Family medicine
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Comparative Study
Integrating the art and science of medical practice: innovations in teaching medical communication skills.
This paper describes the content and methods used to teach communication skills in Undergraduate Medical Education for the 21st Century (UME-21) schools and provides suggestions for future efforts. ⋯ Opportunities for students to develop, apply, and refine their communication skills can be embedded throughout the medical school curricula. Our findings illustrate the variety of methods that may be used to teach and evaluate medical students' communication skill competencies. Future challenges include development of comprehensive longitudinal curricula, practical teaching methods, valid evaluation tools, and faculty development.
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Comparative Study
Partnerships between health care organizations and medical schools in a rapidly changing environment: a view from the delivery system.
The Undergraduate Medical Education for the 21st Century (UME-21) project encouraged the formation or enhancement of partnerships between medical schools and health care organizations distinct from the traditional teaching hospitals. The purpose was to prepare medical students in nine content areas that were components of the UME-21 project. Despite their importance today to medical schools, such partnerships with health care organizations are a challenge to develop and maintain in the midst of a rapidly changing health care environment. This article categorizes the partnerships formed and discusses the benefits and the barriers encountered in such collaborations. ⋯ Partnerships formed as part of the UME-21 project improved medical students' exposure to the health care system and their knowledge and skills for effective practice in the 21st century health system. Barriers encountered included financial pressures, changes in leadership, different organizational missions and priorities, and preexisting prejudices against new relationships. Factors associated with successful partnerships include the presence of a health care organization and an academic "champion" dedicated to the project, strong individual relationships, and a medical school commitment to involve external partners.
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The Côte-des-Neiges diabetes pilot project strove to conceptualize, implement, and assess an integrated health care system for Type 2 diabetes. Using a disease management and population-based approach, a multidisciplinary team sought to (1). organize health care in an integrative framework, (2). promote behavior changes in patients to foster self-care, (3). introduce tools to allow family physicians to modify their practices, and (4). encourage local community action to support patients and providers. ⋯ Approaches to chronic diseases such as diabetes require integrative health care strategies to support patients and providers in their community. In spite of time constraints, patients perceived the value of education with increasing involvement in their illness, physicians reported changes in their practice, and steps were initiated to mobilize community resources.
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Open access is one method of improving the quality of clinical practice. Leaving the majority of appointments open to be scheduled the same day allows patients to have control of their access to care. These appointments can be used for all visit types, including physical exams. Our objective was to implement this system to improve efficiency, and patient/provider satisfaction, while maintaining financial profitability. ⋯ Open access has improved revenue, simplified office processes, decreased nursing work, and improved patient satisfaction without any increase in provider time or clinic expansion.
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There continue to be significant racial and ethnic disparities in rates of childhood and adult immunizations in the United States. The causes are multifactorial, including inequities in education, income, and socioeconomic status; structural and systemic barriers in the health care delivery system; and beliefs, preferences, and practice patterns of the recipients and providers of care. ⋯ The individual clinician can contribute to the narrowing of this gap by being informed of and using available national and regional resources, implementing national standards for culturally and linguistically appropriate health care services, and using every clinical encounter to assure that vaccination is offered and provided. Specific action steps are suggested.