Preparing the Personal Physician for Practice (P4): Essential Skills for New Family Physicians and How Residency Programs May Provide Them (original) (raw)
Related papers
PubMed, 2013
Background and objectives: Mismatch between program directors' expectations of medical school graduates and the experience of students in medical school has important implications for patient safety and medical education. We sought to define family medicine residency program directors' expectations of medical school graduates to independently perform various procedural skills and medical school graduates' self-reported competence to perform those skills at residency outset. Methods: In July of 2011, a paper-based survey was distributed nationwide by mail to 441 family medicine residency program directors and 3,287 medical school graduates enrolled as postgraduate year 1 (PGY-1) residents in family medicine residency programs. Program director expectation of independent performance and recent medical school graduate self-reported ability to independently perform each of 40 procedures was assessed. Results: Surveys were completed and returned from 186 program directors (response rate 42%) and 681 medical school graduates (response rate 21%). At least 66% of program directors expected interns to enter residency able to independently perform 15 of 40 procedures. More than 80% of new interns reported they were able to independently perform five of the 15 procedures expected by program directors. Conclusions: Incongruity exists between program director expectations and intern self-reported ability to perform common procedures. Both patient safety and medical education may be jeopardized by a mismatch of expectation and experience. Assessment of medical students prior to medical school graduation or at the start of residency training may help detect procedural skill gaps and protect patient safety.
Four-year residency training for the next generation of family physicians
The virtual mentor : VM, 2005
Family medicine training is still largely based on a model developed more than 35 years ago, with 3 years of required rotations in multiple areas of medicine, combined with a longitudinal clinic experience in model family practice centers . The physician trained in this model has been prepared to practice in a range of settings and with diverse scopes of practice. The outcome is a physician workforce that is distributed across urban and rural America with important positive effects for the health of communities . The durability and beneficial outcomes of this training model suggest that it should continue, but there are several reasons to consider innovative changes in its character if not its duration:
Residency Training in Family Medicine: A History of Innovation and Program Support
2017
BACKGROUND Residency programs have been integral to the development, expansion and progression of family medicine as a discipline. Three reports formed the foundation for graduate medical education in family medicine: Meeting the Challenge of Family Practice, The Graduate Education of Physicians, and Health is a Community Affair. In addition, the original core concepts of comprehensiveness, coordination, continuity, and patient centeredness continue to serve as the foundation for residency training in family medicine. While the Residency Review Committee for Family Medicine of the Accreditation Council for Graduate Medical Education has provided the requirements for training throughout the years, key organizations including the Society of Teachers of Family Medicine, the American Academy of Family Physicians, the Association of Family Medicine Residency Directors, and the American Board of Family Medicine have provided resources for and supported innovation in programs. Residency Pr...
Required procedural training in family medicine residency: a consensus statement
Family medicine, 2008
Specific procedural training standards for US family medicine residencies do not exist. As a result, family physicians graduate with highly variable procedural skills, and the scope of procedural practice for family physicians remains poorly defined. Our objective was to develop a standard list of required procedures for family medicine residencies. The Society of Teachers of Family Medicine Group on Hospital and Procedural Training convened a working group of 17 family physician educators. A multi-voting process was used to define categories and propose a list of required procedures for US family medicine residency programs. The group defined five categories of procedures within the scope of family medicine. Consensus was reached for a core list of procedures that all family medicine residents should be able to perform by the time of graduation. Defining standards for procedural training in family medicine will help clarify family medicine's scope of practice and should benefit...
Perceptions of Becoming Personal Physicians within a Patient-Centered Medical Home
Journal of Health Education Research & Development, 2016
Objective: Residency training is transforming how to teach residents about practicing as a personal physician in a Patient Centered Medical Home [PCMH], but little is known about how trainees experience these responsibilities. Methods: This study used an online survey with open-ended questions to assess residents experiences with curricular innovations as part of learning to practice as physicians in a PCMH. The survey questions were distributed every six to 12 months. This analysis focuses on responses to a single question administered once, "What does being a personal physician working in a medical home mean to you?" Two independent researchers analyzed text responses using an immersion-crystallization approach. The full research team met to discuss emerging themes. Principal findings: Sixty-two residents representing 78.6% of participating training programs responded to the online survey question that is the focus of this analysis. Overwhelmingly, resident respondents reported finding meaning in the humanistic and interpersonal aspects of medicine. In particular, residents reported that being a personal physician in a PCMH meant being the go-to person for patients' healthcare needs. This included delivering patient-centered, continuous care in the context of a physician-patient relationship that broke down the traditional physician-patient hierarchy. Being a personal physician also included an important role for the physician and clinical team members in orchestrating the referral and care coordination process. To accomplish this, residents recognized that personal physicians needed to learn the art of practice. Conclusion: Physicians trained in newly redesigned residencies understand and embrace their role and relationships with patients and health care teams that emerge as part of the PCMH. Residency redesign efforts can inculcate new family physicians with key practice ideals and knowledge about how to achieve these in practice.
From residency to practice: Mindsets of early-career family physicians
Education and training
Context: A mastery mindset is important for physicians' engagement in lifelong learning. In primary care, early-career physicians face unique challenges in establishing independent clinical practice following residency training. This study aims to shed light on whether family physicians graduating from a competency-based education (CBME) residency program continue to exhibit mastery-oriented mindsets and motivations that could have an impact on lifelong learning and patient care outcomes. Objective: To examine the mindsets of early-career family physicians following graduation from a CBME residency program. Design: Longitudinal, cohort, survey study of family medicine (FM) residents. Setting: One graduating FM resident cohort (2015-2017) at a large Canadian university was surveyed at three time points: 1) end of residency training, 2) one year into clinical practice, and 3) three years into clinical practice. Population Studied: Of 70 eligible FM residents, 52 (74%), 43 (61%), and 29 (41%) completed the questionnaire at each of the three data collection points respectively. Instrument: Baranik et al.'s instrument was used to measure the three types of mindsets (mastery, performance approach, performance avoidance). Each mindset was measured by 4 statements. Participants indicated their level of agreement with each statement (1=not at all agree; 10=completely agree). Main Outcome Measures: Three types of mindsets: Mastery-self-directed, intrinsic motivation towards learning; performance approach-motivation towards impression management; and performance avoidance-motivation towards ego-protection. Descriptive and multivariate analysis of variance were performed. Results: Irrespective of the time in practice, mean scores were the highest on the mastery mindset and the lowest on the performance avoidance mindset measures (P < 0.001). With time, the mastery mindset scores decreased among the cohort (P = 0.04). Conclusions: Family physicians trained in a CBME residency program continued to be mastery-oriented in the first three years of clinical practice despite a downward trend. Residency programs need to ensure graduating physicians are equipped with knowledge and tools to maintain mastery mindset throughout their professional careers.
Family practice graduate preparedness in the six ACGME competency areas: prequel
Family medicine, 2003
Since July 2002, family practice residency program accreditation requires evidence of teaching and assessing residents in six competency areas. This study was conducted to obtain baseline information about family practice graduates' perceptions of the importance of specific competencies and the extent to which residency training prepared them to perform skills representative of the six competency areas. A national, cross-sectional survey was conducted of family physicians who had graduated from residency programs from 1998 to 2000. The response rate was 54% (n=1,228). Graduates reported the most preparation in patient care skills, followed by interpersonal and communication skills and then professionalism. The least preparation was reported for skills pertinent to practice-based learning and improvement, systems-based practice, and some areas of professionalism. Areas of residency education that appear to warrant improvement include education about system aspects of care, practi...