Preventive practicum training in healthcare organizations - The Meharry model

Background: Practicum training for preventive medicine residents often occu rs in agencies whose community is geographically defined and whose governan ce is closely linked to public election. We were unsure about the financial ability of such departments to support training and are concerned that ove r-reliance on traditional health departments might not be best for either m edically indigent populations or preventive medicine. We, therefore, sought to apply a public health model-based on a strategic partnership between nu rsing and preventive medicine-to a large health care organization. The resu lt was formation of a mini-health department, suitable for fully accredited preventive medicine practicum training, within the Alvin C. York Veterans Affairs Medical Center, Murfreesboro, TN. This Center serves a defined population of 21,594 patients and about 1600 e mployees. The theoretical framework for the new department was based on dem onstration of a close fit between the competencies expected of preventive m edicine physicians by the American College of Preventive Medicine (ACPM) an d activities required by the Joint Commission on Accreditation of Healthcar e Organizations (JCAHO). Because of JCAHO requirements, many healthcare org anizations already pay for preventive medicine services. Conclusions: Practicum training for preventive medicine residents often occ urs in agencies whose community is geographically defined and whose governa nce is closely linked to public election. We were unsure about the financia l ability of such departments to support training and are concerned that ov er-reliance on traditional health departments might not be best for either medically indigent populations or preventive medicine. We, therefore, sough t to apply a public health model-based on a strategic partnership between n ursing and preventive medicine-to a large health care organization. The res ult was formation of a mini-health department, suitable for fully accredite d preventive medicine practicum training, within the Alvin C. York Veterans Affairs Medical Center, Murfreesboro, TN. This Center serves a defined pop ulation of 21,594 patients and about 1600 employees. The theoretical framew ork for the new department was based on demonstration of a close fit betwee n the competencies expected of preventive medicine physicians by the Americ an College of Preventive Medicine (ACPM) and activities required by the Joi nt Commission on Accreditation of Healthcare Organizations (JCAHO). Because of JCAHO requirements, many healthcare organizations already pay for preve ntive medicine services. By placing preventive medicine training faculty in to existing budget slots at our institution, systemwide personnel costs for prevention decreased by about $36,000 per year, even as personnel funding for preventive medicine physicians increased from about $24,000 to $376,000 per year. Moreover, there was dramatic, sustained improvement in 17 indica tors of preventive care quality as determined by an external peer review or ganization. In addition to providing a new venue for training, this model m ay also improve the quality and reach of preventive services, decreased fix ed costs for service delivery, and yield new employment opportunities for p reventive medicine physicians.