MHC 797A - Medical Home Longitudinal Advanced Elective
- Shou Ling Leong, MD, Professor of Family and Community Medicine
Successful completion of the first three years of medical school curriculum. Approval from student’s faculty advisor.
This course will be offered at Penn State College of Medicine.
The Medical Home Longitudinal Advanced Elective will provide continuity experiences for students to learn and witness the natural progression of illnesses, develop treatment options over time in a team format, as well as develop empathetic healing relationship with patients. As senior students, they will take on a higher level of responsibility in the management of their patients, similar to that of an intern. Continuity with a preceptor will allow ongoing assessment and mentorship. Students will spend one-half day per week at a Patient Centered Medical Home ambulatory practice sites for 6 months. This allows students to learn about the emerging healthcare model with team-based care, health information technologies, medication safety and practice management. Under the supervision of the preceptor, students will complete a project relevant to the goals and objectives of the course. This course will augment the learning of acute medical care by adding continuity of experiences. Specific scheduling arrangements are required to take this course. Prior to the start of this advanced elective, the course coordinator will arrange for students to be excused from other scheduled courses for a half-day session each week. Courses that are concurrent with the Medical Home Longitudinal Advanced Elective must be within a 1-hour drive of the site for the advanced elective. Further details may be found in section C3 of the course document. Space is limited for this course and is offered on the first-come, first-served basis.
1. The clinical experience
a. Students will have their own panel of patients and be able to provide ongoing in-depth care to patients with chronic medical diseases. In coordination with the medical team at the assigned practice site, students will:
• Follow up on their patients (phone calls, check on responses to medication/treatment; track lab tests )
• Assist with care coordination
• Review consultation from specialist services to ensure that recommendations are implemented
b. Students will meet regularly with their preceptor to develop care plans for the patients, and for feedback and
2. The educational activities will focus on 4 elements of the Patient Centered Medical Home:
• Population management and disease registry
• Team-based care and care coordination
• Medication reconciliation and transitional care
3. The didactics and group learning activities will aim to:
• Teach the knowledge and skills the students need to function effectively at the practice site
• Teach important concepts of the curriculum that the students may not see/experience at the practice site
4. Quality improvement project:
Under the supervision of the preceptors, students will also conduct a quality improvement project, such as a Plan, Do, Study, Act (PDSA) project.
Goal I. Enhance medical student education through a longitudinal experience allowing students to experience and learn from an environment with continuity with patients, preceptors and the clinical practice.
1. Discuss the natural progression of the common chronic diseases over time.
2. Demonstrate patient centered relationship skills.
3. Develop in-depth involvement with patient care and experience continuity with a selected number of patients by planning follow-up appointments, coordinating care with specialty services, ancillary services and/or community resources.
4. Develop a longitudinal relationship with a panel of patients associated with a faculty mentor who can provide ongoing formative feedback.
5. Present a comprehensive higher order assessment and plan tailored to a patient’s unique circumstances.
6. Describe the workflow of the practice and aspects of practice management.
Goal II. Provide opportunities for students to learn the concepts of the chronic disease model and its application to chronic disease management.
1. Name the components of the Chronic Care Model.
2. Apply evidence-based guidelines to the diagnosis and management of chronic diseases.
3. Describe the application of the components of the Chronic Care Model to a common chronic disease.
4. Supervise, diagnose, and manage patients with common chronic diseases.
5. Recognize the socioeconomic impact of the chronic disease on health care spending, overall health care delivery and the utilization of health care resources.
6. Accurately assess their teaching site’s practice activities relative to the Chronic Care Model.
7. Know the capabilities of a fully functional electronic health record (EHR) and disease registries in the management of chronic diseases and use the available EHR in each practice.
Goal III. Prepare students to practice in the changing medical environment by introducing the concepts of the Patient Centered Medical Home.
1. Describe the major features of the Patient Centered Medical Home and its application to health care reform.
2. Describe experiences within health care systems familiar to the students (i.e., at their clerkship site) and contrast this to that found in the Patient Centered Medical Home.
3. Explain how the Patient-Centered Medical Home enhances quality improvement and patient safety.
4. Discuss the epidemiology of medical errors and identify mechanisms to improve patient safety and reduce medical errors, including medication reconciliation and hand-off communication.
5. Develop a perspective that quality health care should be coordinated, interdisciplinary and delivered in a team approach in a longitudinal fashion.