AAFP News Meet with AAFP Vice President for Medical Education Karen Mitchell, MD, to discuss how the new requirements are affecting residents, programs, and their communities.
AAFP News: What are some of the biggest changes to the new requirements that the AAFP has supported?
Mitchell: This is the biggest change in family medicine education since the specialty’s inception. Two of the transformative changes relate to patient care delivery, resident assessment, and learning.
We will have panel metrics in place instead of the 1,650 face-to-face visits that were required. Residents will be required to manage a group of patients in a team-based approach, with the goal of improving health equity and health of the population. That group of patients will be managed in a variety of ways, including telehealth and multi-location care. Continuity of care is emphasized and will need to be measured, along with the minimum number of caregiving hours in the family medicine practice. Patient advisory committees are required for each family medicine practice to meet the health needs of the community. In general, the requirements for the new program continue to cover the holistic nature of family medicine.
Having less restrictive requirements for programs will allow a greater focus on competency-based medical education. Assessment and training of residents will be part of the individual learning plan required for each resident. There is more optional time—required based on the evaluator’s individual learning plan–so that the evaluator’s experience can be tailored to their future practices and learning goals.
Another change is that for the first time there is a two-tier requirement for pregnancy care. Pregnancy care remains the cornerstone of family medicine training. The higher level will have specific requirements for residents seeking independent practice in comprehensive pregnancy care after graduation so that they can receive hospital privileges and credits.
AAFP News: Are there changes that the AAFP has not supported?
Mitchell: We did not obtain a basic FTE request for faculty members for protected non-clinical time. We got program leadership support that increases the amount allowed by the ACGME, as the amount of program manager and plugin manager time depends on the size of the program. But the amount of faculty teaching time is less than the minimum amount supported by the AAFP.
Faculty time is needed to implement program requirements, such as assessment and evaluation of residents, training of residents, career and instruction planning, curriculum development, and creation and management of learning opportunities. A letter from the ACGME Board of Directors approved the Audit Committee for family Medicine A serious request to increase faculty time, but the ACGME Board did not agree to this request.
They agreed to change the faculty-to-resident ratio for programs with 12 or more residents from a 1:6 to 1:4 ratio. This helps. However, programs are still required to meet all ACGME requirements, and this means that many programs will require a greater amount of time and basic support dedicated to faculty. We will continue to monitor the situation.
AAFP News: How will AAFPs implement these changes?
Mitchell: We have Standards of Excellence, published by our Residency Program Solutions Consultants. These residency experts made recommendations for programs to achieve to improve the quality of their programmes. These criteria can be used by residencies to show their institutions what it takes to deliver a high quality residency programme. We are constantly updating this resource. The RPS program also provides counseling to individual programs to help meet their unique needs.
Also, the Leadership in Residence Summit in March will include several workshops focused on helping programs with new requirements. This will be an unmissable event for the residence leaders. The pre-conference event will present a small group format facilitated by RPS consultants for programs looking to find specific solutions to implement the new requirements, along with some examples of best practices sponsored by ABFM and the Association of Residency Managers in Family Medicine.
To help programs meet requirements, the AAFP is developing a collaborative educational opportunity on population well-being, funded by the Department of Health Resources and Services. A trial using the video conferencing format for the ECHO (Extension of Community Health Care Outcomes) project is currently underway. More details to come. However, resident members can access wellbeing resources, including video training sessions, now on the Physician Health First webpage.
AAFP News: What else will programs need to meet these new requirements?
Mitchell: Residences will need increased capabilities for their IT and data systems to create easy ways to organize the reports needed to care for residents in their family medicine practice. We need EHR vendors to include data in their systems to help population health and to be able to generate the necessary reports.
AAFP News: What do students and residents need to know? Will this affect current residents or only those starting in 2023?
Mitchell: For residents, this means that your program should help you understand population management, panel metrics, and data that will help your future practice in a way that was not required in the past. This means that you will play an active role in your own learning by coaching your faculty to achieve learning goals related to your future practice.
For students, you can rest assured that your family medicine residency training will prepare you for future practice models, including team-based care, value-based payment systems, and a willingness to gain skills for any community in the United States. Skills that embody the value of family medicine in our healthcare system. You will gain the comprehensive experience of a family physician, which is the foundation for providing the best primary care services possible.
What excites me most is that through competency-based education and individualized learning plans, family physicians of the future will be in a position to take more ownership of their own learning, with faculty guidance, to prepare them for their professions and the communities in which they live. plan to serve.