INTRODUCING THE BEST PRACTICE GUIDE FOR STRATEGIC PLANNING TO INCREASE STUDENT CHOICE OF FAMILY MEDICINE

The family of Family Medicine has created several initiatives to increase student choice of Family Medicine over the years. The most recent is a set of strategies recommended by the Family Medicine for America’s Health (FMAHealth) Workforce Education and Development Tactic Team¹ which has become the current collective effort to increase student interest, America Needs More Family Doctors: 25×2030.² The FMAHealth Workforce Tactic Team initiated several projects related to these strategies, one of which evolved into a guide of evidence and best practices for Departments of Family Medicine (DFMs) in their piece of the puzzle to attract, retain, and train a diverse workforce of family physicians to address the growing population of the United States.³

The ADFM Education Transformation Committee, targeting ADFM’s strategic priority to “increase the number of US medical school graduates selecting family medicine as a career,” produced the “Best Practice Guide for Strategic Planning to Increase Student Choice of Family Medicine” as a supporting activity for the 25×2030 initiative. The goals of the Guide are to (1) provide evidence-based best practice resources for DFMs regarding increasing student choice of Family Medicine; (2) provide a virtual community to share student choice resources for Council of Academic Family Medicine (CAFM) stakeholders; (3) provide a living repository of success stories and evidence-based strategic planning for DFMs; and (4) provide annual goals and objectives to the ADFM Education Transformation committee to support activities of the 25×2030 initiative.

The Guide builds on the CAFM Four Pillars framework,^4–6 a conceptual model to help DFMs organize their efforts to increase student choice for a family medicine career. The 4 pillars include: pipeline, process of medical education, practice transformation, and payment reform. Although the Guide itself is still under development, we wanted to take this opportunity to share the recommendations (Figure 1) and related data. On our 2019 ADFM member survey, 67% of department chairs reported that they have faculty teaching M1/M2 Community-Based Learning or Service Learning or required community service hours [recommendation #1], while 80% have faculty teaching M1/M2 students Ambulatory Family Medicine or primary care [rec #2], both well-known predictors of student choice of family medicine, along with longitudinal mentors [rec #3]. Pipeline programs for students underrepresented in medicine are more successful for encouraging family medicine if focused on rural or minority students from socioeconomically disadvantaged backgrounds [rec #4].⁷ Predictors for medical student intention to practice in underserved areas include growing up in an underserved setting, a very strong sense of calling, and a high medical school social mission score.⁸ International health electives also significantly influence student choice of family medicine.⁹ Increased exposure to vulnerable patient populations [rec #5] makes it more likely that stidents will go on to practice as primary care physicians in underserved areas by improving self-efficacy through interacting with diverse patient populations.¹⁰

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Figure 1

Best practice guide for strategic planning to increase student choice of family medicine.

Sixty-five percent of DFMs have faculty engaged in curricular innovation including health policy, population health, and/or social determinants of health [rec #6]. Fewer departments (53%) report faculty engaging in research with medical students either in required or elective experiences, though another 40% do so on an ad hoc basis. Among those reporting research with students, 70% included a focus on health disparities and social determinants of health [rec #7]. The majority (70%) of departments reported sharing information regarding student debt, loan repayment, and scholarships during FMIG events, though only 21% disseminate information in collaboration with medical school or university financial aid officers [rec #9]. Additionally, only 11.5% include National Health Service Corps or other loan repayment program information, despite the NHSC track record as the most successful loan repayment plan for family medicine recruitment. While tools exist to assess predictors of family medicine on admission, formal processes such as holistic reviews hold limited evidence thus far, but presence on committees, and contributions to admissions policies hold promise for the future [rec #8].

We continue to gather data, best practice examples, and successes and challenges related to these 10 recommendations. At the 2019 ADFM Annual Conference, we introduced the goals of the Guide and took deeper dives into the topics of admissions committees and preceptorships, with some activating discussion questions. At the conference in 2020, we will focus on early longitudinal community-service or community-based learning; using social determinants of health research to engage and recruit students; student debt; and programs with structural changes such as the 3-year accelerated curricula (eg, 3+3) models.

In addition to the conference session, special topic breakfast on recommendation #4, and a Twitter chat (#BPGatADFM), we will finalize the Best Practice Guide and partner with the American Academy of Family Physicians for web-based “living” resources, and a marketing plan to widely disseminate it, while encouraging DFMs to measure outcomes of their strategic plans [rec #10]. Please watch for more to come on this resource in the future!

• © 2020 Annals of Family Medicine, Inc.