Wednesday, July 13, 2011

Redesigning Residency... the pilots

12 + 4 + 4 + 3 = 23 years. From grade school through college and medical school to residency, that's how long it takes to become a family medicine doctor right now. How about changing the 3 at the end to a 4? Asking that question to various classmates interested in family medicine, I've received a range of answers from "WHAT! No way!" to "ah, 1 more year, what's that in the long scheme of things?" to "That's a great idea!"

A 4 year residency program is just one of the 14 different innovations considered by the P4 project (Preparing the Personal Physician for Practice). P4 is a 6-year pilot project started in 2007 in which 14 family medicine residencies across the country are participating. These residency programs range from university-based to community-based and urban to rural. Each residency program is experimenting with some new innovation to improve family medicine training with the goal of preparing residents with real life skills for practice.

Okay - great, so let's get down to the nitty gritty. What are these innovations that are being considered? As I first mentioned, a number of programs are experimenting with either a mandatory or an optional fourth year of training. These programs generally encourage or require residents to choose a "track" or a "focus" that is either incorporated throughout the four years or is focused upon during the fourth year. For example, Middlesex FMRP in Connecticut requires each resident to complete four years while JPS in Texas and Waukesha in Wisconsin have optional 4th year tracks.

Tufts, on the other hand, is focusing on training its residents predominantly in the outpatient setting, since that's where the majority of family medicine actually practice. Meanwhile, University of Colorado is focusing explicitly on teaching its family medicine residents about the Patient Centered Medical Home. University of Missouri-Columbia is allowing 4th year students at its school who are decided on family medicine to start intern-like rotations, because, honestly speaking, the 4th year of medical school (unless really intentionally designed not to be by self-motivation) is generally speaking a waste of time. That's just to name a few of the 14 innovations (not selected by any favoritism but randomly).

We are now more than half way through the 6 year innovation period. The question is then: what are we doing with this P4 information? Do we want all family medicine programs to be 4 years long? Or do we want to start eliminating the 4th year of medical school? Or do we want to be more intentional about where are residents are training and what they are learning?

These are all questions that are being studied and analyzed. This month's issue of Family Medicine, STFM's academic peer-reviewed journal, focuses specifically on these questions. As we approach another RC review (the committee that determines residency guidelines), what changes do we want to make as the future of family medicine so that we can better train physicians to be prepared to serve their future patients? Better yet, what can we as family physicians do to advocate to the ACGME and to the American public about the needs of family medicine training?

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