Innovation in Family Medicine Residencies: Struggling to Create Classics for the Future
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* Joseph Gravel, Jr.
* Todd Shaffer
* Stoney Abercrombie
* Karen Hall
* Grant Hoekzema
* Stanley Kozakowski
* Michael Mazzone
* Benjamin Schneider
* Martin Wieschhaus

*“Innovation distinguishes between a leader and a follower.”* Steve Jobs *“Innovation! One cannot be forever innovating. I want to create classics.”* Coco Chanel 

Program directors work each day to produce graduates prepared for future practice yet rooted in the ideals and values of the classic family medicine past. Residency programs are currently engaged in a dramatic outburst of activity in new curricular models as well as practice transformation directly involving residents, most commonly using the PCMH model. Students and residents show great enthusiasm for this new model which provides them a possible path out of a “hamster care” future as health care payment models begin to move away from a fee-for-service methodology.

The AFMRD Board of Directors considers the “support and spread of innovation in family medicine residency education” as a major component of its 2011 strategic plan. Defining “innovation” can be a challenge. Does it actually enhance residency recruitment, provide better service for patients, deliver better quality, or ensure our graduates can deliver the new models of care? Is it disruptive or incremental? Will “innovative” ideas actually result in a better family physician? How will we know?

Working with other family medicine organizations through the Council for Academic Family Medicine (CAFM), the AFMRD has developed an “Innovation Needs Assessment Task Force” to create and administer a needs assessment inventory. The task force‘s gap analysis of the current mechanisms to support mutual assistance and shared learning across multiple residency sites will help identify a strategy to measure and track the scope of innovation in the nation’s residencies and family medicine departments. The task force will also create a communications strategy to disseminate the scope and impact of family medicine innovation to students, policy makers, and the public.

The AFMRD efforts in promoting innovation include enhancing inter-program collaborative efforts and providing program director input for the revision of RC-FM requirements that would more easily allow for innovative training. In addition, the development of Web-based platforms has been shown to be an effective means of supporting innovation and outcomes. TransforMED has created Delta Exchange, an interactive, asynchronous tool to share what’s being learned and to engage other innovators. The AFMRD worked to secure free access to this for our members ([http://www.transformed.com](http://www.transformed.com)) to further enhance conversations about transformation and take advantage of this next generation interactive tool.

Is there funding out there to support innovation? The donations of $30 million by an anonymous donor to Harvard Medical School and another $20 million to Boston’s Partners Healthcare for the express purpose of supporting innovation in primary care tell us yes. Since these donations went to 2 institutions that do not formally even acknowledge the specialty of family medicine (no clinical or academic department in either one) suggests that the builders of the old medical-industrial complex still hold sway in the psyche of many of our nation’s power brokers. FM residencies need to become a network of “innovation exemplars” and better communicate these examples to those outside the discipline which may assist us in attracting more financial support.

What about upcoming ACGME revisions to the program requirements? Will barriers to residency innovation be reduced? We think the answer is yes, but with a caveat. The freedom of having reduced prescriptive, time-based, check-off requirements creates more space for innovative ways to train residents, but the burden of proving actual outcome competency measures is also more present. External accountability of our graduates will also inevitably increase. We believe that the growing ability to measure clinical outcomes is an opportunity to more clearly demonstrate that family physicians are this nation’s best hope to create a higher quality, lower cost health care system, but we must provide residents new skills to lead PCMHs and ACOs. Innovation, new ways of looking at and solving problems, therefore, is an imperative for our specialty. We may need to look outside medicine to find ideas and solutions from other business industries to improve our model of delivery of care.

We have over 450 federally funded test sites called family medicine residencies which are a ready-built system to test new ideas to train better primary care physicians and provide better health outcomes than anyone else. If we don’t, others will; and those others may not have the values of the family physicians of the past that inspire us to create “classics” for the future.

*   © 2011 Annals of Family Medicine, Inc.