Initiative Spurs Wave of Innovation in Residency Programs

By Leslie Champlin • Kansas City, Mo.
4/10/2007

Full steam ahead. That's the outlook among dozens of family medicine residency training programs, thanks to the brainstorming generated by the Preparing the Personal Physician for Practice, or P4, initiative, according to Samuel Jones, M.D., of Fairfax, Va., co-chair of the P4 steering committee.

With initial funding from the American Board of Family Medicine, or ABFM, and the Association of Family Medicine Residency Directors, or AFMRD, P4 has spurred creative thinking among the 84 residency training programs that applied to become P4 programs, according to Jones, who also is director of the Virginia Commonwealth University/Fairfax Family Medicine Residency Program.

Although only 14 residencies were named in the final selection, as part of the process of submitting their letters of interest, all of the programs that applied developed innovations that hold promise for family medicine education, said Jones during his April 2 plenary presentation at the Residency Program Solutions Workshop here.

"P4 is innovation," Jones told audience members. "The programs involved in this have been truly innovative. A lot of programs out there were trying new approaches, and this initiative gave them the structure to latch onto."

ABFM and AFMRD spurred implementation of P4 last spring with more than $1.7 million in pledges. TransforMED, AAFP's practice redesign initiative, will staff the six-year project, which will evaluate the efficacy and feasibility of the innovations implemented by the 14 chosen P4 programs.

Here's a sampling of the innovations to be tested:

a four-year curriculum that integrates a master of public health degree and allows for additional focus on chronic disease management, cutting-edge information systems, health behavior change, leadership training and cross-cultural health care;
development of teams in which second- and third-year residents function as group practices and implementation of a Web-based documentation program that allows for customized evaluations, schedules, feedback and procedures documentation; and
a focus on practicing in patient-centered medical homes within the community, with scheduling that enhances access and the continuity of care residents can provide to patients over time.

P4's value rests with its promise of training tomorrow's family physicians for a rapidly changing environment, according to Jones. The programs are intended to prepare residents not only in the breadth of family medicine, but also in skills enabling them to

manage change;
become leaders in organizational development and in multicultural, population-based health care; and
understand and fully implement patient-centered care.

Jones said the P4 initiative was a natural outgrowth of the specialty's ongoing efforts to ensure that family medicine provides high-quality, evidence-based medical care; meets patient expectations; and ensures appropriate income for family physicians' businesses and their employees.

"We have to transform our practices," said Jones, adding that much of the transformation will grow naturally from the expectations of newly graduated family medicine residents. "Folks refer to family medicine residencies as the point of the spear in this change. Our graduates will be populating your practices for years to come," he told audience members.

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