Dolan, Kathryn J.


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Purpose (a): The Medical Home Model as implemented within the guidelines of the Affordable Care Act, requires physicians to utilize community resources provided by many diverse allied health professions and organizations, including social, vocational and rehabilitation service providers which are typically “outside of the four walls” of the medical home. This research addresses approaches to enriching the curriculum to introduce students to the competencies required for community and/or systems based practice, many addressed in the NBOME Domain 7 Competency—Systems Based Practice. In the rapidly changing practice environment, osteopathic medical students need to be prepared for interprofessional practice during their clinic training. Methods (b): Educational objectives for IPE outside the four walls are identified. Varying instructional strategies to meet these objectives are identified and evaluated taking into account their costs, benefits and challenges. Many professionals from diverse allied health professions and organizations are keenly aware of the barriers their clientele face in accessing the care they need and communicating those needs to physicians. Comparison are made between two basic approaches to systematically expose medical students to other members of the extended health care team, a large classroom format where all students are exposed to the same material, and individual or small group visits to specific agencies chosen by the students. Results (c): Student evaluations, performance on quizzes and focus group feedback reveal strengths and weaknesses of these approaches. Large group presentations by community professionals is by far the most efficient delivery method, however is most effective when case studies are used to illustrate the needs and barriers accessing services their clients face. Student focus group feedback led to developing a format that can be applied to diverse agencies and client populations. Individual and small group visits with community agencies are typically rated very favorably by students, however do not offer consistent experiences that meet all learning objectives. Conclusions (d): Recommendations are made for best practices and further development. Medically vulnerable and underserved individuals present with health problems that are deeply embedded in social, economic, community and psychological conditions which must be addressed for successful treatment outcomes. In Accountable Care Organizations (ACO), there will be a need for all practitioners to be able to respond appropriately to a broad array of these common situations and the challenges they pose. Medical students entering training in ACO practice environments will be well served to know how to recognize the needs of medically underserved and vulnerable patients, identify their problems, barriers they experience, and locate appropriate community services “outside of the four walls” of the medical home.