Family Medicine Research

Residency Leadership Skills Drive Program Changes

July 06, 2015 04:03 pm Sheri Porter

Stakeholders invested in training the next generation of family physicians know that the delivery of health care in the United States has undergone significant change in the past decade -- think electronic health records, electronic communications with patients and team-based, patient-centered care.


As a result, physician training -- particularly at the residency level -- must evolve, as well.

"Preparing primary care physicians to practice in a patent-centered medical home (PCMH) model requires skills beyond those typically taught as part of clinical training," wrote authors of an article recently published in the Journal of Academic Education titled "Five Key Leadership Actions Needed to Redesign Family Medicine Residencies."(

In their introduction, the authors noted that although residency programs "routinely undertake minor programmatic revisions, significant transformations in training require leadership -- another area where physicians typically do not receive training."

Researchers set out to explore that gap and, ultimately, developed a list of five key leadership actions they deemed necessary to achieve the successful redesign of family medicine residencies. In short, they challenged residency program leaders to learn how to

  • manage change,
  • develop financial acumen,
  • adapt best-evidence educational strategies to their local environments,
  • create and sustain a vision to engage stakeholders, and
  • demonstrate courage and resilience.
Story Highlights
  • New research about how to prepare family medicine residencies for the future highlights five key leadership actions required to successfully redesign the programs.
  • These latest research efforts built on what was learned from the Preparing the Personal Physician for Practice (P4) project.
  • Authors suggested residency program leaders focus on five key actions that include managing change and developing financial acumen.

Building on the P4 Project

These latest research efforts built on what was learned from the Preparing the Personal Physician for Practice (P4) project( -- a groundbreaking effort undertaken from 2007 to 2012 that aimed to help family medicine residency programs identify the program changes necessary to keep pace with a health care system speeding toward PCMH practice.

A total of 14 family medicine residencies across the country participated in the P4 project, and from 2012 to 2014, those residency programs shared the successes and challenges they encountered as their programs underwent transformative change.

An analysis of the narratives they provided served as the foundation of these recent recommendations that highlight desired leadership skills.

Digging Deeper

Authors provided more findings on each of the leadership skills identified and also shared compelling quotes taken directly from residency program narratives.

For instance, to illustrate the focus on managing change, authors highlighted this quote from a P4 participating residency program: "It's probably easier to 'blow everything up and start all over,' but we have to keep moving and caring for our patients. We don't have the luxury of stopping the merry-go-round."

Researchers determined that change management requires a mix of skills including communicating a vision; articulating value; building relationships and teams; measuring, evaluating and communicating progress; and maintaining flexibility.

When it came to financial matters, one residency wrote, "Our P4 experience led to better understanding and appreciation for the precarious nature of family medicine residency funding and the need for financial flexibility to implement innovative ideas."

The authors noted that effective leaders understood the financial worth of their programs and were able to communicate the value of innovative change to stakeholders. They also generated new revenue streams to cover unexpected expenses and learned how to plan their budgets, keeping financial and time constraints in mind.

Regarding the ability to adapt to the local environment, one residency program wrote, "Because not all family physicians practice the same scope of family medicine, a 'one size fits all' curriculum is simply outdated and counterproductive."

When it came to creating and sustaining a vision, another program said, "The innovative curriculum became a way for the program to create a unique identity, distinguishing it from the other (state) residencies, and later, from residencies across the country." Authors noted that successful leaders took advantage of their participation in the P4 project to draw attention to their programs' "curricular innovations."

Lastly, some thoughts on the topic of courage and resilience: "What was once a passion, at times became a burden and a reminder of unrealized goals," one residency program acknowledged.

The authors noted that more than a few P4 residencies created "radically different educational programming" and persisted in implementing it despite significant roadblocks. "Successful programs were committed to educating others rather than letting a lack of understanding of the new approach stop the effort," researchers wrote.

Putting the Research Into Perspective

In an interview with AAFP News, Stan Kozakowski, M.D., director of the AAFP Medical Education Division and one of the research authors, discussed why the findings are critical to the growth of the specialty.

"Most family medicine residency programs' operations are based on training models that date back to the earliest days of our specialty," said Kozakowski. "One of our goals with this latest project was to understand the characteristics of those leaders who are able to successfully transform their training programs and to disseminate what was learned to the broader family medicine education community."

Kozakowski added that robust family medicine residency practices are a critical component of the "four pillars framework" that was created by the Council of Academic Family Medicine and released in 2014 as the pathway for creating the primary care physician workforce needed for America's future.

Family physicians should care deeply about all P4 project research findings because of the comprehensive nature of the work that saw 14 family medicine residency programs actively test innovations that involved altering the scope, content, sequence, length, location and structure of training, said Kozakowski.

"At the onset of the project, we did not know if the participating programs would be successful in the execution of their innovative changes. This (latest) study examined the leadership skills that were associated with achieving success," he said.

Kozakowski noted that traversing the road ahead, although necessary, will not always be easy. "It takes a high degree of courage for leaders to take a critical look at their actions and potentially change how they go about doing their work."

He strongly encouraged residency leaders to actively experiment with change and then measure the outcomes of that change. They should then commit to sharing what they learn with their colleagues through all available means including social media, public presentations and journals.

"Help advance our collective wisdom as we discover what it takes to prepare the family physicians of the future," said Kozakowski.

Additional Resource
Journal of Graduate Medical Education: Financing Residency Training Redesign(
(December 2014)