(Editor’s note: On Oct. 11, the AAFP and six other family medicine organizations sent a letter urging the Accreditation Council for Graduate Medical Education Board of Directors to reconsider two specific issues related to the new residency requirements.)
October 4, 2022, 6:36 p.m. David Mitchell — The Accreditation Council for Graduate Medical Education released new program requirements for family medicine residencies Sept. 30. The new requirements, which take effect July 1, 2023, are the first major revisions for the specialty’s training programs in a decade.
AAFP News sat down with AAFP Vice President of Medical Education Karen Mitchell, M.D., to discuss how the new requirements will affect residents, programs and their communities.
AAFP News: What are some of the biggest changes in the new requirements that the AAFP supported?
Mitchell: This is the biggest change in family medicine education since the inception of the specialty. Two of the transformational changes are related to patient care delivery, and resident assessment and learning.
We will have panel metrics in place instead of the 1,650 face-to-face visits that had been required. Residents will be required to manage a panel of patients in a team-based approach, aiming for improved health equity and population health. Management of that panel of patients will be done in a variety of ways, including telehealth and care in multiple settings. Continuity of care continues to be emphasized and will need to be measured, along with a minimum number of hours delivering care in the family medicine practice. Patient advisory committees are required for each family medicine practice to address the health needs of the community. Overall, the new program requirements continue to cover the comprehensive nature of family medicine.
Having less proscriptive requirements will allow programs to focus more on competency-based medical education. Resident assessment and coaching will be part of a required individual learning plan for each resident. There’s more elective time — required to be based upon the resident’s individual learning plan — so the resident experience can be tailored to their future practice and learning goals.
Another change is that for first time there is a two-tier pregnancy care requirement. Pregnancy care remains a cornerstone of family medicine training. The higher tier will have specific requirements for residents who seek independent practice in comprehensive pregnancy care after graduation so they can get hospital privileges and credentialing.
AAFP News: Are there changes the AAFP did not support?
Mitchell: We did not get our core faculty FTE request for protected non-clinical time. We got program leadership support that maximizes the amount allowed by the ACGME, with the amount of program director and associate program director time dependent upon the size of the program. But the amount of faculty teaching time is lower than the minimum amount the AAFP supported.
Faculty time is needed to carry out the program requirements, such as assessing and evaluating residents, coaching residents, career planning and education, curriculum development and creating and administering learning opportunities. A letter from the ACGME Board acknowledged the Review Committee for Family Medicine’s diligent request for increased faculty time, but the ACGME Board did not grant that request.
They did approve a change in the faculty-to-resident ratio for programs with 12 or more residents from a 1:6 to a 1:4 ratio. That helps. However, programs are still required to fulfill all the ACGME requirements, and that means that many programs will need higher amounts of dedicated core faculty time and support. We will continue to monitor the situation.
AAFP News: How will the AAFP help programs implement these changes?
Mitchell: We have the Criteria for Excellence, published by our Residency Program Solution consultants. These residency experts have put forth recommendations for programs to achieve to improve the quality of their programs. These criteria can be used by residencies to show their institutions what it takes to deliver a high-quality residency program. We are continually updating that resource. The RPS program also provides consultations to individual programs to assist with their unique needs.
Also, the Residency Leadership Summit in March will have many workshops focused on assisting programs with the new requirements. This will be a can’t-miss event for residency leaders. A preconference event will offer a small-group format facilitated by RPS consultants for programs looking to find specific solutions to implementing the new requirements, along with some best-practice examples being sponsored by the ABFM and the Association of Family Medicine Residency Directors.
To assist programs in meeting requirements, the AAFP is developing a learning collaborative opportunity around resident well-being, funded by the Health Resources and Services Administration. A pilot using the Project ECHO (Extension for Community Healthcare Outcomes) videoconferencing format is underway. More details to come. However, resident members can access well-being resources, including video coaching sessions, now on the Physician Health First webpage.
AAFP News: What else will programs need to meet these new requirements?
Mitchell: Residencies will need increased capabilities of their IT and data systems to create easy ways to curate the reports needed for the residents’ care in the family medicine practice. We need EHR vendors to embed the data into their systems to assist with population health and to be able to generate the necessary reports.
AAFP News: What do students and residents need to know? Will this impact current residents or only those starting in 2023?
Mitchell: For residents, it means your program should assist you with understanding population management, panel metrics and data that will help your future practice in way that has not been required in the past. It means you will take an active role in your own learning with faculty coaching to achieve your learning goals related to your future practice.
For students, you can be assured that family medicine residency training will prepare you for future practice models, including team-based care, value-based payment systems and being prepared to have skills for any community in the U.S. You will have the communication and relationship skills that embody the value of family medicine in our health care system. You will gain the comprehensive experience of a family physician, the basis for providing the best primary care services possible.
What excites me the most is that with competency-based education and individual learning plans, our future family physicians will be in position to take even more ownership of their own learning, with guidance from faculty, to prepare them for their careers and the communities they plan to serve.