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PACER (Professionals Accelerating Clinical and Educational Redesign)
Primary care has undergone dramatic change in recent years, driven largely by the increasing prevalence of chronic disease and an aging population. In response, new training models have emerged to better prepare future health professionals for a career in primary care. But what about the faculty who must teach this new curricula?
As a pilot project, in 2012, the Boards of Family Medicine, Internal Medicine, and Pediatrics worked in harmony to help faculty redesign their residency programs together.
Based on the success of the pilot, in 2015, an interprofessional group of educational leaders and an evaluation team from Oregon Health and Science University—with support from the Macy Foundation, ACGME, the American Board of Family Medicine Foundation, the American Board of Internal Medicine, and the American Board of Pediatrics Foundation—launched the Professionals Accelerating Clinical and Educational Redesign (PACER) project to create a national primary care faculty development program.
Since then, PACER has been equipping faculty at institutions across the country with the skills and tools needed to better prepare students and residents to work in interprofessional primary care teams.
Learning in Teams
Following a highly competitive selection process, nine institutions were chosen to take part in PACER: Eastern Virginia Medical School, Mayo Clinic, Northwell Health, UC Davis, UCSF Fresno, University of Colorado, Palmetto Health (Univ. of South Carolina), Western Michigan University and Wright State University.
Each institution formed a team of ten faculty members from multiple health professions (including medicine, nursing, pharmacy, physician assistant, nurse practitioner, and behavioral health), and across all three residency programs (family medicine, internal medicine and pediatrics).
“We know that primary care teams operating in a collaborative practice model can help us achieve the Quadruple Aim,” said Patrice Eiff, MD, one of PACER’s principal investigators. “That is why with PACER we bring faculty together from across the health professions to work together on clinical and educational transformation. You can’t do this work in silos. Faculty who are responsible for developing interprofessional education for trainees should work across the professions themselves. It’s just common sense.”
The PACER faculty development program is focused around skill-building workshops, collaborative site visits and team coaching:
- Skill-building workshops: Over two days once a year, faculty from all nine institutions came together for a hands-on training to dive deep into building relationships, trust and accountability in the interprofessional faculty teams; confronting team challenges; improving the patient experience; improving the student experience; leadership; and change management. During these workshops, teams from each site also used the time to identify opportunities for change locally at their home institution.
- Site Visits: Between workshops, the PACER coaches and the evaluation team visited each of the nine sites to assess progress and level of collaboration and provide the teams with onsite coaching.
- Coaching: Based on the needs of each team, identified during site visits, an expert faculty coach provides advice around new opportunities and strategies along the way.
“PACER provides a forum for the different health professions faculty to learn about the challenges each face in their educational programs, and then come up with solutions together for how to improve the way they train their students and care for their patients,” explained Dr. Eiff. “Everyone gains.”
Changes in Education
Encouraged by their participation in PACER, sites are testing new teaching approaches, adding more team-based care in their residency clinics, organizing joint grand rounds that include all the health professions, designing more collaborative social determinants of health screenings for patients and piloting new content, such as patient engagement strategies that work to bring the patient and their family into the decision-making process.
Many of the teams have been able to secure additional funding from state agencies and local foundations to pursue their ideas. For example, one site is implementing a project involving multiple health professions to help patients deal with food insecurity.
“What’s exciting about this work is the fact that PACER does not dictate to the sites what they should change or how best to teach team-based primary care,” said Dr. Eiff. “Instead, PACER training catalyzes the sites to pinpoint areas of opportunity and discuss as a team what interprofessional strategies would work best on the frontlines of their classrooms and clinics.’’
Building a Path Forward
Over the next six months, the PACER program is focusing in on completing a comprehensive evaluation to understand what elements of their faculty development approach worked, for whom, and under what circumstances.
Sustainability of the program is also something the team is being very intentional about. Current efforts include developing PACER Regional Centers to provide professional development for faculty in primary care residencies at more health professions schools across the country. The Centers will create regional networks of schools looking to transform their primary care training program and foster collaboration among more primary care health professionals. Advocate Lutheran General Hospital just outside of Chicago will serve as the first Regional Center, and discussions are underway with other institutions to create two more Regional Centers by the end of 2018.
“Building up interprofessional primary care programs is something any institution can do, and it starts simply with bringing faculty together who don’t normally cross paths and beginning to build trust and relationships,” said Dr. Eiff. “At the end of the day, this is about better patient care and helping all of our health care professionals get the most that they can out of their work.”