Criteria for Excellence | Family medicine residency best practices
Best practices and aspirational standards to help family medicine residency programs excel.
Build a stronger family medicine residency program
Criteria for Excellence is an industry-leading resource from AAFP Residency Program Solutions (RPS) that helps family medicine residency programs move beyond minimum requirements toward excellence.
Developed from the collective experience of RPS consultants and residency educators, the Criteria brings together proven practices, emerging approaches and insights from the graduate medical education environment. Use it to evaluate your program, identify opportunities for improvement and guide conversations about your program’s future.
Whether you're developing a new residency, strengthening an established program or planning significant changes to your curriculum or clinical practice, explore the Criteria for Excellence for practical guidance across the many dimensions of residency education.
What's new in the 2026 Criteria for Excellence
The Criteria for Excellence evolves alongside family medicine residency education. The 2026 edition includes new and updated guidance addressing important issues facing today's programs.
Procedural training in family medicine residencies
Coaching in family medicine residencies
Health equity, bias and structural barriers to care and opportunity
Explore the Criteria for Excellence
Residency Program Solutions (RPS)—formerly known as the Residency Assistance Program (RAP)—has been the vanguard for defining excellence in family medicine graduate medical education (GME) since its establishment in 1975. The authors provide consultation services to developing and existing family medicine residency programs across the nation. During consultation work, best policies and practices (also called positive deviances) in residency
education are collected. These ideas and practices from the field, personal experiences as educators, and ongoing assessments of the clinical, educational, and accreditation environments form the basis for the aspirational guidelines outlined in this document.
For more than 45 years, the RPS Criteria for Excellence, a set of national standards developed by consensus and continually revised to reflect changes in education and the health care environment, has served as an ongoing resource for those seeking to improve the quality of family medicine GME.
Since the last publication of the Criteria for Excellence, the health care landscape continues to undergo rapid change. The concepts of “Triple Aim” (improving the health of populations, improving the patient experience, and reducing per capita costs of health care) and “Quadruple Aim” (the Triple Aim, plus improving the work life of health care clinicians) have become well established in the family medicine literature. Health professional well-being and resilience have taken center stage at many professional meetings and discussions as the medical community grapples with the recognition of the toll that burnout has taken on patients and the professionals providing health care. Additionally, workforce assessments continue to show shortages in the supply of family physicians to meet the health care needs of the country to achieve the quadruple aim.
Family medicine’s contribution to the health care system is imperative to create a strong foundation in primary care, shown in other countries to improve healthcare outcomes. To meet this need, the number of family medicine GME positions needs to increase, with the largest growth in rural and medically underserved areas.
- Among other significant contemporary health care trends include:
- Reinvention of community-oriented primacy care (COPC) in response to the increasing concern about health equity;
- Impact of social determinates of health;
- Changes in health care delivery through population health management;
- Value-based payment systems;
- Coordinated care through accountable care organizations;
- Practice redesign;
- Team-based care through the shared principles of primary care; and
- Changes in technology, including electronic health records and machine
learning/artificial intelligence.
Over the past few years, the Accreditation Council for Graduate Medical Education (ACGME) has embarked upon major revisions to the Family Medicine Program Requirements. This sparked a series of national discussions to re- envision family medicine residency education, starting with the needs of society in the face of an increasing gap in health outcomes, made even more poignant with the experience of the COVID-19 pandemic. The result is a recommitment to the core primary care principles of continuity and comprehensiveness to meet the health care needs of communities.
Family physicians are being called to address health equity and social determinants of health, positively impacting population health. A growing body of literature shows that the quality of care; rate of complications; and cost of
care delivered in the local clinical learning environment correlates with performance of graduates on these same parameters for as long as two decades following graduation. The requirements effective July 1, 2023, afford more flexibility to programs to create community-based care, training in care teams where people live and work. The core comprehensive nature of family medicine remains, encompassing continuity care in multiple settings (outpatient, inpatient, emergency care, home) where residents learn skills to meet the community’s needs.
With fewer time- and numbers-based requirements, residents will be assessed through competency-based medical education. This will require increased individual learning, with educational coaching to develop individual learning plans. As technology and assessment tools are changing, the process of assessment and evaluation is changing. Learning must be more than information transfer, it’s also decision making, judgement and professionalism.
Residents will be expected to partner in their learning to become master adaptive learners. Faculty will need to learn alongside residents to support the learning process. The evolving nature of learner evaluation and assessment, particularly regarding the relationships between ACGME competencies, domains of competency, Milestones, and Entrustable Professional
Activities (EPAs), has created complexity in the GME realm. It is important for programs to establish processes that provide clarity for all participants.
This rapidly changing environment creates challenges, as well as opportunities for family medicine program directors and their educational and clinical teams. The accreditation standards created by the ACGME and the Review Committee for Family Medicine (RC-FM) represent the minimum requirements with which a program must demonstrate substantial compliance in order to achieve accreditation. In contrast, the goals set forth in this document represent standards for excellence to which a program should aspire. While there is no official designation or certification for a program that achieves most of the goals or best practices, the convention used in this document is to describe a program meeting or exceeding these goals as a “Program of Excellence.” Continuous improvement is the hallmark of a Program of Excellence. We strive to have every resident learn in a high-functioning practice environment so that they will deliver the highest quality of care for optimal health outcomes and have the tools needed to be adaptable and resilient throughout their careers.
We anticipate the pace of change will continue to escalate, and this publication will continue to be updated on an ongoing basis so that residency leaders can remain current with new requirements, innovations, and standards of program excellence.
As in the past, we provide the reader the opportunity to conduct a self- assessment for many topic areas within the Criteria for Excellence. The assessment is meant to stimulate questions, help initiate conversations with key stakeholders, and become part of a process of continuous improvement for program leaders.
Consistent with our 45-plus year tradition, the Criteria for Excellence has taken the ACGME institutional and program requirements into account, but is not, and never has been, bound by ACGME accreditation requirements in developing a vision of excellence. We do note in the document when recommendations are at odds with current accreditation requirements and when implementation likely would require a waiver from the RC-FM.
Karen Mitchell, MD, FAAFP, AAFP Vice President, National Residency & Academic Partnerships
Editor
Karen B. Mitchell MD, FAAFP, Vice President, National Residency and National Initiatives, AAFP
Contributing Authors (2023, 2024, 2025, 2026 Editions)
Deborah Clements, MD, FAAFP, HALM
Steven D. Crane, MD
Alan B. Douglass, MD, FAAFP
Roger D. Garvin, D, FAAFP
John Gazewood, MD, MSPH, FAAFP
William R. Gillanders, MD, FAAFP
Diana Heiman, MD, CAQSM
Bryan Hodge, DO
Hobart Lee, MD, FAAFP
Walter W. Mills, MD, MMM, FAAFP, FACPE
Elissa J. Palmer, MD, FAAFP
Judith A. Pauwels, MD, FAAFP
Randy Pearson, MD, FAAFP, FACSM
Louis A. Sanner, MD, MSPH, FAAFP
Gregory Sawin, MD, MPH
Stephen H. Schultz, MD, FAAFP
RPS Programming Manager
Beverly Cline
Emeritus RPS/RAP Directors
Stanley M. Kozakowski, MD, FAAFP
Perry A. Pugno, MD, MPH, CPE, FAAFP
Norman B. Kahn, MD, FAAFP
Jane L. Murray, MD
Daniel J. Ostergaard, MD, FAAFP
Thomas L. Stern, MD
Residency Program Solutions gratefully acknowledges the valuable contributions of previous consultants to earlier editions of the Criteria for Excellence.
The Criteria for Excellence is intended to assist with:
- Developing or expanding residency programs. Many key decisions must be made early in the process concerning overall curriculum design, clinical practice operations, and engagement with the hospital(s) and other community sites. The resources needed (e.g., faculty complement, job descriptions) for an excellent program and the financial viability of the program are key to success.
- Residency programs striving for excellence.
- Residency programs contemplating a major curriculum overhaul or practice enhancements.
- Residency programs which are concerned that they don't have the resources needed to become excellent—or even remain viable. This document provides detailed advice about resources needed for excellence.
- Residency programs which want to use the Criteria for Excellence scores as part of agenda setting for program improvement.
- RPS consultants to help evaluate programs and provide feedback and support during RPS consultations.
Creating a Program of Excellence involves many interconnected dimensions, including accreditation, education, leadership, clinical practice and finance. We recognize that you may have limited time and need to focus first on topics related to your program’s most pressing needs. Each section of the Criteria for Excellence includes links to related topics and resources to help you explore relevant guidance.
While you can explore the Criteria by topic, the guidance throughout the site is interconnected and often dependent on other areas of program performance. We encourage you to explore the full Criteria for Excellence over time to develop a comprehensive view of what contributes to a successful residency program. Definitions of important terms and links to additional resources are available in Key Terms and Concepts.
Assess your residency program
Self-assessments throughout the Criteria for Excellence can help you evaluate your program and identify opportunities for improvement. A score of 1 represents the lowest rating (Never Occurs/Is Done Poorly), while 5 represents the highest (Always Occurs/Is Done Extremely Well).
Consider your results in the context of your Annual Program Evaluation and other improvement priorities, as well as feedback from important stakeholders—including patients, community members, residents, faculty, staff, specialty colleagues, hospitals, applicants and graduates. Your assessment results can help identify priorities for improvement and opportunities for future innovation.
We wish you every future success and remind you that assistance is available through a variety of consultation services through RPS.
Assess your residency program
The Criteria for Excellence isn't only a reference—it is a tool for continuous improvement.
Use the self-assessments throughout the Criteria to evaluate your program's current practices, identify opportunities for improvement and inform priorities for your Annual Program Evaluation and other program planning.
Put the Criteria into practice with RPS
Want expert guidance applying the Criteria for Excellence to your residency program? RPS consultants use the Criteria to evaluate programs and provide practical feedback and recommendations based on your program's goals and challenges.