ACGME Pilot Project to Test Four-year Family Medicine Residency

The Accreditation Council for Graduate Medical Education (ACGME) recently issued a call for proposals (9-page PDF; About PDFs) for what has been dubbed the Family Medicine Length of Training Pilot.

According to the ACGME, the purpose of the project is to gather information to help determine whether "extending the length of the education program in family medicine to four years, through the development of innovative education paradigms, further prepares family physicians to serve as highly effective personal physicians in a high-performance health care system."

The pilot will begin in July 2013 and conclude by June 2019. A total of 20-25 residency programs will be selected to participate; an equal number of programs will serve as the control group.

Residency programs interested in participating in the pilot should download an application right away; the deadline for application submission is May 15. Programs will be notified of their selection status by July 15.

In addition to answering basic questions about their residency programs, applicants to the project, titled Implementation of a Four-Year Residency Curriculum in Family Medicine, must explain why their program wants to offer a fourth year of residency. Applicants also will describe the kinds of innovative methods their programs would initiate and how those ideas relate to the patient-centered medical home (PCMH) model of care.

Residents in each of the selected programs will be expected to meet an additional set of competencies that include

The ACGME Review Committee for Family Medicine (RC-FM) will oversee the pilot and will establish pilot policies, create selection criteria and select participating residencies. The American Board of Family Medicine Foundation has committed as much as $2 million to finance evaluation of the project.

Stan Kozakowski, M.D., director of the AAFP Division of Medical Education and the AAFP's liaison to the RC-FM, said that family medicine residency programs have struggled for some time to pack everything residents need to know into a three-year curriculum.

The recent advent of the PCMH model of care -- and the complexities of training residents in that new model -- has exacerbated already tight residency training schedules because it introduces a number of new elements.

"A different kind of physician leader is needed for that kind of family medicine practice," Kozakowski told AAFP News Now. But having said that, "the length of residency training has been an ongoing debate since the founding of the specialty of family medicine," he added.

Indeed, program requirements established for family medicine in 1969 acknowledged the wide variation of circumstances under which family physicians functioned and called for a flexible education program that might need future adjustments.

The ACGME pointed out in the call for proposals that discussions about extending family medicine residency education have not been without controversy. Some people see a four-year program as a logical innovation "given the increasing complexity of medical care, decreased clinical experience (due in part to reduced residency work hours) and responsibility in medical school, the reduction in available education hours, and now the addition of new skills needed to practice in medical homes," said the ACGME.

However, others have expressed concern that adding an additional year to residency training would deter physicians from pursuing a career in family medicine. Furthermore, the ACGME acknowledged that the concept of a four-year family medicine residency was supported by some, but not a majority, of medical students and residency program directors.

"People are very passionate on both sides of the argument, and we need both groups to participate," said Kozakowski. "The stakes are so high. We have to get this right; it's time to take action and find answers to these decades-old questions.'"