Health system and patients thrive when all graduates of medical training have sufficient exposure to primary care and related concepts (Schneider et al, 2017). A “teach the teacher” program is typically designed to enhance junior faculty teaching of residents and students in the clinical or classroom setting. This model of train the trainer is favored for medical education because the similarities in background allows for easier acceptance of new concepts by peer learners.
Our fellowship will focus mental health training on several new advances in patient- centered, interprofessional mental health care.Such approaches have yielded improved outcomes in terms of patient/provider satisfaction, cost, and quality. There is currently a need for PCPs to be trained and supported during adoption of the collaborative care model. Through enhanced training in novel tools and models of care, our fellows will graduate poised to better meet the mental health needs of the surrounding communities.
Through well-vetted modules, group workshops, and exercises exploring QI through the lens of the Social Determinants of Health and Mental Illness components, fellows will be empowered to begin QI work. This experiential learning will include self-designed projects, mentoring from the fellowship director, and peer support. Targeted projects will address an actual need in the practice linked to an existing publicly reported quality metric, while balancing the resources and limitations of the practice and surrounding community, as well as the one-year fellowship timeline.
Social Determinants of Health
Leaders in the medical community call for physicians to target the larger structures and public policies that influence the SDH through advocacy (Woolf & Purnell, 2016). Cincinnati and Hamilton County have a critical need for healthcare workers to address SDH. In Cincinnati, more than 50% of children under the age of 6 live in poverty, including 75% of African American children (Baker et al, 2015). Overall, 34% of Cincinnatians live in poverty, doubling the average rate for all of Ohio and ranking among the most impoverished cities in the nation. Training in transformational primary care will take into account the health disparities of our local community.
Substance Use Disorder
Evidence suggests patients using Medication Assisted Treatment (MAT) to treat opioid addictions, have decreased likelihood of illicit opioid use, fewer criminal behaviors, better psychosocial functioning, and reduction in risk of death. Fewer than half of DATA 2000 waiver certified physicians actually move to providing MAT. This has resulted in an estimated one million opioid treatment eligible people not receiving the care they need for dependence (Vashishtha, Mittal & Werb, 2017). Our fellowship will help providers overcome barriers through targeted modules, DATA 2000 waiver training, and access to individualized tele- mentoring from an addictionologist to support fellows during the initial 6 months of MAT initiation.
Wellness and Burnout
Burnout has a known correlation with decreased quality of care and patient safety, lower patient satisfaction scores, increased prevalence of addiction among physicians, and increased risk of physician suicide (Drummond, 2015). It also leads to physician attrition from the work force. Primary care provider attrition is a particularly worrisome issue in Cincinnati where there is already a current and projected shortage in the primary care workforce. The fellowship goal of improving the informal learning environment of the workplace will be accomplished by empowering fellows with skills for self-monitoring, creating action plans, reflective practice, and adapting the plan.