Hofstra Northwell: IMPACcT Program Promotes Team-Based Primary Care

Hofstra Northwell School of Medicine introduced a program in 2016 to help improve patient care by shaping and training the future primary care leaders and physicians. The IMPACcT, or Improving Patient Access, Care, and Cost through Training, program has set out to bring more primary care providers into the health care world, as the shortage of primary care physicians increases nationally.

According to the Association of American Medical Colleges, “projections show a shortage ranging between 61,700 and 94,700, with a significant shortage showing among many surgical specialties” for the next decade. This need for primary care physicians helped spark the idea behind the development of IMPACcT.

“There’s lot of data that suggests that many learners are going into non-primary care for cost issues, burnout issues, demand issues, so we’re really trying to meet a national need that is going to improve the lives of patient care,” Johanna Martinez, MD, MS, Graduate Medical Education Director of Diversity and Health Equity, assistant professor at Hofstra Northwell School of Medicine, and one of the core faculty member involved, told MD Magazine. “We also know that when there are more primary care providers within any region, the health outcomes of patients are better.”

The program promotes itself as a primary care training enhancement award, and stresses the need for more interprofessional work for primary care providers. Consisting of 5 tracks — medical students, medical residents, pharmacy students, physician’s assistant students, and psychology externs – IMPACcT provides an expanded primary care education curriculums, team based clinical care, and a one-on-one mentorship program.

“They get a much more enhanced clinical experience — again, for many of these learners, they’ve been ‘siloed’ into just medicine or just pharmacy or just psychology,” Martinez said of the medical students involved in the program. “Now, for the first time ever, they’ve been exposed to other professions, they’re learning from other professions, they’re building skills together. We’ve really established a community of practice amongst all of the disciplines and professions.”

Interprofessional care and practice is becoming a more widely used approach to providing care for patients, with agencies like Nexus Healthcare, the Health Resources and Service Administration (HERSA), and the American Board of Internal Medicine (ABIM) promoting multidisciplinary team work. Martinez noted that “lots of the professional medical societies are really pushing the inter-professional, team-based patient-center care world.”

A 2011 study led by Diana R. Bridges, MSN, RN, CCM, in the Department of Interprofessional Healthcare Studies at the Rosalind Franklin University of Medicine and Science examined the collaboration between teams of multidisciplinary professionals, highlighting that successful team efforts lead to improved health care outcomes for patients.

Bridges and colleagues noted that “understanding others' professions and your own role in the healthcare team is critical” in interprofessional settings and that students in these programs need “to ‘see’ the impact of interprofessional efforts and reflect on the experience to help reinforce interprofessional learning outcomes.”¹

“For the learners, it’s been an extremely amazing and rewarding experience from both an educational and clinical skillbuilding point of view,” Martinez said. The IMPACcT program wrapped up its first complete year earlier in 2017, with the goal of having students complete the program for all 4 years they attend Hofstra Northwell School of Medicine.

The program provides opportunities for more than just students, however. With the program’s structure highlighting the fact that the physician is not just the leader of the team, but a contributing member, there was a need to break down some of the “hierarchal barriers,” as Martinez noted, about the roles of each member. Faculty involved in the program, many of whom did not receive this sort of training in medical school, were handed the chance to develop skills and gain from the program as well.

“I think that for the faculty members, this was really a novel concept, so we had to do a lot of faculty development training around the idea that the physician is part of the team, not just the leader of the team,” Martinez said. “The faculty members and preceptors have gotten lots of development around professional education into professional care, precepting skills in addition to leadership skills, educational and curriculum assessment and development skills.”

“I think they’ve come into a whole new set of skills that, in traditional medical school, most of the more senior faculty members had not experienced when they were in their training,” she added.

In her study, Bridges echoed a similar sentiment, stating that “the training of mentors/faculty is an important element in the successful interprofessional curriculum. Mentors and faculty need to feel confident in their interactions with students. The significance of any interprofessional course needs to be shared with faculty so they can see its importance.”

The program also features a mentoring partnership with one of the general internal medicine faculty members, chosen based on the mentee’s interest, goals, and experience, according to the program’s overview. Mentees and mentors remain partnered throughout their time in the program, holding regularly scheduled one-on-one meetings, and cross-mentoring from the other participating faculty members.

“It’s really a tailored mentoring experience for each of our learners,” Martinez told MD Magazine. “It is really uniquely designed for their discipline, and where they want to see their future careers go.”

IMPACcT is a collaborative effort on all fronts, with the program itself presenting opportunities for psychology externs from Zucker Hillside Hospital, part of the Northwell Health system, and for pharmacy students at St. John’s University in Queens, NY.

The program’s leaders, including program director Joseph Conigliario, MD, MPH, and co-director Alice Fornari, EdD, RD, range widely in multiple disciplines, with track directors for each field — Nancy LaVine, MD, (residents); Lauren Block, MD, MPH (medical students); Celia Lu, PharmD (pharmacy); Daniel Coletti, PhD (pscyhology); and Crystal McGowen, MS, PA (physician’s assistants) – leading each of the 5 tracks of the program.

“I think for those facilities that are looking to do those similar things, we’re always welcoming collaborators and people who are interested,” Martinez told MD Magazine. “Our leadership team is quite large and we are a multidisciplinary team, so they can reach out to any of us. It is really giving them a chance to be centers of excellence in inter-professional education and clinical practice.”