Combined Family-Emergency Medicine Residency in the Works

Christiana Care Health System family medicine residency program in Wilmington, Del., plans to launch a combined family medicine-emergency medicine training program in July 2007.

As envisioned, the program initially will accept two first-year residents and one second-year resident, according to Jennifer Naticchia, M.D., director of the Christiana Care residency program. The program will accept as many as two residents in each succeeding year, for a total of 10 residents matriculating through the five-year combined program at any one time.

Naticchia said the combined residency training program implements suggested guidelines outlined in the Future of Family Medicine report. Those guidelines call for providing education that is individualized to meet learners' needs, geographic needs and the needs of the communities in which residents plan to serve.

Guidelines (PDF file: 6 pages / 32.1 KB. More about PDFs.) announced in March by the American Board of Family Medicine, or ABFM, and the American Board of Emergency Medicine, or ABEM, stipulate that combined family medicine-emergency medicine training must provide 30 months of training under the direct supervision of each specialty, for a total of 60 months of training. Program graduates can sit for certification in each specialty and practice as family physicians, emergency physicians or both. They also can enter subspecialty training programs approved by either board or undertake research.

Christiana Care staff members have begun the paperwork to gain approval from the ABFM and the ABEM, Naticchia said.

"We knew it was coming, so we started getting organized with our leadership and committees," she said. "We polled our residents. Everyone was enthusiastic, especially in family medicine."

Janice Nevin, M.D., M.P.H., chair of family and community medicine at Christiana Care, agreed. "There was immediate interest, not only from our department, but also from the emergency medicine department, for a combined program," she said.

Much of that interest stems from the recognition that family physicians make a significant contribution to rural emergency departments. According to a 2005 survey of AAFP active members, between 1,500 and 2,000 family physicians provide emergency department care either exclusively or as a major part of their practices. About half of family physicians provide at least some emergency medical services.

"Combined training is a clear advantage for students who are contemplating a career in family medicine in rural areas where they also may be the sole provider of emergency care services," said Nevin. "For those folks who may practice emergency medicine primarily, the family medicine training provides additional skills that will enable them to understand what happens before and after the emergency room encounter. That will make them more competent emergency room physicians."

When first discussed in 2005, 72 family medicine residency programs expressed interest in offering this type of combined training, according to Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education.

"This is an exciting new beginning of a collaborative training," he said. "It's appropriate that Dr. Nevin, as former president of the Association of Family Medicine Residency Directors, would be out in front with a new program. We anticipate that it will set high standards and demonstrate the wisdom of this collaborative project."