Educating Medical Students and Residents on Medical Home

Medical Home Resident Education Initiative Work Group (REIWG)

The Medical Home REIWG was convened under the auspices of the National Center for Medical Home Implementation to assess and address the needs in the area of resident education related to medical home for all children and youth, including children with special health care needs (CSHCN), care coordination, and family-centered care, respectively. The overarching goal of this initiative is to provide direction, tools, and resources to residency program directors, faculty, and others in their efforts to educate trainees regarding the core tenets of medical home. This includes the promulgation of suggested strategies for medical home implementation at the hospital, practice, and community levels. An initial focus of the initiative is the development of activities related to medical home implementation to be organized according to the related Accreditation Council for Graduate Medical Education (ACGME) Core Competencies.

Work Group Roster

  • Renee Turchi, MD, MPH, FAAP, Chairperson
  • Garry Gardner, MD, FAAP
  • Matthew Garber, MD, FAAP
  • Marcia Jackson, PhD (Instructional Designer)
  • Thomas S. Klitzner, MD, PhD, FAAP
  • Jennifer M LeComte, DO
  • Aditee P. Narayan, MD, MPH, FAAP
  • Umbereen S. Nehal, MD, MPH, FAAP
  • Robyn Nolan, MD
  • Eugene C. Rich, MD, FACP
  • Janet Serwint, MD, FAAP
  • Scott Shipman, MD, FAAP
  • Dennis Vickers, MD, MPH, FAAP
  • Susan Wiley, MD, FAAP (EHDI Content Expert)

For more information on the REIWG, Contact Us.

AAP Community Pediatrics Training Initiative (CPTI)

The Community Pediatrics Training Initiative (CPTI) is a national program of the American Academy of Pediatrics (AAP) designed to improve residency training by supporting pediatricians in becoming leaders and advocates to create positive and lasting change on behalf of childrens health. The CPTI Program provides faculty and residents with training, technical assistance & resources, networking opportunities, and funding opportunities. Additionally, the goals of the CPTI are to:

  • Promote child advocacy by enhancing resident educational and experiential opportunities
  • Increase community partnerships to enhance resident knowledge and skills to practice community pediatrics
  • Promote faculty development and scholarship that advances community activities and training
  • Promote and support evidence-based community practices to improve child health
  • Achieve institutional change that incorporates and sustains community pediatrics

Additional Resources:

  • Community-based Resident Projects Toolkit PDF
    The Community-based Resident Projects Toolkit assists residents in project development, evidence-based public health, asset-based community development, working with community-based organizations, cultural competency, media awareness, legislative and social advocacy, evaluating resident projects and sustainability.
  • Community Pediatrics Curriculum PDF
    The Community Pediatrics Curriculum is a resource for pediatric residents to learn about the eight core competencies in community pediatrics. These competencies are: delivery of culturally effective care; child advocacy; medical home; special populations; pediatrician as consultant, partner, and collaborative leader; educational and child care settings; community and public health; and research and scholarship.
  • Community Pediatrics: Making Child Health at the Community Level an Integral Part of Pediatric Training and Practice
    Pediatrics. April 2005
    This supplement contains a collection of articles about training and practice in community pediatrics that offer specific examples of clinical practice and research. The supplement's articles and commentaries discuss epidemiologic and historic perspectives on community pediatrics; examples of successful programs and training; and an agenda and next steps for research, program, and policy change.
Residency Education in Community-based Pediatrics and Medical Home

Medical Home as Continuity Care Clinics
This session, held at the CPTI Symposium in Philadelphia on March 25, 2005, discussed how to teach residents to effectively care for children and families, including those with special needs, by focusing on providing medical homes to children in the context of a continuity clinic.

ACGME Program Requirements for Residency Education in Pediatrics

The American College of Graduate Medical Education (ACGME) states in its Requirements for Pediatric Residency Program that “there must be structured educational experiences that prepare residents for the role of advocate for the health of children within the community. These should include both didactic and experiential components that may be integrated into other parts of the curriculum, eg, continuity, adolescent behavior/development, or they may be designed as distinct longitudinal or block rotations.” The ACGME refers to this as a Community Experience requirement. The ACGME endorsed general competencies for residents PDF to the level expected of a new practitioner. Note the relationship of the medical home into these outcome competencies in pediatric residency training.

  • Patient Care
    Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.
    • Accessible, Family-Centered, Compassionate
    • Comprehensive, Continuous
    • Coordinated
    • Informed decisions
    • Develop, carry out care plans
    • Counsel and educate families
    • Work with health care professionals to provide patient-centered care
  • Medical Knowledge
    Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.
    • Demonstrate Knowledge and apply to Comprehensive Care
  • Practice-based learning and improvement
    Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.
    • Comprehensive
    • Coordinated
    • Investigate, evaluate patient care
    • Use systematic methodology to improve patient care
    • Use information technology to improve care
  • Interpersonal & communication skills
    Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates.
    • Family-Centered Care
    • Coordinated Care
    • Demonstrate effective communication and teaming with patients, families, other health professionals
    • Create ethically sound and therapeutic relationships with patient
    • Use effective listening, nonverbal, questioning, explanatory and writing skills
  • Professionalism
    Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.
    • Culturally Effective Care
    • Altruism, Compassion, Respect, Honor, Sense of duty, Integrity, Advocacy, Sensitivity to diversity
  • Systems-based practice
    Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.
    • Accessible
    • Coordinated Care
    • Be aware and responsive to the larger health care system
    • Utilize community resources appropriately
    • Be aware of differences between health care delivery systems, including costs and resource utilization
    • Practice cost-effective care while also mindful of  the quality of care
    • Advocate and assist patients in receiving quality care
    • Partner with health care managers to provide and improve care 
Medical Student Education

Joint Principles for the Medical Education of Physicians as Preparation for Practice in the Patient-Centered Medical Home
American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians. American Osteopathic Association
These principles guide medical school curricula in ensuring all medical students understand and can act on the elements of the PCMH, including using evidence-based medicine and clinical support tools, performance measurement, and health IT that supports patient care, access and communication.

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Medical Student Awareness of the Patient-Centered Medical Home PDF
Family Medicine—November/December 2011

Promising Practices

Changing Pediatric Residency Training to Improve Quality of Care for Children and Youth with Special Healthcare Needs
A collaborative planning partnership was established between the National Initiative for Children's Healthcare Quality (NICHQ), the Lucile Packard Foundation for Children’s Health, and Mattel Children’s Hospital UCLA to address the failure of graduate training programs to properly train pediatricians to care for complex patients. The final report produced by this partnership proposes using quality improvement methods to close this gap through new residency training experiences and curricula. The result would be a re-designed training program that strengthens the competency of graduating pediatricians in the management of children with chronic conditions/special healthcare needs.

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Incorporating Patient- and Family-Centered Care into Resident Education: Approaches, Benefits, and Challenges
Journal of Graduate Medical Education (June 2011)
This article addresses the importance of patient- and family-centered care (PFCC) in the medical education of residents. It explores the status of PFCC in participating programs, barriers to PFCC graduate medical education, simple and far-reaching approaches to actively engage residents in PFCC, and suggestions for incorporating PFCC into residency curricula, teaching, and assessment.

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Johns Hopkins Aliki Initiative
In 2007, the Center for Innovative Medicine at Johns Hopkins Bayview Medical Center launched the Aliki Initiative, a novel curriculum in patient-centered care for internal medicine residents and medical students. The curriculum emphasizes that optimal care can be delivered only if treatments are tailored to the individual patient. The trainees ideally develop a deeper understanding of their patients' living situation and social support system. Although this video is focused on adult care, many of the themes discussed are relevant to pediatrics, including patient- and family-centered care.

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Med Schools Start Picturing Their Place in a Medical Home World
American Medical News
This article indiscusses how medical schools and residency programs are addressing teamwork, quality improvement, and community-based care to prepare students for practicing in a patient-centered medical home. This article highlights the ongoing work that the National Center for Medical Home Implementation has been engaged in related to developing a residency training curriculum around the medical home concept of care. The article also highlights the Picker Institute grant that the AAP received to pilot test a portion of the curriculum focused on eliciting family feedback at every encounter.

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Moving the Medical Home Forward: Innovations in Primary Care Training and Delivery
Association of American Medical Colleges (AAMC)
This report highlights academic practices that have successfully incorporated key attributes of the patient-centered medical home (PCMH) model of care into their delivery system while serving as a training site for medical residents and other health professionals.

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Pediatric Medical Home Project at UCLA
The goal of the Pediatric Medical Home Program at UCLA is to provide care to our pediatric patients with special health care needs that is accessible, family-centered, continuous, comprehensive, coordinated, compassionate, and culturally-effective.The program, established in 2003, is based at the Pediatric Resident Continuity Clinic at the Mattel's Children's Hospital UCLA.  The patients enrolled into the program receive virtually all of their medical care at UCLA, including primary care and specialist visits.   The program focuses on children with complex medical needs. 

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Project DOCC Houston—Delivery of Chronic Care Medical Home
Project DOCC is a national training program involving families of children with chronic illness/disabilities as faculty to transfer their knowledge and life experiences to first year pediatric resident physicians in more than twenty medical center in the United States as well as in Australia. Created in 1994 by three parents, Project DOCC's philosophy is that, by understanding how families deal with illness and or disabilities out side the hospital setting, pediatric resident physicians become better and more compassionate physicians.

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TEAM (Together Everyone Achieves More)
This program is a collaborative effort between healthcare providers and families and underscores the need to forge alliances in order to improve care, quality of life, and outcomes for CSHCN. Project TEAM is part of the Children with Special Health Care Needs Section of the Behavioral Pediatrics rotation for Third Year Pediatric Residents at Children’s Hospital of Wisconsin and the Medical College of Wisconsin. This program is coordinated and funded by Children's Hospital of Wisconsin, the Medical College of Wisconsin and a MCH Title V Services Block Grant, through the Maternal Child Health Bureau of the Health Resources and Services Administration, Department of Health and Human Services. For more information contact Anne Juhlmann at 414/266-3196 or ajuhlmann@chw.org.

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University of Hawaii Integrated Pediatric Residency Program—Medical Home Hawaii
The goals of this program are for pediatric residents to understand and apply the Medical Home principles within continuity care practice. Emphasis is on the ability to demonstrate continuity, accessibility, comprehensive, and coordinated care that is delivered with family-centered, culturally effective, and compassionate care to actual patients in practice.

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University of South Carolina School of Medicine—Families and Residents Education Experience PDF
This program at the University of South Carolina School of Medicine is a collaborative effort between the Department of Pediatrics and Family Connection. The program teaches pediatric residents the knowledge and skills necessary to provide family-centered, community-based care for children with special needs and their families. This program is unique in that families are the teachers and the community becomes the classroom."For more information contact: Kathy Taylor at Family Connection of South Carolina – 800/578-8750, kathytaylor@familyconnectionsc.org. or Betsy Wolff, Project Coordinator for the State Medical Home Team – 803/782-0238, betsywolff@aol.com.

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Wisconsin Medical Home Special Needs Rotation PPT
Children's Hospital of Wisconsin (CHW) Special Needs Program: A Primary Care/ Tertiary Care Medical Home Partnership - Holly Colby, RN, MS

  • Evolution of the Special Needs Program
  • Care coordination at Children’s Hospital of Wisconsin
  • Reimbursement strategies
  • Issues/Challenges

Together Everyone Achieves More: A Children with Special Health Care Needs Rotation for Third Year (PL-3) Residents at CHW - Anne K. Juhlmann RN, BSN

  • Focus of the Rotation
  • Assessing Resident Learning
  • Family Views

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