Practice observation visit for interprofessional training in primary care

Abstract

Primary care (PC) is the foundation of healthcare, and a larger, more interprofessional (IP) workforce is needed to provide integrated whole-person care to all. Our innovative IP Primary Care Course (PCC), an elective classroom course, enrolled 84 learners over three years from dentistry, medicine, nursing, nurse practitioners, pharmacy, physician assistants, public health, and social work. The course centerpiece is the Practice Observation Visit (POV), as a low-cost, adaptable, IP exercise applicable to all health professions at all levels of training. The objective is to demonstrate the major themes of PC: first contact care, continuity of care, comprehensive care, variety of clinical work, variety of patients, variety of clinical content, complexity, family context, and collaborative IP team practice. Learners spend one half-day shadowing a PC clinician, observing day-to-day practice, patients, problems, and teamwork. Patient Logs record age, sex, new/established status, and number of problems. Problem Logs record clinical problems, acute/chronic care, preventive service, or administrative tasks. Data are aggregated across students and presented for discussion and reflection. Students write personal reflections and comment on other students' reflections. Assessment of the POV with student observation logs and comments documented achievement of all objectives. The POV was the course highlight for 99% (70/71) of students; 76% (54/71) rated it Very High Value and 23% (16/71) High Value. Three evaluation studies demonstrate effectiveness. A. Student evaluations showed 99% rated IP PCC high value, 93% recommended it to others, 41% advocated it be required for all students, 56% reported it recruited them to plan PC careers. B. Before-and-after 5-year follow-up study showed sustained increases in PC and IP knowledge, attitudes, and practice. C. Controlled waitlist study compared PCC to similar waitlist students and confirmed the 5-year follow-up results. More PCC students reported working in PC (74% vs. 27%), direct patient care PC (48% vs.19%), and underserved communities (74% vs. 46%). The low-resource, high-impact POV can be adapted early, easily, and universally across health professions with documented impact upon trainees, knowledge, attitudes, and careers.