1. David M Levine, MD MA 1 and Mack Lipkin, MD 2 1: Harvard Medical School, Brigham and Women’s Hospital 2: New York University School of Medicine, Bellevue Hospital Problem Objective Intervention House staff feel ill-informed and unable to effect systems change while educated and socialized in an obsolete system. Provide a vehicle for education, discussion, and action toward system-level change in primary care. Primary care visioning group

2. Fortnightly to every other month PGY1 PGY2 PGY3 Faculty MS4 What’s new Brainstorm around need area Project updates Open mic

3. Average 8 Attendees 9 Meetings 30% participation Visioning Projects CHC Needs Assessment House Calls Intensive Inpatient @ Home CHW Program Low Literacy Resources Procedure Training What’s New

4. Participation rates Project-specific action items Funding Home visit kit Home visit checklists Precepting processes Grant funding Lessons Cloud-based spreadsheets Discussion with faculty in and out of visioning group Making leadership a stakeholder for integration in megastructures

5. Given impetus, space, and time, primary care internal medicine house staff became a productive, effective team of changemakers.