Academic medicine : journal of the Association of American Medical Colleges
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An effective interprofessional medical team can efficiently coordinate health care providers to achieve the collective outcome of improving each patient's health. To determine how current teams function, four groups of business students independently observed interprofessional work rounds on four different internal medicine services in a typical academic hospital and also interviewed the participants. In all instances, caregivers had formed working groups rather than working teams. ⋯ The authors draw on these observations to form recommendations for enhancing interprofessional rounding teams. These are to include the bedside nurse, pharmacist, and case manager as team members, begin with a formal team launch that encourages active participation by all team members, use succinct communication protocols, conduct work rounds in a quiet, distraction-free environment, have teams remain together for longer durations, and receive teamwork training and periodic coaching. High-performing businesses have effectively used teams for decades to achieve their goals, and health care professionals should follow this example.
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The primary-care-oriented Teaching Health Center Graduate Medical Education (THCGME) program funded by the Patient Protection and Affordable Care Act of 2010 offers opportunities to explore alternative solutions to such graduate medical education (GME) policy issues as institutional indirect educational costs, variations in trainee-related productivity gains, and the program costs of GME innovations. THCGME reporting requirements may also provide data on the impact of various educational innovations on career choice and clinical care as well as other information that could be useful in devising a more transparent and equitable system of support for GME. THCGME program advocates should, however, be cautious in applying any lessons learned to broader GME policy reform. ⋯ Furthermore, the organizational infrastructures established, program leaders developed, data collected, and lessons learned from the program can inform more fundamental change in U. S. GME payment policy.
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The community health center (CHC), or neighborhood health center as it was originally known, was an innovation developed under President Lyndon Johnson's War on Poverty to address the needs of poor urban and rural Americans. The ranks of CHCs have grown from 8 pilot health centers in 1965 to more than 1,100 health centers serving over 19 million Americans in 2012. The capacity of CHCs is limited by the availability of primary care clinicians (physicians, nurse practitioners, and physician assistants) who are trained to work in these settings. ⋯ This new federal initiative aligns the graduate medical education (GME) mission of preparing competent professionals with the CHC mission of providing quality and comprehensive care; it also helps address health care reform and the need for more primary care clinicians. Of the first 21 THCGME grants, 15 (71%) were awarded for family medicine residency training. As Chen and colleagues suggest in this issue of Academic Medicine, the THCGME program is an important step in reform of GME financing and training.