INTELLIGENT DESIGN OR EVOLUTION? INNOVATION IN FAMILY MEDICINE RESIDENCIES

Michael K. Magill

doi:10.1370/afm.671

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Intelligent Evolution?
Randall Longenecker

Published on: 03 February 2007

Published on: (3 February 2007)
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Intelligent Evolution?
Randall Longenecker, Bellefontaine, Ohio, United States
As Program Director for an integrated "2-2-2" rural training track in family medicine over the past 10 years, I have had the incredible opportunity to design, implement and continue to refine an apprenticeship-style residency program under the watchful eye of our current RRC in Family Medicine. I have found the RRC very encouraging of innovation and have been innovating to my heart's content, working within the rules th...
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As Program Director for an integrated "2-2-2" rural training track in family medicine over the past 10 years, I have had the incredible opportunity to design, implement and continue to refine an apprenticeship-style residency program under the watchful eye of our current RRC in Family Medicine. I have found the RRC very encouraging of innovation and have been innovating to my heart's content, working within the rules that currently exist and with the expectation that outcomes need to match or exceed those of traditional programs. I will leave it to others to judge how successful we've been, but I know it's been lots of fun, our program still exists, and we have had greater student interest than ever before.
We can't blame the RRC. The intelligent design process described in this essay is much too ponderous and slow-moving, in part because the entities engaged in the process are much too large and bureaucratic. Our program's small size and community-embeddedness, matched with hardship, creativity, and a continuity of faculty over the past 10 years allowed us to adapt within the space of a year to the realities of declining student interest in generalist practice, especially family medicine, and even more, rural practice.
And we can't simply blame the AHC's, although I am tempted! Innovation as such is not rewarded by most of the academic institutions with which I am familiar. A colleague in a neighboring state recently learned that her 12 week predoctoral community-based program, wildly successful by any accepted measures of student interest and performance, community participation, and life-changing experiences was cut because it does not meet the institution's measures of fame and fortune or catch the imagination of what appears to me to be the unimaginative leadership of that institution.
We can only take responsibility for ourselves. We need to adapt to current realities and encourage each other in our efforts. I believe that if family medicine is going to innovate, then mainstream FM must down-size to the level of the community and be more curious about what goes on at the fringe of our specialty, recognizing and rewarding exemplary practice there.
Competing interests: None declared
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Competing Interests: None declared.