The success of health care in any nation relies on the ability of medical educators to prepare future physicians to address impending societal health care needs. Although we teach medical students that quality medical care must be grounded in a solid evidence base, knowledge without a contemporary framework through which they can apply this knowledge will not provide them with the tools necessary to effectively care for patients. These issues become particularly important when caring for the rapidly growing elderly population living with chronic illness and a cadre of physicians who feel unprepared to meet patient needs due to limited training in chronic care1, 2
The importance of education in chronic care becomes even more significant when one realizes that 133 million Americans have at least one chronic condition and that treatment for those patients accounts for nearly 75% of all medical expenditures2
. Moreover, surveys have shown that less than one half of U.S. patients with hypertension, depression, diabetes, and asthma are receiving appropriate treatment3
. These facts should alert us to not only enhance undergraduate and graduate clinical training regarding individuals with chronic disease but also, in parallel, to provide students with an effective framework within which to use their clinical skills.
A framework that has been proven to both improve quality of care and reduce health costs in chronic disease care is called the Chronic Care Model4
. Inspired from efforts to improve chronic illness management at the Group Health Cooperative of Puget Sound in Washington State, the model was developed by Dr. Edward H. Wagner at the MacColl Institute for Health Care Innovation3–5
. In brief, the Chronic Care Model is comprised of six elements that provide a conceptual framework for care that integrates chronic care management through incorporation of interdisciplinary teams. The aim is to improve care by educating, empowering, and building confidence in patients and their families in the self management of their chronic conditions3
. The six core elements involved are: Community Resources, Self-Management Support, The Healthcare Organization, Delivery System Design, Decision Support, and Clinical Information Systems. Although no one element supercedes another, they work in tandem to help fulfill the primary goal of improved chronic care. Hence, its aim is to provide a multidimensional solution to the complex problem of addressing chronic care4
Success of the Model in a variety of health care settings has sparked interest in applying the model to residency training in order to enhance the relevance and excellence of clinical education6
. In fact, implementation of the Model in this context has been shown to improve the quality of care provided by primary care residents while functioning as a vehicle to achieve the six core competencies set forth by the Accreditation Council of Graduate Medical Education7
. Trainees using the Model have indicated benefits including an appreciation of multidisciplinary learning from team members and patients and increased collaboration with patients to identify areas of change. Moreover, a study conducted by Greene8
has shown that resident access to a chronic care training intervention led to greater use of Model elements and a 43% reduction in asthma related emergency department use.
We integrated the Model into a novel fourth-year medical school community health improvement course and studied student perceptions regarding the integration of Model elements into their course projects.