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Lawrence Family Medicine Residency Transition to a Four Year Program (an ACGME Length of Training Pilot Program)

Wendy Brooks Barr MD, MPH, MSCE; Whitney LeFevre, MD; Clark Van Den Berghe, MD; Joseph Gravel MD Lawrence Family Medicine Residency, Greater Lawrence Family Health Center, Lawrence, MA

Overview1. Development of competencies in all aspects of PCMH in our NCQA Level 3 Family

Medicine Center through immersion in and graduated responsibility for management of the medical home.  Including:a. team-based careb. population medicinec. community healthd. information masterye. chronic disease managementf. practice-based improvementg. leadership

2. Increased depth of experience in core clinical aspects of Family Medicine, particularly essential in low resource clinical environments, with development of added competencies key to the care of underserved populations.

3. Increased opportunity for residents to develop additional competencies in areas of personal interest through the expansion of areas of concentration (AOCs).

4. More meaningful and longitudinal community experiences which will serve as a foundation for substantive community involvement for residents throughout their careers.

• Family Medicine Length of Training Pilot (FM-LTP). • Developed by the ACGME Review

Committee in Family Medicine (RC-FM), in conjunction with the American Board of Family Medicine (ABFM)

• Goals: • To find innovative methods to prepare

Family Physicians to “serve as highly effective personal physicians in a high performance health care system.”

• Inform whether four years should become the standard length of training in Family Medicine

• Evaluation method: Match and compare selected programs with a group of existing three-year programs

• Evaluation Team: Oregon Health and Science University

• Timeline:: Selected 2013, evaluation through 2019

 • Selected 4 Year Residency Program:

• Mid Michigan Medical Center-Midland (Michigan) • Middlesex Hospital FMR (Connecticut) • John Peter Smith Hospital (Texas) • Oregon Health and Science University Program

(Oregon) • Lawrence Family Medicine Residency

(Massachusetts) • University of Nevada, Reno (Nevada)• National Capital Consortium (Virginia) • US Naval Hospital Camp LeJeune (North Carolina) • US Naval Hospital Camp Pendleton (California) • US Naval Hospital Jacksonville (Florida)

Objectives Evaluation

Why 4 Years? Recruitment Outcomes

2009 (Class of '13)

2010 (Class of '14)

2011 (Class of '15)

2012 (Class of '17)

2013 (Class of '18)

2014 (Class of '19)

0

100

200

300

400

500

600

700

800

900

1000

Total ApplicantsUS GradsAvg Matched Step2R1 ITE Score

Applicant Metrics By Recruitment Year

• Changing to required 4 year curriculum has not hurt recruitment• Trend towards more total applicants and US medical school seniors• Trend toward higher R1 ITE scores and no change on Step 2 Scores of matched

applicants

1. Successful recruitment of high quality residents into the program as measured by:• 100% Match Rate• Increased number of US medical seniors applying to the

program• Matched residents with higher achievements

USMLE Step 2 scoresR1 In-training Exam ScoresNational Medical Student Recognitions (AOA, Gold

Humanism, Pisacano)2. A high level of resident achievement in residency

as measured by:• Initial ABFM Certification Exam scores• Community involvement during residency• Completion of QI and scholarly activity projects

3. A high percentage of graduates reporting:• Leadership roles in CHCs • Leading QI projects in their practices • Working in HPSA or international sites• Practicing full-spectrum family medicine

www.postersession.com

Lawrence Family Medicine Residency Transition to a Four Year Program (an ACGME Length of Training Pilot Program)

Wendy Brooks Barr MD, MPH, MSCE; Whitney LeFevre, MD; Clark Van Den Berghe, MD; Joseph Gravel MD Lawrence Family Medicine Residency, Greater Lawrence Family Health Center, Lawrence, MA

GOALS: Provide residents with opportunities to develop advanced competency in an area of interest. Develop resident skills in self-directed learning and promote the practice of life-long learning and skill development.

Curricular InnovationsAreas of Concentration Four Year CurriculumInnovation Area

New / Additional Training

PCMH R4 “Clinic Chief” block experience; progressive leadership within clinical teams

Group Visits Lead at least 3 cycles of group visits in 2 clinical areas

HIV Required experience with HIV-care management team

Addiction Medicine

Required experience in addiction medicine/chronic pain

Mental Health

Enhanced focus on team-based behavioral health management

Underserved Care

Longitudinal experiences; focus on social determinants of health during R1 “education week”

Community Medicine

Longitudinal involvement with defined community in Lawrence

Information Mastery

Enhanced didactics; skill tasks in clinical experiences

Leadership Increased advocacy efforts; progressive clinical leadership

Research Increased curricular time; more research methodology training

Population Medicine

Review community and patient data; design, implementation and evaluation of interventions based on population data

Integrative Medicine

Core longitudinal experiences in proven integrative modalities

Phase 1 AOCs (Active)

Global Health

Advanced Surgical Maternity Care

Integrative Medicine

HIV

Academic/Faculty Development

Health Systems Leadership

Sports Medicine

Women’s Health

Phase 2 AOCs

(In Progress)

Behavioral Health

Addiction Medicine / Pain Management

Hospitalist

R1 Adult Medicine (10 wks)

AM NF(2 wks)

Maternity Care (6 wks)

MC/PD NF (4 wks)

Pediatrics (4 wks)

Surgery (2wks)

Outpatient Longitudinal (14 wks)

Spanish Elective

(2wks)

Spanish/ Intro to

FM (4 wks)

Vacation (4 wks)

R2 Adult Medicine(4 wks)

ICU (4 wks)

AM NF(4 wks)

Maternity Care

(4 wks)

MC/PD NF

(2 wks)

PD (2 wks)

Neo (2wks)

Peds ED

(2 wks)

ED (4 wks)

Outpatient Longitudinal(16 wks)

Elective (4 wks)

Vacation(4 wks)

R3 Adult Medicine (6 wks)

AM NF

(2 wks)

MC (2 wks)

MC/PD NF (4 wks)

Pediatrics (4 wks)

ED (4 wks)

UMASS Sports Med

(4 wks)

Outpatient Longitudinal(10 wks)

Longitudinal AOC

(4wks)AOC (4 wks)

Elective (4 wks)

Vacation(4 wks)

R4Adult

Medicine (4 wks)

FM NF

(2 wks)

MC (2 wks)

MC/PD NF

(2 wks)

Peds ED

(2 wks)

Clinic Chief/PCMC

(6 wks)Outpatient Longitudinal

(20 wks)

Longitudinal AOC

(4wks)AOC

(8 wks)Elective(2 wks)

Vacation(4 wks)

Outpatient Longitudinal Curriculum Content by Year of TrainingR1: Gynecology, Orthopedics/Sports Med, Geriatrics, Behavioral Health, PCMH, Outpatient Pediatrics, Community MedicineR2: Gynecology, Orthopedics/Sports Med, Surgery, Dermatology, Geriatrics, Palliative Care, PCMH, Community MedicineR3: Behavioral Health, HIV, Addiction Medicine, PCMHR4: Geriatrics, Integrative Medicine, Subspecialty Care, Dermatology, Adolescent Medicine, Outpatient Pediatrics, PCMH, Community Medicine,