BY CINDY BORGMEYER
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*Because of the patient-centered nature of the modules on performance in practice (Part IV), patient satisfaction/communication will be a significant component of Part IV, as well. Editor's note: Go to https://www.abfp.org/moc/about.aspx for details on the program. |
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A chilly reception greeted the Maintenance of Certification Program for Family Physicians, or MC-FP, when the American Board of Family Practice announced it in 2003. Many FPs cried foul, arguing against adding another morsel to FPs' already full plates.
Despite FPs' objections -- voiced during the 2003 Annual Assembly and in dozens of letters, e-mails and phone calls to AAFP -- the ABFP pushed ahead with program implementation this year. Though still evolving, MC-FP is basically a done deal. That won't change. But you can find help preparing for it.
AAFP course targets MC-FP
"I think whenever you have something new, there's going to be some anxiety associated with it," said Eloka Ikedionwu, M.D., of Justice, Ill., during AAFP's new Case Studies in Family Medicine course Feb. 26 - 28 in San Francisco. "But it's just like every other thing in medicine -- you have to wait. Don't discount it until you see how it plays out."
For a quick review of the MC-FP process, see the box at right.
The AAFP course, to be repeated annually, was designed with MC-FP in mind and featured case-based learning sessions. Topics included those slated for inclusion as self-assessment modules, or SAMs, under Part II of MC-FP. Among them were diabetes, hypertension, asthma and coronary artery disease. MC-FP uses case studies, as do various AAFP and constituent chapter CME offerings.
"I usually prefer a case studies format, and this has been very helpful," said Ikedionwu. "It's more like a roundtable discussion, where you have the ability to ask questions."
"It's far more interesting than didactic presentations, and you get just as much information, especially when you have a good course leader," agreed Martin Brauweiler, M.D., of Sandwich, Ill., who also attended the course. Being able to interact with course facilitators and with other participants created a potent learning environment, he said.
Interaction is key to learning
Interaction is the cornerstone of an initiative the Illinois AFP hopes will help its members gear up for MC-FP. Beginning this fall, SAM study groups will piggyback on an existing quality improvement program, Medicine for Today, said Vincent Keenan, C.A.E., executive vice president of the IAFP.
A collaboration between the IAFP and the Medicare and Medicaid programs, Medicine for Today offers FPs CME credit for participating in QI projects addressing health problems identified by the state's public health department. One of those areas is diabetes -- a perfect fit with one of the two SAMs currently offered by the ABFP.
Here's how the SAM study groups will work.
Group members go online and work through their SAM. If they encounter problems, they bring them back to the group for discussion. "Everyone will be working through their SAM, and everyone will have a chance to bring to the group things they found interesting or things they found difficult," Keenan explained.
FPs in the SAM study groups can earn CME credit for the activity, he said. The group offers a platform for resolution of clinical questions and enhances the overall learning experience.
After all, Keenan noted, "The ABFP SAMs are not about passing the test; they're about a way of learning that the ABFP is hoping to promote as a standard."
"Our job is to be smart and nice"
Joane Baumer, M.D., of Fort Worth, Texas, is principal investigator for the Quality Circle project, a joint effort of the Texas AFP and Procter & Gamble Co. The project, initiated in March, bears a strong likeness to the quality improvement in practice component of MC-FP's Part IV.
Each quality circle comprises 10 physicians from the same community. The circle determines a health issue to evaluate, and then each physician gathers relevant patient data from his or her practice to feed to the group. The group discusses the pooled data, swaps best practices and then starts the whole process again.
"We want to see if anything we've done in terms of sharing with each other, getting this information and looking at each other's data is going to change what we do as a group," said Baumer. "That to me is exciting. There's lively discussion and -- probably most important -- some discovery going on."
It's no picnic leaving your comfort zone. "This is invading our space and our minds and challenging us to think," Baumer said. "As a practicing physician for 20 years, I know you don't have time to do a lot of research, but you can get together with a few of your friends occasionally and say, 'How are you doing this?' or 'How are you doing that?' We can look at what's expected of us and then at what we're really doing."
For a reality check on what's expected, turn to your patients, Baumer advised. She described an encounter with one of her patients -- a 5-year-old -- who informed her in no uncertain terms that good doctors are smart and nice.
"So our job is to be smart and nice," Baumer said. "We're developing all these tools for professionalism -- self-reflection, introspection, self-regulation, altruism. Those are the 'nice' skills, the adaptive-emotive skills.
"On the other side, you've got the 'smart' skills, the cognitive-analytic skills. Those are the things that we're just beginning to develop the tools to measure. Now the board comes to us and says, 'We want you do this and this and this,' and what I think they're really trying to get at is: Are we smart and nice?"
To reach writer Cindy Borgmeyer, e-mail cborgmey@aafp.org.
FP Report is published by the
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Copyright © 2004 by
American Academy of Family Physicians.