Changing Gears: Family Medicine Residencies Transitioning to Competency-Based Medical Education (CBME) Framework With the New ACGME FM Program Requirements

The updated Accreditation Council for Graduate Medical Education (ACGME) Family Medicine Program Requirements¹ go into effect on July 1, 2023. As we all work through what redesign will look like on the ground level, we have an incredible opportunity to embrace our full-scope past and move into the educational reality of competency-based medical education (CBME). This is both a revival of what makes family medicine so special and an innovation in how we teach this broad scope.

The ACGME Family Medicine Review Committee (FM-RC) and the American Board of Family Medicine (ABFM) recently released a set of outcomes considered core for family medicine² (Table 1). This set of 12 outcomes is a combination of the Entrustable Professional Activities (EPAs) and milestone competencies. Our programs will now develop how we teach and assess these outcomes so we can ensure that residents in our programs are independently competent in each of these areas. We will need to develop or adopt assessments that minimize bias and maximize accuracy, reliability, and ease of use. Will our residents be both competent and confident in the care of ill children or hospitalized adults? These questions will be the challenge of the next few years as we build, revise, and implement these assessments.

Luckily, there are others from whom we can learn—in particular, our family medicine colleagues in Canada who have paved the way for the last decade.³ Educational research and the framework called out by Van Melle will help guide us.⁴ Family medicine organizations are dedicated to developing resources for our programs. For example, the ABFM Foundation has funded an initiative to provide CBME faculty development training with Eric Holmboe, MD, and the Society of Teachers of Family Medicine (STFM) CBME Taskforce. This is also an opportunity to work with our residency management systems such as New Innovations and MedHub to create the app-based, immediate, resident-led feedback we need. These assessments will allow us to make the necessary determinations of competency.

There are many changes in the required curriculum that reflect the movement toward a CBME framework. The increase in elective time, although challenging at first, is really woven into the fabric of the Individualized Learning Plans (ILPs) which are the cornerstone of CBME to develop Master Adaptive Learners. An elective is any rotation that is not required of everyone in your program. An elective can be a resident-driven learning opportunity or it can be a list of selectives that meet your program’s mission and allow flexibility for residents to meet their own career goals and the needs of their future communities. However, this elective time can also be used to give us flexibility for additional rotations based on a resident’s need to meet the outcome goals (Table 1). We have long known that some residents are on a steeper or flatter learning curve for individual competencies. By creating a robust ILP paired with careful competency assessment we can work with residents to get them prepared for their future practice.

Although all these changes need to be implemented in our individual programs, we will have an easier time if we work together. There has been much talk about learning collaboratives and while they are not required by our new requirements, we think they will be very helpful. STFM is putting together a Learning Collaborative task force to look at best practices and ABFM Foundation will be setting up grant opportunities to assist in development of new collaboratives. We also have robust existing communities of practice for residency education excellence, including the AFMRD member discussion forum and resources in AFMRD PD Toolbox. There is active work to improve these resources for members and we encourage members to add new resources from their own innovations and best practices. We also need to be able to give feedback to both the ACGME and to the ABFM of what is working and what is not. The posted outcomes are provisional so please share your experiences. What none of us can do alone, we can definitely do together. Sometimes our greatest challenges lead to our best opportunities.

• © 2023 Annals of Family Medicine, Inc.