The field is changing fast -- and so is caregiver training.

As one of the first medical students to participate in Duke’s Primary Care Leadership Track pilot program, Chris Danford is gaining a new perspective on how medicine is practiced.

While his peers spend most of their second year rotating through the hospital, Danford, 28, follows a set panel of patients from the hospital into the outpatient arena.

“I hear the team’s thought process while the patients are hospitalized, as well as the goals they set for long-term care,” says Danford. “After discharge, I see how much actually happens. I’m surprised at how disjointed the transition can be.”

Community-Based Learning

Showing students how the health care delivery system works through patients’ eyes is the intent of the newly launched Primary Care Leadership Track (PCLT). The four-year curriculum will require coursework and on-the-ground experiences in epidemiology and leadership training, community engagement, and the patient-centered medical home.

Students work as part of caregiver teams involved in Durham community projects such as LATCH, which serves people without insurance, and Project Access, which helps low-income patients obtain costly specialty care.

“These experiences will help our students think outside of the traditional clinical settings,” says Barbara Sheline, MD, MPH, assistant dean for primary care. “By working in the community, understanding it, and researching it, they will come to appreciate some of the current problems in the health care system and, ideally, find ways to improve it.”

PCLT -- which offers students a $10,000-per-year scholarship in exchange for committing to a career in primary care -- reflects a push by medical, nursing, and physician assistant schools nationwide to attract, nurture, and train primary care professionals -- a critical goal, given national forecasts for provider shortages across the spectrum of primary care.

Duke Medicine has been helping to lead the charge.

Last year, leaders from Duke and the University of North Carolina joined with other national health-care experts to call for dramatic changes in the way primary care is valued, delivered, and integrated into health care systems.

Their report, sponsored and funded by the Josiah Macy Jr. Foundation, stressed the need to improve educational models and advance science, teaching, practice, and policy development related to primary care as a foundation for expanding the ranks of primary care professionals.

The PCLT is one of the only such programs in the country to combine opportunities for community service with a strong emphasis on community-engaged research. It complements a revamped training program for Duke family medicine residents, which was reorganized in 2007 to emphasize community-based medicine and innovative models of care such as medical homes.

“Even before health care reform came into play, we knew some real changes needed to occur in how we care for patients and train future physicians in these new models of care,” explains Dev Sangvai, MD, chief of Duke’s Division of Family Medicine.

“We needed to enhance the way residents approach patient care, and get them thinking about health care across the continuum of needs rather than from an episodic perspective. Providers also should be thinking about their patients from a population health perspective. These approaches to patient care are generally not taught in the traditional residency model, but they are in our program.”

Duke’s highly ranked School of Nursing and physician assistant (PA) program are also making changes with an eye toward future needs in primary care.

Last fall, the nursing school received a nearly $1.3-million federal grant to help alleviate caregiver shortages by increasing enrollment and accelerating graduation rates of students in its adult primary care nurse practitioner and family nurse practitioner programs.

Similarly, Duke’s PA program won federal support this year to develop an extended primary care rotation track that will expand the number of PAs practicing in rural, underserved areas in North Carolina.

Team-Based Training

And to better prepare students for the new world of primary care, in which health professionals work as teams to coordinate patient care, Duke’s medical, nursing, PA, and physical therapy programs now offer regular team-based training sessions that bring students of various disciplines together for joint learning and problem-solving -- unmatched preparation for the future of clinical practice.

“It’s increasingly apparent that primary care will be the epicenter of medicine in the future,” says John Anderson, MD, chief medical officer of Duke Primary Care. “It’s being redefined as the career where all the action is happening.”

Read more about the new Primary Care Leadership Track on page 11 of the Summer 2011 issue of DukeMed Alumni News (PDF, 2 MB).