Criteria for Excellence | Chapter 8A: Curriculum development
Design a residency curriculum that meets requirements while supporting innovation and growth.
Develop a forward-thinking family medicine residency curriculum
A Program of Excellence ensures that its educational curriculum meets the minimum requirements outlined in the Accreditation Council for Graduate Medical Education (ACGME) Program Requirements. It also uses the flexibility permitted within these requirements to execute innovative curricular design. The residency curriculum is a tool to achieve specific educational aims. Formal curriculum documents communicate expectations about the learning goals and environment to residents, faculty, and other stakeholders. This section is not a prescription for a defined curriculum. It is intended to help programs create a forward-thinking curriculum that meets the needs of its residents and the community.
Meet ACGME curriculum requirements
The ACGME Program Requirements related to curriculum can be distilled into the following broad areas:
- Overall educational goals for the program available to and understood by residents and faculty
- Competency-based goals and objectives for each assignment at each educational level
- Regular interactive educational activities to explore and analyze pertinent evidence related to the specialty.
- Clear delineation of patient care responsibilities for the resident, with progressive responsibility over time and related necessary supervision
- Intentionally designed experiences that maximize opportunities for direct observation of residents to accurately assign Milestones and assess professional development.
- Direct observation of incoming first-year residents, and others as needed, is emphasized.
- Examples of these opportunities include simulation, video precepting, bedside rounds, and supervision of procedures.
- Integration into the curriculum of a meaningful process for measuring progress utilizing Milestones in the six ACGME Core Competencies: 1) Patient Care; 2) Medical Knowledge; 3) Interpersonal and Communication Skills; 4) Professionalism; 5) Practice-Based Learning and Improvement; and 6) Systems-Based Practice
- Specific content related to core clinical areas (e.g., care of children, care of the older adult)
- Activities contributing to the clinical learning environment at both the program and larger system levels, including active engagement by residents in quality improvement and safety event monitoring and reporting.
Adapt residency education to changing community and health care needs
The content and environment of care, including means and location of care delivery, are rapidly evolving. Programs must meet existing ACGME requirements while developing the ability to change and respond to evolving external demands from patients, communities, and payers.
Many residencies have long histories in their communities. As a result, communities and hospital systems may have fixed expectations regarding curriculum, residency contributions to their systems, and service-related activities by residents. Over time, these expectations may become inconsistent with current needs. The residency program must continually engage and educate its sponsors about growth and change in resident education. This ensures that expectations remain aligned with current curriculum. It also helps sponsoring institutions understand how the residency program facilitates institutional success.
New programs face challenges in integrating their systems, residents, faculty, and expectations into established medical communities. They may find that some curricular areas (e.g., maternity care, hospital-based care) conflict with established or developing practice patterns in the health care community. It is important to promote understanding of the educational need to support these areas of practice.
Keys to successful family medicine residency curriculum development
A Program of Excellence’s curriculum is a constant work in progress. Some benchmarks are available to help programs succeed in these efforts. Programs can access examples of curriculum documents and content from resources including the Family Medicine Residency Curriculum Resource (login required), and the Society of Teachers of Family Medicine (STFM) Resource Library (no login required).
As a Program of Excellence considers curriculum development, the following principles are key to success:
Balance ACGME requirements with curricular innovation
The program must meet minimum requirements in all areas of the ACGME Program Requirements.
If the program can demonstrate adequate volume and teaching expertise, current Review Committee for Family Medicine (RC-FM) requirements permit considerable flexibility in developing longitudinal curriculum and bringing expanded experience (e.g., pediatrics, maternal care, care of the older adult, gynecology, behavioral health) into the family medicine practice.
A Program of Excellence is familiar with Detail Requirements that offer opportunities for innovation in programs in good standing. Faculty engaged in these innovations are expected to assess the outcomes and present their findings regionally or nationally as scholarly activity. (See the Research and Scholarly Activity section for additional information.)
Engage residents and faculty in curriculum design
Both faculty and residents are engaged in the process of curriculum design. The larger the change considered, the greater the need for such involvement. Residents’ direct involvement in curriculum development is fundamental to acceptance, engagement, and good educational outcomes. Residents should understand the requirements and goals of the program’s curriculum and participate in designing workflows and education to meet them.
Establish clear learning goals and competency-based objectives
A Program of Excellence has clear learning goals and objectives. This is the fundamental task of curriculum development, but it is too often given short shrift. Curriculum design should always flow from a program’s learning goals and objectives to what activities will best help achieve them, not the reverse. This will require faculty to understand the difference between goals and objectives and know how to write good ones. Kern’s six-step approach to curriculum development and evaluation is a gold standard for teaching methods that follow goals and objectives.
The program’s goals and objectives must clearly address the six ACGME Core Competencies and lead to competency-based evaluation tools. Evaluations are much easier to develop when goals and objectives are clear and well written. (See the Competency-based medical education section for additional information.)
The Entrustable Professional Activities (EPAs) for family medicine are one agreed-upon way to describe the work of being a family physician. A Program of Excellence should refer to the EPAs as it is developing or evaluating its curriculum. (See the Entrustable Professional Activities section for additional information.)
Continuously evaluate and improve the residency curriculum
Programs are required to have a mechanism for curriculum review that includes, but is not limited to, the Program Evaluation Committee (PEC). The PEC should be a significant part of residency function. Each curricular area should be evaluated on goals and objectives, as well as locations, faculty, and content. Curriculum decisions should be made with attention to the shifting needs of residents, the training community, and graduates’ community of practice. This can take place as part of the Annual Program Evaluation or in a separate process. Major curricular changes should be included in the annual Program Improvement Plan.
Prepare residents for broad-scope, whole-person care
Family medicine is a specialty with a substantial ambulatory focus, so family medicine residencies need to prepare residents to succeed in outpatient medicine in the context of broad-scope, whole-person care. A Program of Excellence has specific curriculum to address resident learning in the outpatient setting. The Building Blocks of Primary Care Assessment for Transforming Teaching Practices (BBPCA-TTP) are an excellent starting point for the process of developing a Clinic First curriculum.
Curriculum for a Program of Excellence relies on the expertise of family physicians as much as possible, with specialty collaboration as needed. Faculty should strive to develop areas of expertise. When members of other specialties are involved in curriculum development and delivery, it is crucial for family physicians to guide outside faculty regarding the exact nature of what family medicine residents should be expected to learn. This is often a delicate discussion that requires careful guidance to reinforce the expertise of both family physicians and other specialists.
Use active learning and technology in resident education
Curriculum for a Program of Excellence explicitly addresses residents as adult learners. It takes advantage of residents’ natural curiosity, engagement, and special skills, and it utilizes emerging technology to develop residents’ skills and knowledge. Wherever possible, passive learning modalities (e.g., lectures, assigned readings) should be replaced with robust, active educational engagement between faculty and residents.
With limited exceptions, a faculty member other than the program director should be responsible for each discrete curricular content area and the ongoing evaluation and improvement of that area. (See the Leadership Team and Staffing section for additional information.) The responsible faculty member is expected to collaborate with faculty around the country through conference attendance and learning collaboratives.
Integrate residency curriculum with the health care system
The setting for a Program of Excellence’s clinical training is a health care system. When developing curriculum, the program must address the following areas:
Team-based care and the patient-centered medical home (PCMH) model
Workflow efficiency in a highly functioning practice: Reasonable productivity goals for both faculty and residents should be embedded in the curriculum. Achievement of these expectations will improve the program’s financial strength and also prepare residents to meet practice expectations after graduation.
Resident leadership: Residents must be recognized and valued as future colleagues and partners in the community, region, and health care system. Communicating regular updates to the system and medical community regarding residents’ roles will reinforce this. For internal and external faculty and administration, residents are the embodiment of the learner and should be able to describe their educational goals. Support should be available so that residents can attend national educational conferences to participate in presentations about curricular changes they had a role in leading.
Quality and system improvement and patient safety: Every residency program should be engaged in a structured curriculum in these areas.
Integration of technology into health care: This includes electronic health records (EHRs), social media, medical informatics, and health care decision aids.
References
1. Kern DE, Thomas PA, Howard DM, et al. Curriculum Development for Medical
Education: A Six-Step Approach. The Johns Hopkins University Press; 1998.