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Alyssa Fayerman MED’27 Looks at Inter-Staff Communication in Primary Care

Geisel medical student Alyssa Fayerman MED’27 spent eight weeks in the summer investigating inter-staff communication in primary care at Dartmouth Hitchcock Clinics in Concord, New Hampshire. Alyssa received funds from the Center for Global Health Equity to complete a Co-designed, Community-based Internship (CCI) that she initiated with departmental leadership to evaluate communication within healthcare teams, acknowledging the impact this can have on patient care and provider/staff satisfaction and retention. CCIs are designed to provide professional and graduate students with insight into the health disparities affecting underserved populations and the quality of care they receive.

Dartmouth Hitchcock Clinics Concord

Under the guidance and mentorship of J. Henry Feng, MD, MPH, primary care/internal medicine physician and department head at Dartmouth Hitchcock Clinics in Concord and Clinical Assistant Professor of Medicine in the Geisel School of Medicine, Alyssa sought to understand the current landscape of communication practices and preferences in a rural/suburban primary care clinic in the Northeast Region of the US and identify areas for quality improvement. Following are some summaries/excerpts from Alyssa’s reflections about her experience.

"By shadowing all the positions on the nuclear healthcare team within primary care — providers, nurses, medical assistants (MA), and secretaries, I gained an understanding of their workflows. I experienced both sides of the communication process (both the sender’s and receiver’s perspectives), which is something I’ve realized most staff do not witness. I appreciate having gained this insight as it illuminated the contexts and complexities of communication and the importance of regularly including and engaging interdisciplinary perspectives, as each position has a unique and important role to play in patient care. The ability to attend department and provider meetings was also eye-opening and valuable.

Alyssa Fayerman MED’27 reviews data from inter-staff communication project

I additionally conducted and transcribed interviews with staff in each position and developed a staff survey, which received 44 responses, representing a strong response rate of 60%. This aspect of my project taught me about finding a balance between structure and natural conversation in semi-structured interviews, as well as about the iterative nature of questionnaire development, the tangible impact of survey fatigue, and the importance of considering future analysis during question design. Preliminary findings yielded actionable insights such as an unexpectedly universal preference for in-person communication across all roles and tasks and a need to focus quality improvement efforts on inter-staff communication regarding asynchronous patient needs (i.e., message or request that a patient awaits remotely) as well as the communication of general information to providers and staff, particularly about community resources. These findings and recommendations were presented to staff at a department meeting and, more broadly, as posters and abstracts.

Geisel School of Medicine at Dartmouth Health Biomedical Research Day

Perhaps the most meaningful outcome of this experience has been the mentorship I received. Dr. Feng guided me through the technical aspects of research but also encouraged my independence – his availability, responsiveness, and support were instrumental in helping me navigate the intricacies of this project, and his mentorship also transcends the project.

Finally, this project reinforced the idea that global includes local. Global health projects often overlook local needs, and I am thankful to have been able to work on a project that, on the one hand, functions within the greater US healthcare system while at the same time differs from the community I am more familiar with in Lebanon - which is a slightly different patient population with unique needs and different services.  

I am grateful to the Center for Global Health Equity for making this opportunity possible. I can confidently say that it has enriched my capabilities as a future provider."                                                                                                                                                                                                                                                                              -Alyssa Fayerman MED’27

Check out Alyssa’s poster below from the Geisel School of Medicine and Dartmouth Health Biomedical Research Day, held September 18, 2024, at Dartmouth Health in Lebanon, New Hampshire.