Teaching care management in a longitudinal primary care clerkship

Abstract

Background: Harvard Medical School developed a longitudinal primary care clerkship as an opportunity to teach 7 themes of modern medicine: care over time, evidence-based medicine, prevention, uncertainty, cost effectiveness, teamwork, and shared decision making.

Purpose: To evaluate the effectiveness of the longitudinal experience.

Methods: Students followed 1 patient throughout a 9-month clerkship and integrated the 7 themes into their management plans. We coded their written reports for number and duration of student-patient encounters; characteristics of students, preceptors, sites, and patients related to encounter frequency; and integration of themes into management plans.

Results: The median number of student-patient contacts was 4.0, as was the median number of months that students maintained contact with the patients. Patients with complex diagnoses were seen more times. No characteristics of patient, student, preceptor, or site limited the number or duration of contacts. Proportions of students integrating each theme into their plans ranged from 66% (care over time) to 11% (cost effectiveness). Those who had a greater number of patient contacts integrated more themes into their plans.

Conclusions: Longitudinal relationships with patients can be achieved with a variety of patients and drive integration of some themes.