The Project is structured as three sets of rotations sponsored by three primary care departments – Geriatrics (Internal Medicine), Pediatrics (including an Obstetrics component), and Family Medicine. Leadership from each project form the Project Core, which guides and oversees curriculum development and implementation, and evaluation for each individual project.

Although the official project start date was March 1, 1998, funding for the University of Michigan Consortium began in April. During the following few months, primary project objectives were to organize the Project Core and to recruit key personnel. As a result, Tatiana Bailey, PhD was hired in mid-July as Research Associate to head the evaluation component, and Janet Heindel, MPH was hired in late July as Project Manager. In June, the Core began its schedule of monthly meetings designed to address main curriculum as well as project tasks, updates, and challenges. At the same time, the three primary departments – Internal Medicine, Pediatrics, and Family Medicine - also began developing momentum along parallel yet more discipline-specific courses.

Core Activities:
In its effort to develop a curriculum in managed care, the Project Core has identified the resource paper, Preparing Learners for Practice in a Managed Care Environment (Council on Graduate Medical Education, September 1997) as the basis for its curricular planning. The document serves as a useful organizing framework to insure comprehensiveness and avoid unnecessary redundancy, and at the same time lends itself easily to adaptation for the inclusion of issues unique to the Medicaid setting.

Each member of the Core has been assigned a competency for which they are outlining key objectives and developing central learning tools that can be used in each project:

1. Health Systems Finance and Organization: Scott Merwin, Caroline Blaum, Brent Williams
2. Community-Based Systems of Care: Tom Shope, Chris Henrickson
3. Practice of Evidence-Based Medicine: Brent Williams
4. Patient-Provider Relationships: Randy Ward, Chris Henrickson
5. Promoting Interdisciplinary Teamwork: Jeff Halter
6. Medical Informatics: Brent Williams

In each department, specific learning experiences are under development to provide community-based opportunities to enhance the learner’s acquisition of competencies in Medicaid managed care. Currently under development are ten specific month-long rotations, in addition to a Family Medicine continuity experience comprised of weekly clinics year-round:

A final discussion of the rotations through which the GME Project will be implemented is to be provided in the Descriptive Matrices by October 1.

In conjunction with the Michigan Public Health Institute, details are under development as to how and when centralized evaluation instruments will be administered. In addition, each project has made the decision that they intend to develop their own cognitive assessment instrument. Research Associate, Tatiana Bailey, is meeting with project members to outline the structure of their evaluation mechanisms, as well as developing contacts at other institutions to identify existing evaluation tools to measure competencies among graduate health professionals.

1) Our next step is to finalize the content of the proposed community-based rotations. This involves the detailed preparation of sites, preceptors, and activities.

2) Next we must develop the specific instrumentation and educational strategies involved in the rotation experiences. This requires the mobilization of faculty members - the challenge being the considerable amount of time and effort required in writing new learning objectives and creating new learning tools (case studies, exercises, a packet of selected articles) for each educational experience.

3) We face challenges in the actual implementation of the educational strategies within each rotation. Specific sites and teachers must be identified for each curricular objective. When necessary, we must be able to provide faculty members with appropriate educational materials in an environment where they are sometimes learning new materials alongside the learners.

4) We are also challenged by the internal communication within our own sites and the external communication with Lansing required in the process of re-budgeting and final resource deployment.