• Guest Editorial

    How Do We Match FP Training to Society’s Future Needs?

    November 18, 2020, 2:19 pm Karen Mitchell, M.D. -- The Accreditation Council for Graduate Medical Education implements major revisions to the residency requirements for family medicine only rarely, about every 10 years. Consider then how much has changed in family medicine in just the last year, let alone the last decade.

    headshot of Karen Mitchell, M.D.

    For example, more than 80% of family physicians began offering virtual visits this year in response to COVID-19. For many, telemedicine is here to stay. Other innovations, like artificial intelligence, are bringing to market products that have the potential to drastically change our practices.

    Meanwhile, less than 10% of family physicians practice obstetrics, but it has been argued that family medicine could be the answer to the crisis our rural communities face regarding maternity care.

    So as we ponder the next decade and beyond, we have to ask ourselves, “What should we be teaching family medicine residents, and how?”

    Earlier this year, the ACGME announced plans to develop and implement major revisions of the common program requirements for our specialty. This is a big deal because the new guidelines will have a profound influence on the next generation of family physicians.

    The AAFP, through its Commission on Education, is uniquely positioned to inform this important process, and what follows outlines the role the Academy and its sister organizations are playing.

    Although the concept of revising residency requirements is not new, the process the ACGME is using this time around is. The accrediting body invited the family of family medicine organizations to give input and evidence to help guide its work on an unprecedented scale. The AAFP and the American Board of Family Medicine have partnered to create Starfield Summit IV: Re-Envisioning Family Medicine Residency Education.

    The AAFP conducted a series of focus groups this fall, gathering insights regarding a series of core questions from students, residents and active family physicians, as well as members involved in medical education (including the COE and Residency Program Solutions consultants). Likewise, other family medicine organizations also sought input from their members via surveys and focus groups.

    Here are the core questions being asked:

    • What does society need from the personal physician of the future?
    • What should we teach?
    • How should we teach?
    • How can residency education support graduates’ ability to shift practices and populations over time?
    • What is the right balance between regulation and innovation?
    • How can we improve the social accountability of graduate medical education?

    These same questions will be addressed in a series of articles and commentaries in a supplement to Family Medicine, the official journal of the Society of Teachers of Family Medicine, to be published in 2021. But first, draft versions will be presented and discussed Dec. 6–7 during the virtual Starfield Summit. Authors will be asked to complete revisions to their drafts shortly after the summit for consideration by the ACGME’s program requirement writing group, whose members will participate in the meeting as observers.

    The ACGME’s writing group, led by Stacy Potts, M.D., MEd., chair of the organization's Shaping GME: Future of Family Medicine Major Revisions Project, and comprised primarily of current and former program directors, is expected to propose new program requirements by spring 2021. The writing group will consider feedback offered during a 45-day comment period before submitting its updated proposal for approval through a rigorous and lengthy ACGME process. Implementation likely would come in July 2022.

    The core questions could have far-reaching implications for things like length of training, type and location of rotations, and assessment of that training.

    Does every resident need the same amount of training for every aspect of care, or should some aspects require fellowships or other additional training?

    Should there be room for innovation based on the needs of a program’s community or region?

    These are the kinds of vital issues we plan to address during the Starfield Summit. My thanks to the many family physicians (and future family physicians) who offered their feedback this fall, those who will participate in next month’s summit and those tasked with the sizable challenge that awaits the writing group.

    Stay tuned.

    Karen Mitchell, M.D., is the director of the AAFP’s Division of Medical Education.