The Association of Departments of Family Medicine (ADFM) has articulated a number of concerns regarding family medicine residency education, such as the need for fl exibility, a simplification of requirements, and more innovation/experimentation in the residency education continuum. The original Residency Review Committee (RRC) requirements were 2 pages in length and have now expanded to 40 pages.1,2 The Future of Family Medicine report stated that “innovation in family medicine residency programs will be supported by the RRC for Family Medicine through 5–10 years of curricular fl exibility … the discipline should actively experiment with 4 year residency programs that include additional training to add value to the role of family medicine graduates in the community.”3 The Residency Assistance Program, now known as Residency Programs Solutions (RPS), has suggested 3 levels of obstetrical training (the minimum being 2 months of obstetrical experience with no continuity obstetrics requirement) and a core curriculum that is competency based.4 The P4 project has identified 14 residency programs in order to support innovative educational process and content.5 Graduates of these innovative programs will be accepted by the ABFM to sit for the certification exam and the RRC looks forward to the impact these innovative programs may have on future editions of the RRC requirements. The P4 project is a major step to move residency education into the 21st century.
RRCs are accrediting bodies that determine whether a program has met the minimum standards to provide training sufficient to produce a competent family physician. Accreditation is substantially meeting the requirements—no program meets all requirements 100% of the time. The RRC has tended to be reactive to what it sees in the field and in the PIFs. In essence, the RRC has functioned as a rule-making body with measuring tools. The RRC has to respond to the ACGME, which oversees all RRCs. National accreditation organizations such as the ACGME may find that creativity and fl exibility are a challenge. However, there is a sense that change may be forthcoming.
ADFM and the Association of Family Medicine Residency Directors (AFMRD) have much to gain by improving communication with each other and with the RRC for family medicine. Many concerns identified by ADFM are likely to be shared by AFMRD. ADFM should encourage the RRC to:
-
Permit several levels of obstetrical training with a fl oor of only 2 months of rotational experience and no continuity requirement. Specific rationale should be provided by programs requesting this option such as prohibitive malpractice costs or zero recent graduates practicing obstetrics in order to keep programs in step with reality.
-
Define the core curricular requirements that can be met in 18–24 months either through block rotations and/or longitudinal experiences. This would increase the available fl exible time in each program.
-
Develop methods/measures/tools that permit individual resident advancement instead of solely using block/time criteria for advancement.
-
Define criteria for developing tracks, focused experiences and fourth year concentrations.
-
Change the predominant measurement parameters from number of patients seen or months experienced to competencies achieved.
-
Advocate that residencies ensure that residents participate in research programs that produce new information about caring for patients – instead of simple literature reviews.
These 6 concerns are content areas that have potential solutions. However, none of these concerns can be effectively resolved unless the RRC requirements are significantly simplified and shortened. ADFM in collaboration with AFMRD could draft an example of a shortened/focused RRC requirements. However, major revision of the RRC requirements with simplification and brevity as a goal will not occur without developing a ‘new relationship’ between ADFM, AFMRD, and the RRC. These relationships must be established by structured communication. First, communication between ADFM and the AFMRD should occur regularly by having representation at each other’s appropriate meetings. Second, ADFM should regularly invite the chair of the RRC to give a report at the annual winter meeting. Third, the ADFM Residency Committee should develop principles for innovation and research, in collaboration with AFMRD, and request that they become part of future RRC requirements. Lastly, ADFM should develop educational sessions on residency innovation, research in residencies and competency-based education for presentation at annual ADFM meetings.
ADFM can see the RRC as an obstructive force that needs to be moved out of the way or the RRC may be seen as a latent agent of change that needs better communication and proactive assistance in order to move the discipline into the future. The latter approach is likely to get better results in a more timely manner.
- © 2007 Annals of Family Medicine, Inc.