Enhancing Team-Based Skills in Primary Care: A Competency-Based Approach to Training and Workforce Development

Abstract

Providers working with a team in primary care settings require training to develop the unique skills needed in an integrated, team-based environment. Training focuses on developing a core set of skills that prepares team members to address patient behavioral issues. The training enhances and complements the foundational skills related to the member’s distinct function on the team. Training and workforce development programs begin by assessing the learner’s level of need then supporting core competency development. Integrated, team-based training programs and courses are aligned to address the interdependence of the three worlds (i.e., clinical, operational, financial) of healthcare delivery.

Appendix: Example of a Practitioner Performance Evaluation

Knowledge/Skill

These core competencies were compiled from workgroup reports and other existing evaluation measures of behavioral health practice. Student interns will demonstrate their knowledge and application of ideas and concepts by either discussing, describing, or incorporating concepts in their case consultations, planning notes, case presentations, consultation group discussions, and/or performance review meetings.

Dimensions

Student interns are expected to develop an increased awareness of the implications and impact of the multiple dimensions of their work. (Example: Student interns should become increasingly able to articulate and address the operational and financial implications of clinical practices.)

• C = clinical

• O = operational

• F = financial

Behavioral Anchors

The behaviors that the evaluator may observe in the course of working with the student intern

Focus of Evaluation

This column lists the most likely places that the student intern would demonstrate the behaviors that are to be evaluated.

Item evaluation scale (select ˝ the column that applies to each item)

• Proficient – The student intern consistently demonstrates behaviors that are appropriate and applicable to the current work.

• Progressing – The student intern occasionally demonstrates behaviors that are appropriate and applicable to the current work.

• Missing – The student intern does not demonstrate behaviors when it would be appropriate and applicable to the current work.

• Not observed – The student has not had the opportunity for the evaluator to observe the student’s behavior.

	Knowledge or skill	Dimensions	Care behavioral anchors	Focus of evaluation	Proficient	Progressing	Missing	Not observed
Conceptual and professional development
1	Systems orientation	C	Identifies clinical models that are appropriate for the primary care setting	Verbal report to mentor includes description of approach among range of models
2		O	Identifies policies and procedures related to sustaining integrated practices	Refers to related on-site policies in descriptions of clinical practices
3	Primary care culture	C	Communicates unique features of primary care setting	Suggests clinical approaches that work well within primary care setting
4		O	Practices brief hallway consultations with other clinic providers	Review of occurrences of hallway handoffs
5	Cultural adaptation	C	Readily available for warm handoffs during patient exam visits	Available to provide patients with immediate BH assistance
6		O	Collaboration with medical team performance	Feedback from medical team reports about intern support of medical team goals
7	Professionalism	C	Clearly describes the unique, complimentary roles of each member of the interprofessional medical team	Performs a unique clinical role on interprofessional medical team
8		O	Collaborates well with other providers in the clinic	Medical team feedback about student intern collaborative interactions
9	Practice-based learning	C	Generates educational opportunities for practice members to examine behavioral factors related to patient medical conditions (e.g., lunch and learns)	Review list of presentations student intern shared with medical team
10		O	Attends regular medical staff learning opportunities (e.g., grand rounds)	Review list of presentations attended
11	Biopsychosocial orientation	C	Describes the behavioral, physical, and relational dimensions of patients’ medical issues	Review feedback from medical team
12		O	Supports integrated clinical pathways that provide comprehensive treatment of targeted patients	Review student intern’s treatment plans
13	Quality improvement	C	Identifies targets for behaviorally oriented, quality improvement projects	Proposes steps for a quality improvement plan
14		O	Regularly participates in improvement conversations	Provides useful suggestions for improving clinical practice
Clinical skills/practice
15	Screening and assessment of behavioral health issues related to medical conditions	C	Consistently uses validated outcome measures to assess patients	Review list of measures used
16		O	Translates assessment results in practical terms that support the work of the medical team	Summary note for medical team in patient medical record
17	Population-based approaches	C	Identifies needs and approaches to address patient populations	Review student intern’s use of population-based protocols
18		O	Participates in care pathways that support medical team responses to patient population needs	Role of BH in care pathways
19	Evidence-based interventions	C	Uses evidence-based interventions related to focused, patient populations	Review list of evidence-based approaches
20		O	Chooses evidence-based interventions that support integrated pathways	Student intern reports identifying specific data fields from patient medical records or EHR
21	Informatics and data	C	Engages in bi-directional, transparent notes and communication with other medical team members thru EHR	Review content and communications within student intern’s clinical notes
22		O	Uses template EHR for clinical notes	Review accuracy of student intern’s clinical notes
Practice management
23	Documentation	C	Develops clinical notes that provide a clear and succinct summary of patient BH issues directly related to medical condition(s)	Review clarity and form of student intern’s clinical notes
24		O	Develops clear, accurate EHR notes that are understandable and useful to other medical team members	Review applicability of student intern’s clinical notes to other team members’ roles
25	Time management	C	Performs brief, targeted patient assessments and interventions	Student intern’s visits with patients average less than 30 min
26		O	Work with patients supports the established clinic workflow	Feedback from medical director and other medical team members of student intern’s participation in workflows
27	Resource management	C	Appropriately refers patients to self-management and/or community resources with clear rationale for referral	Review the relevance of the list of resources referred to patient conditions and needs
28		O	Appropriately refers patients to other medical team members with clear rationale for referral	Feedback from medical team that intern provides appropriate referrals
29	Compliance with clinic policies and protocols	C	Uses approaches to patient care that are consistent with clinic policies	Feedback from team lead that intern supports clinic policies and procedures
30		O	Demonstrates support of existing clinic workflows and practices	Feedback from medical team that intern supports practices
Collaboration
31	Communication with providers and patients	C	Describes clear connections between patients’ BH issues and their medical conditions	Feedback from medical team that intern clarifies relationship of BH issues to patient medical conditions
32		O	Identifies ways collaborative care can effectively address patient medical and behavioral issues	Feedback from medical team that intern discusses team-based care efforts
33	Interprofessional relationships	C	Consults with medical team members to support patient medical outcomes	Feedback from medical team that intern seeks out consultations
34		O	Develops relationships to supports clinic practices	Feedback from medical team that intern discusses ways to coordinate practice
35	Care coordination	C	Explores with patients ways to use the various medical team resources	Review description of referrals within student intern’s clinical notes
36		O	Provides accurate and sufficient information necessary for other team members to provide patient continuity of care	Review recommendations within student intern’s clinical notes
37	Identifies and supports medical team shared goals	C	Communicates with patients about the medical team’s treatment goals	Review relevance to treatment goals within student intern’s clinical notes
38		O	Addresses shared goals during case consultations and staff meetings	Connections of case review reports to shared medical team goals
39	Supports patient engagement on care team	C	Invites patients to contribute to the treatment decision-making processes	Review descriptions of patient communications in student intern’s clinical notes
40		O	Articulates the patients’ views during case consultations	Reports addressing patient views in student intern’s case reviews

Financial Implications

Student interns will also demonstrate their knowledge and application of the financial implications of their clinical work by either discussing, describing, or incorporating concepts in their case consultations, planning notes, case presentations, consultation group discussions, and/or performance review meetings.

	Dimensions	Care behavioral anchors	Focus of evaluation	Proficient	Progressing	Missing	Not observed
41	F	Describes ways that work with patient populations optimizes practice financial resources	Reports addressing PHM approaches in student intern’s case reviews
42	F	Describes impact of behavioral involvement on shared financial responsibility with the medical team	Feedback from medical team that intern discusses appropriate use of financial resources in treatment planning
43	F	Displays awareness of needed documentation for use of specific billing codes and appropriately completes documentation in notes	Review descriptions of billing codes in student intern’s clinical notes
44	F	Identifies how recommended treatments impact the utilization of resources	Reports addressing resource utilization in student intern’s case reviews