, single-specialty clinics (n = 48; 46%), and more than half (n = 55; 53%) were part of integrated health systems. Electronic health records (EHRs) were in place in 60 (58%), and no significant difference existed in EHR use according to medical school, despite up to a 10-fold variation from school to school in other PCMH features. Among sites with EHRs, 8 (14%) did not allow access to medical students. Preceptor attitudes about how practice transformation and new information technology are affecting the quality of medical education differ widely from site to site.


CONCLUSIONS
Primary care transformation toward the PCMH is already well under way in a national sample of FM teaching sites, and this transformation is having important effects on medical student education.
Saultz
John W
JW
Department of Family Medicine, Oregon Health & Science University, Portland, Oregon, USA. saultz@ohsu.edu
O'Neill
Peggy
P
Gill
James M
JM
Biagioli
Frances E
FE
Blanchard
Shawn
S
O'Malley
Jean P
JP
Brown
David
D
Rogers
John C
JC
Carney
Patricia A
PA
D000553:Ambulatory Care; D002982:Clinical Clerkship; D003430:Cross-Sectional Studies; D004504:Education, Medical, Undergraduate / Q000379:methods*; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005194:Family Practice / Q000193:education*; D018802:Patient-Centered Care; D011320:Primary Health Care / Q000379:methods*; D013337:Students, Medical; D014481:United States