Resident Physician Training: Shifting our focus From Acute to Chronic Care

Chronic diseases are the leading cause of death and disability in the US with more than 75% of our health care spending on patients with chronic conditions. As more patients develop chronic diseases, it is essential for residency education to shift training from acute care to chronic care. Shifting focus to chronic illness care is especially applicable to the ambulatory setting where physicians develop a longitudinal relationship with patients and integrate management of chronic conditions with the individual circumstances of the patient.

The chronic care model (CCM) identifies self-management skills and team-based delivery of health care as key components of a successful health care system. This model is relevant to the clinic setting where physicians assist patients in developing self-management skills as part of chronic illness care. This physician-patient partnership is dependent on the physician’s ability to envision the impact of chronic illness on the psychological and social aspects of care and to develop a multi-disciplinary and multi-cultural approach to the treatment of chronic illness.

Little is known about how to adequately train physicians in assisting patients with self-management skills. Using a research validated framework of chronic illness (FFPM™) that has been used to train clinicians and assist patients, we developed an instrument to study residents’ knowledge and understanding of the impact of chronic illness. The first stage of this pilot project utilized the instrument to measure the evolving knowledge and understanding of residents on the impact of chronic illness in the physical, psychological and social domains /spheres of patient care. The instrument will assist us in identifying additional content and strategies for curriculum development. In Spring 2015 we engaged in the process of measuring the validity and reliability of the survey tool and subsequently piloted the tool with residents.