From Floor to “Soar” – Aiming for Evidence-Based Residency Innovation

Funding for graduate medical education (GME) costs the American public approximately $20 billion per year.¹ While this funding reflects a positive investment in the health of Americans, has it resulted in significantly decreased health care costs, improved patient experience, improved health of populations, improved clinician well-being, and advances in health equity? This “Quintuple Aim” of health care is embedded in the definition of GME in family medicine,² yet by most measures, our return on investment has been poor indeed.³

From 2017-2019, the Board on Health Care Services of the National Academies of Sciences, Engineering, and Medicine agreed that the goals of GME are to train physicians who:

• provide excellent, cost-effective care

• address the US population’s physician workforce needs (regarding specialty distribution, geographic distribution, and diversity)

• advance biomedical and health systems science

• contribute to leadership in health care⁴

We in family medicine willingly share our innovations, methods, and curricula in meetings and member forums, without particular synergy or organized purpose. Enter the collaborative effort of SOAR, Strengthening Outcomes and Assessments in Residency. This initiative between the Association of Family Medicine Residency Directors (AFMRD) and the American Board of Family Medicine (ABFM) began in 2023, with the goal of enabling family medicine residency programs to harness one another’s successes and the wealth of data available to the ABFM to grow in the direction of greater social and community accountability.⁵

SOAR has used 3 primary mechanisms to advance this lofty goal:

• Appreciative inquiry: At the last 2 AAFP Residency Leadership Summit meetings, many residency leaders met in a preconference workshop. We heard from leaders whose program outcomes indicated they were positive examples in chosen focus areas (eg, care of children and behavioral health care), who had been invited to reflect on the uncommon practices/behaviors which led to those outcomes. Attendees were challenged to apply these innovations, and design and plan implementation of activities in their own programs.

• SOAR Scholars: The inaugural SOAR Scholars have completed their year of study. Dr Alex Reedy Cooper examined the relationship between Catholic affiliation of a sponsoring institution and GME outcomes, and Dr Varshaben Songara compared the milestone progression for international and US medical graduates. They will be reporting their findings in the coming year.

• Communities of practice: These are learning networks, with a focused, well-defined purpose. Built on a foundation of trusted relationships, members learn and develop practice based on existing knowledge in order to generate/discover new knowledge. SOAR has been working to create platforms and environments which will enable such communities to develop the trust, mutual respect, reciprocity, and commitment to surface innovative residency structure and experiment together.⁶

In family medicine, our core purpose is to heal patients and communities. In order to meet that call, our vision is for SOAR to become a hub which helps program directors help each other to standardize our training efforts AND to innovate in meaningful ways. Working together, we can SOAR to accomplish what is most needed—to train physicians who are equipped and empowered to make the Quintuple Aim a reality for every person.

• © 2024 Annals of Family Medicine, Inc.