February 3, 2023

Our Field of Dreams – October 2022

In the 1989 movie Field of Dreams, Kevin Costner plays a character named Ray who struggles with his memories of his relationship with his deceased father, who was a devoted baseball fan. There is a scene where the voice of the main character says to himself that if he builds a baseball field, his father will perhaps come back and play baseball on a team that is created amongst the ghosts of past heroes. There is a most famous quote from this scene: “If you build it, he will come”.


I interpret the theme here as – If you (we) put much effort and belief into the success of a project, it’s more likely to succeed- and I believe this characterizes what has been happening with our educational mission within Duke Primary Care.


Over the last four years, there has a dramatic shift in focus in our clinics.  While excellence in clinical care is still our top priority, we have embraced the importance of teaching, and we now have a significant number of clinician educators spread out amongst our 40 clinics. Four different clinical programs at Duke send learners to our sites, and a fifth program will begin this fall rotating learners from an innovative training program at Fort Bragg.  Close to 300 students come to our clinics, and if we had the space, another 200 would like to also join us.


Cultural change is never easy, and we have stumbled at times. Staffing turnover, limited physical spacing, COVID, and occasional provider hesitancy have together made it more difficult for us to teach.  But we have addressed many of these roadblocks, we have trained our providers to become better teachers, and we have rewarded providers with a teaching stipend that recognizes the extra work and effort that is involved when our provider’s precept students while caring for patients.


Our School of Medicine is rolling out an innovative new curriculum for medical students that will start in August 2023.  Changes are being made to ensure that 1/3 of the clinical rotations for these students take place in the outpatient setting.  To accommodate the 120 medical students in each clinical year, medical school leaders have asked us to step forward and accept a larger number of students into our clinics. Details of the curriculum will be provided soon to everyone.  What is important here I believe is the acknowledgment that we have successfully “built it”.  We worked to bring about a change in focus and culture, we enacted a number of tangible innovations in our workflow, and as a result, “they will come”.


This is a bit of a long-winded and circuitous way of saying thank you for your efforts at teaching our learners.  It is noticed by many in the health system, and it is hugely appreciated and respected.