title: Advancing educational continuity in primary care residencies: an opportunity for patient-centered medical homes.
abstract: Continuity of care is a core value of patients and primary care physicians, yet in graduate medical education (GME), creating effective clinical teaching environments that emphasize continuity poses challenges. In this Perspective, the authors review three dimensions of continuity for patient care-informational, longitudinal, and interpersonal-and propose analogous dimensions describing continuity for learning that address both residents learning from patient care and supervisors and interprofessional team members supporting residents' competency development. The authors review primary care GME reform efforts through the lens of continuity, including the growing body of evidence that highlights the importance of longitudinal continuity between learners and supervisors for making competency judgments. The authors consider the challenges that primary care residency programs face in the wake of practice transformation to patient-centered medical home models and make recommendations to maximize the opportunity that these practice models provide. First, educators, researchers, and policy makers must be more precise with terms describing various dimensions of continuity. Second, research should prioritize developing assessments that enable the study of the impact of interpersonal continuity on clinical outcomes for patients and learning outcomes for residents. Third, residency programs should establish program structures that provide informational and longitudinal continuity to enable the development of interpersonal continuity for care and learning. Fourth, these educational models and continuity assessments should extend to the level of the interprofessional team. Fifth, policy leaders should develop a meaningful recognition process that rewards academic practices for training the primary care workforce.
authors.affiliation: J.L. Bowen is professor of medicine, Oregon Health & Science University, Portland, Oregon, and physician education consultant, Office of Academic Affiliations, Veterans Health Administration, Washington, DC. D. Hirsh is associate professor of medicine, Harvard Medical School, Boston, Massachusetts, and staff physician, Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts. E. Aagaard is professor of medicine, Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado. C.P. Kaminetzky is associate chief of staff for education, VA Puget Sound Health Care System, Seattle, Washington, and assistant professor, University of Washington School of Medicine, Seattle, Washington. M. Smith is Henry A. Palmer Endowed Professor, Community Pharmacy Practice, and assistant dean, Practice and Public Policy Partnerships, University of Connecticut School of Pharmacy, Storrs, Connecticut. J. Hardman is assistant professor of medicine, associate program director, and medical director, Internal Medicine Resident Practice, Oregon Health & Science University, Portland, Oregon. S.G. Chheda is associate professor of medicine and pediatrics, Department of Medicine, Division of General Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Judith L
authors.initials: JL
authors.lastname: Bowen
authors.forename: David
authors.initials: D
authors.lastname: Hirsh
authors.forename: Eva
authors.initials: E
authors.lastname: Aagaard
authors.forename: Catherine P
authors.initials: CP
authors.lastname: Kaminetzky
authors.forename: Marie
authors.initials: M
authors.lastname: Smith
authors.forename: Joseph
authors.initials: J
authors.lastname: Hardman
authors.forename: Shobhina G
authors.initials: SG
authors.lastname: Chheda
mesh_terms: D004503:Education, Medical, Graduate / Q000379:methods*; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000379:methods*; D017145:Models, Educational; D018802:Patient-Centered Care; D058007:Physicians, Primary Care / Q000193:education*; D016730:Program Development