Do medical residents perform patient-centered medical home tasks? A mixed-methods study

Area of Science:

• Medical Education
• Health Services Research
• Primary Care Transformation

Background:

• Patient-Centered Medical Home (PCMH) settings are increasingly used for resident training.
• Defined PCMH entrustable professional activities (EPAs) require practical evaluation.

Purpose of the Study:

• To assess if residents trained in PCMH sites report higher engagement in PCMH tasks compared to those in non-PCMH sites.

Main Methods:

• Survey and nominal group data collected from post-graduate trainees across three residency programs.
• Comparative analysis of reported engagement in PCMH tasks based on training site type (PCMH vs. non-PCMH).

Main Results:

• Residents at PCMH sites were more likely to engage in tasks related to access, continuity, care planning, self-care support, and population management.
• No significant difference was found in reporting engagement for care coordination or performance measurement tasks.
• PCMH residents reported increased collaboration with medical assistants, but not other healthcare professionals.

Conclusions:

• PCMH training enhances resident engagement in several key PCMH domains, excluding care coordination and quality assessment.
• Facilitators like teamwork and continuity, and barriers like technology and inefficiency, were consistent across PCMH and non-PCMH settings.
• Curricula focusing on PCMH principles, continuity, and communication are recommended to improve resident integration into team-based care.