Interdisciplinary ambulatory education and service in primary care at the University of New Mexico

Development of an interdisciplinary women's health training model

In response to expanded residency training requirements in women's health, faculty from internal medicine, obstetrics/gynecology, and psychiatry at Yale University School of Medicine established an interdisciplinary women's health training and education model, the Interdisciplinary Women's Health Clinic (IWHC). The model was one component of a larger, comprehensive women's health program at Yale funded by the Department of Health and Human Services between 1996 and 2000 under the National Centers of Excellence in Women's Health (CoE) designation. This article describes the structure and function of the model, its value to residents and the institution, and its limitations that led to its closure when Department of Health and Human Services support ended. The IWHC was designed as a consultation service that augmented the primary care provided to low-income, minority-group women in an established outpatient primary care setting. An interdisciplinary team of residents and faculty provided and coordinated a range of services for patients and participated in a weekly core curriculum. The model was an important resource to residents and provided high-level integrated care to patients. The combined educational experience helped refine a core interdisciplinary women's health curriculum. Despite these benefits, the IWHC could not be sustained outside the financial and programmatic structure of the larger CoE program. This experience suggests that longitudinal models where residents from different disciplines train in a shared educational and clinical setting may be more durable. Interdisciplinary models are effective ways to train residents and provide integrated care to women. The model's success depends on highly developed collaborative relationships between faculty, nonclinical sources of support, and long-term institutional commitment.

A review of medical and allied health learners' satisfaction with their training in women's health

OBJECTIVE

Graduating learners from Oregon Health and Sciences University programs and from the National College of Naturopathic Medicine were surveyed about their attitudes toward their training in women's health.

STUDY DESIGN

The survey addressed learner satisfaction with training in women's health, their preferred learning methods, and their clinical comfort in managing 17 clinical problems. The survey addressed knowledge of complementary and alternative medicine.

RESULTS

Satisfaction with training in women's health varied by program. Satisfaction increased with increasing proportion of women seen during training. Clinical confidence scores increased with increasing proportion of women seen during training. Physical assault and breast disease were areas of least clinical confidence. All groups preferred learning in clinical rather than didactic settings. Experience with alternative and complementary medicine was very limited except among naturopathic students.

CONCLUSIONS

Areas of common educational need were identified among a variety of learners. This information will assist educators in designing multidisciplinary programs to meet the needs of this diverse group.

The primary care specialties working together: a model of success in an academic environment

In today's environment of decreasing resources and increasing competition among clinical delivery systems, survival and ultimate success require interdisciplinary cooperation and, if possible, integration. Academic leaders at the University of California, Irvine (UCI), have developed a collaborative model in which faculty in family medicine, general internal medicine, and general pediatrics cooperate extensively in education, research, and patient care. Generalist faculty jointly administer and teach both a four-year "doctoring" curriculum for medical students and an array of integrated curricula for primary care residents, including a communication skills course. Several primary faculty jointly developed a collaborative unit for health policy and research, now an active locus for multidisciplinary research. Other faculty worked together to develop a primary care medical group that serves as a model for interdisciplinary practice at UCI. Recently, the university recruited an associate dean for primary care who leads the new UCI Primary Care Coalition, reflecting and promoting this interspecialty cooperation. This coalition does not represent a step toward a generic primary care specialty; UCI's generalist disciplines have preserved their individual identities and structures. Yet interdisciplinary collaboration has allowed primary care faculty to share educational resources, a research infrastructure, and clinical systems, thus avoiding duplicative use of valuable resources while maximizing collective negotiating abilities and mutual success.