The Cost of Family Medicine Residency Training:

Background and Objectives: Numerous organizations are calling for the expansion of graduate medical education (GME) positions nationally. Developing new residency programs and expanding existing programs can only happen if financial resources are available to pay for the expenses of training beyond what can be generated in direct clinical income by the residents and faculty in the program. The goal of this study was to evaluate trended data regarding the finances of family medicine residency programs to identify what financial resources are needed to sustain graduate medical education programs. Methods: A group of family medicine residency programs have shared their financial data since 2002 through a biennial survey of program revenues, expenses, and staffing. Data sets over 12 years were collected and analyzed, and results compared to analyze trends. Results: Overall expenses increased 70.4% during this period. Centers for Medicare and Medicaid Services (CMS) GME revenue per resident increased by 15.7% for those programs receiving these monies. Overall, total revenue per resident, including clinical revenues, state funding, and any other revenue stream, increased 44.5% from 2006 to 2016. The median cost per resident among these programs, excluding federal GME funds, is currently $179,353; this amount has increased over the 12 years by 93.7%. Conclusions: For this study group of family medicine programs, data suggests a cost per resident per year, excluding federal and state GME funding streams, of about $180,000. This excess expense compared to revenue must be met by other agencies, whether from CMS, the Health Resources and Services Administration (HRSA), state expenditures or other sources, through stable long-term commitments to these funding mechanisms to ensure program viability for these essential family medicine programs in the future.

Download Full-text

Addressing the Scholarly Activity Requirements for Residents: One Program's Solution

Journal of Graduate Medical Education ◽

10.4300/jgme-d-10-00201.1 ◽

2011 ◽

Vol 3 (3) ◽

pp. 379-382 ◽

Cited By ~ 19

Author(s):

Peter J Carek ◽

Lori M Dickerson ◽

Vanessa A Diaz ◽

Terrence E Steyer

Keyword(s):

Medical Education ◽

South Carolina ◽

Family Medicine ◽

Graduate Medical Education ◽

Residency Program ◽

Scholarly Activity ◽

University Of South Carolina ◽

Family Medicine Residency ◽

Graduate Medical ◽

Regional Medical

Abstract Background Scholarly activity as a component of residency education is becoming increasingly emphasized by the Accreditation Council for Graduate Medical Education. “Limited or no evidence of resident or faculty scholarly activity” is a common citation given to family medicine residency programs by the Review Committee for Family Medicine. Objective The objective was to provide a model scholarly activity curriculum that has been successful in improving the quality of graduate medical education in a family medicine residency program, as evidenced by a record of resident academic presentations and publications. Methods We provide a description of the Clinical Scholars Program that has been implemented into the curriculum of the Trident/Medical University of South Carolina Family Medicine Residency Program. Results During the most recent 10-year academic period (2000–2010), a total of 111 residents completed training and participated in the Clinical Scholars Program. This program has produced more than 24 presentations during national and international meetings of medical societies and 15 publications in peer-reviewed medical journals. In addition, many of the projects have been presented during meetings of state and regional medical organizations. Conclusions This paper presents a model curriculum for teaching about scholarship to family medicine residents. The success of this program is evidenced by the numerous presentations and publications by participating residents.

Download Full-text

A cross-sectional study of United States family medicine residency programme director burnout: implications for mitigation efforts and future research

Family Practice ◽

10.1093/fampra/cmaa075 ◽

2020 ◽

Vol 37 (6) ◽

pp. 772-778

Author(s):

Tamatha M Psenka ◽

John R Freedy ◽

Lisa D Mims ◽

Alec O DeCastro ◽

Carole R Berini ◽

...

Keyword(s):

Medical Education ◽

Depressive Symptoms ◽

Family Medicine ◽

Graduate Medical Education ◽

Emotional Exhaustion ◽

Future Research ◽

Programme Director ◽

Family Medicine Residency ◽

Graduate Medical ◽

Residency Programme

Abstract Background Academic physician burnout is concerning. Too little is known about factors associated with residency programme director burnout. Continued uncertainty risks adverse outcomes including graduate medical education leadership turnover and negative impact on recruiting and retaining under-represented minority residency programme directors. Objective This study assessed symptoms of burnout (emotional exhaustion, depersonalization) and depression along with evidence-based individual and environmental risk factors in a U.S. sample of family medicine residency programme directors. Methods The omnibus 2018 Council of Academic Family Medicine Education Research Alliance survey was used to contact programme directors at all Accreditation Council for Graduate Medical Education accredited U.S. family medicine residency programmes via email. Descriptive data included programme director and programme characteristics, Areas of Worklife (workload, values and control), loneliness (lack companionship, feel left out and feel isolated), burnout (emotional exhaustion, depersonalization) and depressive symptoms. Chi-square tests contrasted descriptive variables with burnout and depressive symptoms. Logistic regression (LR) modelled associations between significant descriptive variables and burnout and depressive symptoms. Results The survey response rate was 45.2% (268/590). Programme directors reported: emotional exhaustion (25.0%), depersonalization (10.3%) and depressive symptoms (25.3%). LR models found significant associations with emotional exhaustion (Workload: lacking time and other work-related resources); lack of companionship, depersonalization (North West Central residency region; Workload and lack of companionship) and depressive symptoms (Black/African American ethnicity). Conclusions One-quarter of U.S. programme directors report burnout or depressive symptoms. Future research should consider associated variables as possible intervention targets to reduce programme director distress and turnover.

Download Full-text

Medicine in the 21st Century: Recommended Essential Geriatrics Competencies for Internal Medicine and Family Medicine Residents

Journal of Graduate Medical Education ◽

10.4300/jgme-d-10-00065.1 ◽

2010 ◽

Vol 2 (3) ◽

pp. 373-383 ◽

Cited By ~ 74

Author(s):

Brent C. Williams ◽

Gregg Warshaw ◽

Anne Rebecca Fabiny ◽

Nancy Lundebjerg, MPA ◽

Annette Medina-Walpole ◽

...

Keyword(s):

Internal Medicine ◽

Primary Care ◽

Medical Education ◽

Family Medicine ◽

Graduate Medical Education ◽

Care Hospital ◽

Residency Programs ◽

Accreditation Council ◽

Graduate Medical ◽

Family Medicine Residents

Abstract Background Physician workforce projections by the Institute of Medicine require enhanced training in geriatrics for all primary care and subspecialty physicians. Defining essential geriatrics competencies for internal medicine and family medicine residents would improve training for primary care and subspecialty physicians. The objectives of this study were to (1) define essential geriatrics competencies common to internal medicine and family medicine residents that build on established national geriatrics competencies for medical students, are feasible within current residency programs, are assessable, and address the Accreditation Council for Graduate Medical Education competencies; and (2) involve key stakeholder organizations in their development and implementation. Methods Initial candidate competencies were defined through small group meetings and a survey of more than 100 experts, followed by detailed item review by 26 program directors and residency clinical educators from key professional organizations. Throughout, an 8-member working group made revisions to maintain consistency and compatibility among the competencies. Support and participation by key stakeholder organizations were secured throughout the project. Results The process identified 26 competencies in 7 domains: Medication Management; Cognitive, Affective, and Behavioral Health; Complex or Chronic Illness(es) in Older Adults; Palliative and End-of-Life Care; Hospital Patient Safety; Transitions of Care; and Ambulatory Care. The competencies map directly onto the medical student geriatric competencies and the 6 Accreditation Council for Graduate Medical Education Competencies. Conclusions Through a consensus-building process that included leadership and members of key stakeholder organizations, a concise set of essential geriatrics competencies for internal medicine and family medicine residencies has been developed. These competencies are well aligned with concerns for residency training raised in a recent Medicare Payment Advisory Commission report to Congress. Work is underway through stakeholder organizations to disseminate and assess the competencies among internal medicine and family medicine residency programs.

Download Full-text

Empathy Can Be Taught, and Patients Teach it Best

Journal of Medical Education and Curricular Development ◽

10.1177/23821205211000346 ◽

2021 ◽

Vol 8 ◽

pp. 238212052110003

Author(s):

Sudhagar Thangarasu ◽

Gowri Renganathan ◽

Piruthiviraj Natarajan

Keyword(s):

Medical Education ◽

Graduate Medical Education ◽

Core Competencies ◽

Core Competency ◽

Role Modeling ◽

Residency Programs ◽

Graduate Medical ◽

Mixed Messages ◽

Attending Physicians ◽

Medical Education Curriculum

Empathy toward patients is an essential skill for a physician to deliver the best care for any patient. Empathy also protects the physician from moral injury and decreases the chances for malpractice litigations. The current graduate medical education curriculum allows trainees to graduate without getting focused training to develop empathy as a core competency domain. The tools to measure empathy inherently lack validity. The accurate measure of the provider’s empathy comes from the patient’s perspectives of their experience and their feedback, which is rarely reaching the trainee. The hidden curriculum in residency programs gives mixed messages to trainees due to inadequate role modeling by attending physicians. This narrative style manuscript portrays a teachable moment at the bedside vividly. The teaching team together reflected upon the lack of empathy, took steps to resolve the issue. The attending demonstrated role modeling as an authentic and impactful technique to teach empathy. The conclusion includes a proposal to include the patient’s real-time feedback to trainees as an essential domain under Graduate Medical Education core competencies of professionalism and patient care.

Download Full-text

Addressing the Mandate for Hand-off Education

Anesthesiology ◽

10.1097/aln.0000000000000070 ◽

2014 ◽

Vol 120 (1) ◽

pp. 218-229 ◽

Cited By ~ 19

Author(s):

Meghan B. Lane-Fall ◽

Amber K. Brooks ◽

Sara A. Wilkins ◽

Joshua J. Davis ◽

Lee Ann Riesenberg

Keyword(s):

Medical Education ◽

Curriculum Development ◽

Graduate Medical Education ◽

Communication Skill ◽

Skill Development ◽

Anesthesia Resident ◽

Residency Programs ◽

Accreditation Council ◽

Graduate Medical ◽

Hand Off

Abstract The Accreditation Council for Graduate Medical Education requires that residency programs teach residents about handoffs and ensure their competence in this communication skill. Development of hand-off curricula for anesthesia residency programs is hindered by the paucity of evidence regarding how to conduct, teach, and evaluate handoffs in the various settings where anesthesia practitioners work. This narrative review draws from literature in anesthesia and other disciplines to provide recommendations for anesthesia resident hand-off curriculum development and evaluation.

Download Full-text

The “Zing Factor”—How Do Faculty Describe the Best Pediatrics Residents?

Journal of Graduate Medical Education ◽

10.4300/jgme-d-13-00146.1 ◽

2014 ◽

Vol 6 (1) ◽

pp. 106-111 ◽

Cited By ~ 10

Author(s):

Glenn Rosenbluth ◽

Bridget O'Brien ◽

Emily M. Asher ◽

Christine S. Cho

Keyword(s):

Medical Education ◽

Graduate Medical Education ◽

Knowledge Integration ◽

Clinical Skills ◽

Medical Knowledge ◽

Residency Programs ◽

Graduate Medical ◽

Trained Interviewer ◽

And Behaviors ◽

Assessment Strategies

Abstract Background Faculty in graduate medical education programs may not have uniform approaches to differentiating the quality of residents, and reviews of evaluations suggest that faculty use different standards when assessing residents. Standards for assessing residents also do not consistently map to items on evaluation forms. One way to improve assessment is to reach consensus on the traits and behaviors that are (or should be) present in the best residents. Methods A trained interviewer conducted semistructured interviews with faculty affiliated with 2 pediatrics residency programs until content saturation was achieved. Interviewees were asked to describe specific traits present in residents they identify as the best. Interviews were recorded and transcribed. We used an iterative, inductive approach to generate a coding scheme and identify common themes. Results From 23 interviews, we identified 7 thematic categories of traits and behaviors: personality, energy, professionalism, team behaviors, self-improvement behaviors, patient-interaction behaviors, and medical knowledge and clinical skills (including a subcategory, knowledge integration). Most faculty interviewees focused on traits like passion, enthusiasm, maturity, and reliability. Examination score or intelligence was mentioned less frequently than traits and behaviors categorized under personality and professionalism. Conclusions Faculty identified many traits and behaviors in the residents they define as the best. The thematic categories had incomplete overlap with Accreditation Council for Graduate Medical Education (ACGME) and CanMEDS competencies. This research highlights the ongoing need to review our assessment strategies, and may have implications for the ACGME Milestone Project.

Download Full-text

Residency Programs' Evaluations of the Competencies: Data Provided to the ACGME About Types of Assessments Used by Programs

Journal of Graduate Medical Education ◽

10.4300/jgme-02-04-30 ◽

2010 ◽

Vol 2 (4) ◽

pp. 649-655 ◽

Cited By ~ 22

Author(s):

Kathleen D. Holt ◽

Rebecca S. Miller ◽

Thomas J. Nasca

Keyword(s):

Medical Education ◽

Interpersonal Communication ◽

Graduate Medical Education ◽

Medical Knowledge ◽

Residency Programs ◽

The Public ◽

Graduate Medical ◽

Resident Assessment ◽

Using Data ◽

Almost All

Abstract Background In 1999, the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project began to focus on resident performance in the 6 competencies of patient care, medical knowledge, professionalism, practice-based learning and improvement, interpersonal communication skills, and professionalism. Beginning in 2007, the ACGME began collecting information on how programs assess these competencies. This report provides information on the nature and extent of those assessments. Methods Using data collected by the ACGME for site visits, we use descriptive statistics and percentages to describe the number and type of methods and assessors accredited programs (n = 4417) report using to assess the competencies. Observed differences among specialties, methodologies, and assessors are tested with analysis of variance procedures. Results Almost all (>97%) of programs report assessing all of the competencies and using multiple methods and multiple assessors. Similar assessment methods and evaluator types were consistently used across the 6 competencies. However, there were some differences in the use of patient and family as assessors: Primary care and ambulatory specialties used these to a greater extent than other specialties. Conclusion Residency programs are emphasizing the competencies in their evaluation of residents. Understanding the scope of evaluation methodologies that programs use in resident assessment is important for both the profession and the public, so that together we may monitor continuing improvement in US graduate medical education.

Download Full-text

Educational Experiences Residents Perceive As Most Helpful for the Acquisition of the ACGME Competencies

Journal of Graduate Medical Education ◽

10.4300/jgme-d-11-00058.1 ◽

2012 ◽

Vol 4 (2) ◽

pp. 176-183 ◽

Cited By ~ 7

Author(s):

Lourdes R. Guerrero ◽

Susan Baillie ◽

Paul Wimmers ◽

Neil Parker

Keyword(s):

Medical Education ◽

Los Angeles ◽

Patient Care ◽

Graduate Medical Education ◽

Role Models ◽

Monitoring And Evaluation ◽

Learning Activities ◽

Web Based ◽

Residency Programs ◽

Graduate Medical

Abstract Background The Accreditation Council for Graduate Medical Education (ACGME) requires physicians in training to be educated in 6 competencies considered important for independent medical practice. There is little information about the experiences that residents feel contribute most to the acquisition of the competencies. Objective To understand how residents perceive their learning of the ACGME competencies and to determine which educational activities were most helpful in acquiring these competencies. Method A web-based survey created by the graduate medical education office for institutional program monitoring and evaluation was sent to all residents in ACGME-accredited programs at the David Geffen School of Medicine, University of California-Los Angeles, from 2007 to 2010. Residents responded to questions about the adequacy of their learning for each of the 6 competencies and which learning activities were most helpful in competency acquisition. Results We analyzed 1378 responses collected from postgraduate year-1 (PGY-1) to PGY-3 residents in 12 different residency programs, surveyed between 2007 and 2010. The overall response rate varied by year (66%–82%). Most residents (80%–97%) stated that their learning of the 6 ACGME competencies was “adequate.” Patient care activities and observation of attending physicians and peers were listed as the 2 most helpful learning activities for acquiring the 6 competencies. Conclusion Our findings reinforce the importance of learning from role models during patient care activities and the heterogeneity of learning activities needed for acquiring all 6 competencies.

Download Full-text