The Project is set up as a set of educational programs sponsored by five primary care departments – Geriatrics, Pediatrics, Obstetrics/Gynecology, Family Medicine, and Internal Medicine. The Project Core is made up of leadership from each department, as well as the associate dean for Graduate Medical Education and a representative for M-Care, the Project's managed care partner. The Core provides direction and coordination for the Project's curriculum development, its implementation, and its evaluation.

The activity of the Project Core during the period April 1 through May 31, 1999 focused on reinvigorating the process of producing documentation for the curricula that has been created for this Project. Meetings were held with Brent Williams, the Project Director, and James Jensen, the new Project Administrator, reviewing with each department's Core leadership and staff the progress that has been made so far and the steps necessary to continue to completion next June. A series of timelines resulted from these meetings, consisting of a variety of deadlines for preparing draft and final versions of the curriculum–based learning objectives / rotation descriptions / seminar syllabi that each department will produce to document its Project related activities.

Project leadership attended the April 13 Symposium. "Caring in the Community," the videotape produced by the Project over the last several months, was shown and selected aspects of the Project were presented at the plenary session.

On April 19, the position of Project Administrator was filled after a one and a half month vacancy. James Jensen began the job with a clean slate, having worked for the U of M library system for the previous dozen years, and started learning about the Project from extensive files and explanations that Janet Heindel had prepared and left behind.

Significant to the future activities of the Project was a meeting with the Executive Director of M-Care, Zelda Geyer-Sylvia, to look into developing physician profiles for residents. Also discussed were plans to provide exposure to the mechanics of managed care organizations by having residents of all departments to sit in and observe M-Care committee activities such as case review, benefits decisions, utilization monitoring, and the like.

In early May the Project's videotape, "Caring in the Community," began to be shown on a daily basis over the patient education channel of the UM Hospital’s cable TV system. This cable system is in use in clinical waiting rooms and in patient's rooms throughout the hospital complex.

A summary of the results of the Attitude Survey for the Project to date is included as Appendix A.

Geriatrics: The Geriatrics managed care curriculum rotations continued on schedule, with the Attitude Survey being administered to each resident at the start and conclusion of each rotation. The locally developed Program Evaluation Survey is taken after the completion of each rotation.

Pediatrics: The four Pediatrics rotations also continued, along with planning to test a knowledge evaluation instrument and to administer the Attitude Survey.

Family Medicine: Family Medicine continued its managed care rotation at The Corner Health Clinic in Ypsilanti, incorporating the new Adolescent Health Curriculum.

Obstetrics/Gynecology: The chairman of the OB/Gyne department and OB/Gyne Project participants met with Core leadership to revitalize this department's participation in the Project. A new steering committee was appointed by the chairman to begin, from the ground up, to plan and implement a OB/Gyne curriculum and rotation.

Internal Medicine: Delivery of the Core Lectures continued, one in April and one in May. The audience consisted of approximately 40 graduate resident physicians and an equal number of undergraduate medical students at the University of Michigan Hospital. As with the March lectures, these lectures were also cablecast to U of M residents working at the Veterans Administration Hospital here in Ann Arbor.

Although the position of Project Administrator has been filled, staffing issues continued to be a significant stumbling block for the Project. James Jensen has needed to be brought up to date with all the Project's activities, history, and personnel, on top of needing a basic familiarization with the UM Medical Campus, its geographic layout, computer systems, and administrative complexities. Additionally, all this training started when the Project Director, Brent Williams, was out of town at national conferences encompassing the Project as well as other matters. Also significant is the fact that the department of Family Medicine has continued to operate without administrative support dedicated to this project, which has hampered its production of documentation for the Project.

Thus far, the University of Michigan has administered and received responses from 36 trainees. The summary that follows has only 32 responses since 4 of the responses are "post" and their small number will not yet produce meaningful interpretations. Although the sample size is small, this summary serves to give a glance at trends seen thus far for trainees who have not yet had significant exposure to managed care. Most respondents are interns (69%) from General Medicine (50%).

With respect to managed care, a large proportion of respondents agree that managed care is an effective way to control costs (56% agree or strongly agree) but they also believe that cost concerns have priority over quality of care concerns (44% agree or strongly agree). Ironically, however, respondents also feel that managed care encourages preventive health care (64% agree or strongly agree) and that specifically, capitation encourages preventive care (50% agree or strongly agree). They seem to also believe that practice guidelines improve clinical outcomes (53%). Respondents view that assessing the health needs of a defined population is important to their success in a managed care environment (78% stated it was important or very important). Yet, many also disagreed or strongly disagreed that managed care is a fair way to compensate health professionals (47%).

With respect to Medicaid, a portion of respondents feel that Medicaid providers should be required to accept Medicaid patients (33% agree or strongly agree). They also believe that Medicaid reimbursement is the greatest barrier to participation in Medicaid managed care (44% agree or strongly agree). Interestingly, only 36% of respondents agree or strongly agree that unique skills are needed to treat the Medicaid population.

Most respondents do believe they will be practicing in a managed care setting (75% stated it was very or somewhat likely). Most also believe they will be serving the under-served populations (66% very or somewhat likely) or specifically, the Medicaid population (83% very or somewhat likely). In terms of future plans, most respondents plan to enter a primary care practice (35%) or fellowship training program (35%) after graduation.

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