Demonstration of health-systems change in medical education: Development of an interdisciplinary clinical experience and preliminary outcomes

Introduction: The Department of Veterans Affairs (VA) Office of Academic Affiliations has supported the Atlanta VAMC's Patient-Centered Specialty Care Education in Women's Health (WCOE-SC) Program in collaboration with its affiliates, Morehouse School of Medicine and Emory University School of Medicine, to incorporate system-level change in medical education through interdisciplinary and inter-professional clinical training in a patient-centered care model across specialties. The WCOE-SC provides comprehensive women's medical care housed in a primary care clinic with obstetrics/gynecology, psychiatry, cardiology, and pain management services offered within the same clinical infrastructure with shared facilities, associated health staff, and electronic health records systems. Trainees engaged to date include medical students and residents from affiliated institutions. Methods: The formative evaluation in Year 1 focused on identifying the benefits, barriers and processes engaged in the development of a clinical setting and interdisciplinary/interprofessional collaborations to facilitate educational transformation, collaborative learning opportunities, and enhanced care delivery. Seven key informant interviews and three focus groups were conducted with facility leadership, clinical faculty, trainees and institutional partners. Content analysis techniques were utilized to analyze the qualitative data results. Results: The respondents indicated that interprofessional collaborations were a critical element of the WCOE-SC planning and training implementation process. Collaborations were fostered through implementation of several committees to engage faculty in the planning process to open the clinic. Integrated health information systems, staff proximity, healthcare organization leadership support, as well as institutionalized primary care patient-centered medical home clinical infrastructure were elements of the existing system that contributed to an environment ready for specialty care integration. Several examples of clinical encounter collaboration were identified such as same day scheduling for specialty and primary care appointments, on-site consultation for specialty issues, and complex patient management eased through informal interdisciplinary communication and proximity, identified as a unique component of the WCOE-SC infrastructure. Health professions trainees indicated satisfaction with the training experience and expressed interest and positive attitudes towards integrated care and women's health. Challenges identified included adequate clinic support staff, equipment and panel designations as critical components to address within the system during clinic development. Implications: In conclusion, the implementation of an interprofessional training experience is critical to prepare healthcare providers for systems-change and create exposure to best-practice driven clinical models for integrated care. The development of integrated clinics requires institutional partnership, multidisciplinary collaboration and participatory infrastructures to support curriculum and clinical activities responsive to current contexts for patients and trainees engaged in the process.