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J Am Board Fam Med. 2008 Sep-Oct;21(5):451-7. doi: 10.3122/jabfm.2008.05.080083.

The medical home: locus of physician formation.

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Department of Family Medicine, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Manning Drive, Chapel HIll, NC 27599, USA.


Family medicine is currently undergoing a transformation and, amid such change, the medical home has emerged as the new polestar. This article examines the medical home through the lens of philosopher Alasdair MacIntyre and offers a perspective, informed by Hubert Dreyfus and Peter Senge, about medical homes as practical sites of formation for family physicians. The intellectual past of family medicine points to contextually sensitive patient care as a practice that is particular to the discipline, with the virtue of "placing patients within contexts over time" as a commonly held virtue. Dreyfus provides a model of knowledge and skill acquisition that is relevant to the training of family physicians in practical wisdom. In this model, there is a continuum from novice to more advanced stages of professional formation that is aided by rules that not only must be learned, but must be applied in greater contextually informed situations. Senge's emphasis on learning organizations-organizations where people are continually learning how to learn together-presents a framework for evaluating the extent to which future medical homes facilitate or retard the formation of family physicians.

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