title: Effects of adding a new PCMH block rotation and resident team to existing longitudinal training within a certified PCMH: primary care residents' attitudes, knowledge, and experience.
abstract: BACKGROUND
  Although the patient-centered medical home (PCMH) model is considered important for the future of primary care in the USA, it remains unclear how best to prepare trainees for PCMH practice and leadership. Following a baseline study, the authors added a new required PCMH block rotation and resident team to an existing longitudinal PCMH immersion and didactic curriculum within a Level 3-certified PCMH, aiming for "enhanced situated learning". All 39 residents enrolled in a USA family medicine residency program during the first year of curricular implementation completed this new 4-week rotation. This study examines the effects of this rotation after 1 year.
  
  
  METHODS
  A total of 39 intervention and 13 comparison residents were eligible participants. This multimethod study included: 1) individual interviews of postgraduate year (PGY) 3 intervention vs PGY3 comparison residents, assessing residents' PCMH attitudes, knowledge, and clinical experience, and 2) routine rotation evaluations. Interviews were audiorecorded, transcribed, and analyzed using immersion/crystallization. Rotation evaluations were analyzed using descriptive statistics and qualitative analysis of free text responses.
  
  
  RESULTS
  Authors analyzed 23 interviews (88%) and 26 rotation evaluations (67%). Intervention PGY3s' interviews revealed more nuanced understanding of PCMH concepts and more experience with system-level PCMH tasks than those of comparison PGY3s. More intervention PGY3s rated themselves "extremely prepared" to implement PCMH than comparison PGY3s; however, most self-rated "somewhat prepared". Their reflections demonstrated deeper understanding of PCMH implementation and challenges than comparison PGY3s but inadequate experience to directly see the results of successful solutions. Rotation evaluations from PGY1, PGY2, and PGY3s revealed strengths and several areas for improvement.
  
  
  CONCLUSIONS
  Adding one 4-week block rotation to existing longitudinal training appears to improve residents' PCMH knowledge, skills, and experience from "basic" to "intermediate". However, this training level appears inadequate for PCMH leadership or for teaching junior learners. Further study is needed to determine the optimum training for different settings.
authors.affiliation: Department of Family Medicine; Department of Medical Science, Warren Alpert Medical School of Brown University, Providence, RI.
authors.forename: Gowri
authors.initials: G
authors.lastname: Anandarajah
authors.affiliation: Department of Family Medicine.
authors.forename: Christopher
authors.initials: C
authors.lastname: Furey
authors.affiliation: Department of Family Medicine.
authors.forename: Rabin
authors.initials: R
authors.lastname: Chandran
authors.affiliation: Department of Family Medicine, University of South Florida Morsani College of Medicine, Tampa, FL; Department of Family Medicine, Leigh Valley Family Health Network, Allentown, PA.
authors.forename: Arnold
authors.initials: A
authors.lastname: Goldberg
authors.affiliation: Department of Family Medicine.
authors.forename: Fadya
authors.initials: F
authors.lastname: El Rayess
authors.affiliation: Department of Family Medicine.
authors.forename: David
authors.initials: D
authors.lastname: Ashley
authors.affiliation: Department of Family Medicine; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Roberta E
authors.initials: RE
authors.lastname: Goldman
keywords: curriculum; family medicine; new models of healthcare; population health; primary care; residency education