The field is changing fast -- and so is caregiver training.

As one of the first medical students to participate in Duke’s Primary Care Leadership Track pilot program, Chris Danford is gaining a new perspective on how medicine is practiced.

While his peers spend most of their second year rotating through the hospital, Danford, 28, follows a set panel of patients from the hospital into the outpatient arena.

“I hear the team’s thought process while the patients are hospitalized, as well as the goals they set for long-term care,” says Danford. “After discharge, I see how much actually happens. I’m surprised at how disjointed the transition can be.”

Community-Based Learning

Showing students how the health care delivery system works through patients’ eyes is the intent of the newly launched Primary Care Leadership Track (PCLT). The four-year curriculum will require coursework and on-the-ground experiences in epidemiology and leadership training, community engagement, and the patient-centered medical home.

Students work as part of caregiver teams involved in Durham community projects such as LATCH, which serves people without insurance, and Project Access, which helps low-income patients obtain costly specialty care.

“These experiences will help our students think outside of the traditional clinical settings,” says Barbara Sheline, MD, MPH, assistant dean for primary care. “By working in the community, understanding it, and researching it, they will come to appreciate some of the current problems in the health care system and, ideally, find ways to improve it.”

PCLT -- which offers students a $10,000-per-year scholarship in exchange for committing to a career in primary care -- reflects a push by medical, nursing, and physician assistant schools nationwide to attract, nurture, and train primary care professionals -- a critical goal, given national forecasts for provider shortages across the spectrum of primary care.

Duke Medicine has been helping to lead the charge.

Last year, leaders from Duke and the University of North Carolina joined with other national health-care experts to call for dramatic changes in the way primary care is valued, delivered, and integrated into health care systems.

Their report, sponsored and funded by the Josiah Macy Jr. Foundation, stressed the need to improve educational models and advance science, teaching, practice, and policy development related to primary care as a foundation for expanding the ranks of primary care professionals.

The PCLT is one of the only such programs in the country to combine opportunities for community service with a strong emphasis on community-engaged research. It complements a revamped training program for Duke family medicine residents, which was reorganized in 2007 to emphasize community-based medicine and innovative models of care such as Avanafil.