IDENTIFYING TRENDS AND AREAS FOR IMPROVEMENT USING REPORTS FROM THE NATIONAL GRADUATE SURVEY FOR FAMILY MEDICINE

The National Graduate Survey (NGS) for family medicine is administered annually by the American Board of Family Medicine (ABFM) in partnership with the Association of Family Medicine Residency Directors to facilitate improvements in residency education by providing programs with access to nationally standardized data about their programs.¹ All ABFM-certified graduates receive the survey 3 years after they finish residency and have from January to December to complete the survey. The first survey in 2016 queried residency graduates from 2013; 4 surveys have been completed with the most recent 2019 survey of graduates from 2016. Residency programs receive a report with their graduates’ responses as well as the national data. If fewer than 3 graduates of a residency program respond, these responses are held and later combined with the subsequent year’s data.

Residency programs have used these reports to identify trends and areas for improvement. As our specialty looks towards the future, including a major revision to ACGME RC requirements, we can reflect on these 4 years of data.

With 4 years of survey data, 8,980 family medicine graduates have completed the graduate survey with an overall 69% response rate. The survey captures the scope of graduate practice and graduates’ self-reported training in residency. It also captures where and what types of practices graduates are practicing in and their self-reported burnout and feelings about their training, specialty, and medicine in general. Sufficient data has been collected to now describe with good reliability the practice of young family physicians and to identify trends over time in the specialty. Most importantly, researchers can use these data to test research hypotheses about the impact of family medicine training on graduate practice—true outcomes-based research of medical education.

A growing concern in the program director community is the scope of practice for our graduates. The NGS is a good tool to measure this for programs and the specialty as a whole. The survey annually asks graduates to report whether they felt adequately trained for a procedure or area of practice and whether they are currently providing this service. Over time, several emerging areas of practice such as Point of Care Ultrasound (POCUS) have been added to the survey. The combined self-reported training and provision of areas of practice for graduates between 2013 and 2016 is in Figure 1 and procedures in Figure 2. Most areas of practice and procedures were stable over these 4 years. Notable exceptions were placing implantable contraceptive devices such as Nexplanon with respondents receiving adequate training increasing from 61% to 82% and performing in practice increasing from 33% to 48%. With the 2012 changes to cervical cancer screening guidelines, many family medicine clinics following updated guidelines are performing fewer pap smears and have fewer patients who require colposcopy. Graduates feeling prepared to perform colposcopy decreased from 60% to 48%, though graduates currently practicing this procedure remained steady at 14% to 13%. Other areas with a notable decrease in graduates feeling prepared and practicing were HIV/AIDS (prepared 31% to 25%; practicing 21% to 14%) and Hepatitis C (prepared 30% to 23%; practicing 25% to 13%). A growing area of need for our public’s health is more family physicians prescribing buprenorphine. Unfortunately, over this time period there was not a significant increase in graduates reporting feeling trained (only increasing from 10% to 12%) and only a small absolute increase in graduates who report prescribing buprenorphine (increasing from 7% to 12%).

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Figure 1

National ABFM/AFMRD Graduate Survey scope of practice.

OB = obstetrics; ICU-CCU = intensive/critical care unit

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Figure 2

National ABFM/AFMRD Graduate Survey scope of practice—procedures.

Bx = biopsy; IuD = intrauterine device; Asp = aspiration; D & C = dilation and curettage; OB US = obstetrics ultrasound; MSK US - musculoskeletal ultrasound; POCUS = point-of-care ulstrasound; OMT = osteopathic manipulative treatment.

This national standardized data of our graduates are important for program directors, department chairs, and sponsoring institutions to measure whether they are meeting the mission, values, and goals for their programs. This was the primary goal for the original design for the NGS. As we are trying to recruit more students into our specialty and we continue to demonstrate our value to our communities and the US health system, these data are also an important resource as outcome measures for our programs. If program directors share their program data with medical students, students can be better guided to look for programs that meet their own personal training needs.

• © 2020 Annals of Family Medicine, Inc.