Flexibility Envisioned in New Residency Requirements

The Accreditation Council for Graduate Medical Education announced plans for a major revision of the family medicine residency requirements early in 2020. Seven family medicine organizations (the AAFP, the American Board of Family Medicine, the American College of Osteopathic Family Physicians, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group and STFM) then engaged thousands of family physicians, residents and medical students through focus groups and surveys leading up to Starfield Summit IV: Re-Envisioning Family Medicine Residency Education in December.

In advance of that summit, nine evidence summaries and 24 commentaries were commissioned, and drafts were made available to participants and observers in advance of the meeting. The new Family Medicine special issue features the reviewed and revised versions of those articles, which will be considered by the ACGME writing group as it develops updated requirements this fall. The articles address a wide range of topics, including practice as curriculum, length of training, workforce diversity, rural health, behavioral health and the social accountability of graduate medical education.

Karen Mitchell, M.D., vice president of the AAFP’s Division of Medical Education, said an open comment period is expected in November before the revised requirements go the ACGME Board of Directors. If approved, the new requirements will be implemented in July 2022, she said.

Mitchell and ABFM President and CEO Warren Newton, M.D., M.P.H., detail the specialty-wide effort in one of the Family Medicine articles and offer their thoughts regarding the need for urgent change in a related editorial.

Mitchell said the ACGME writing group identified seven key principles that likely will be reflected in the revised requirements:

• comprehensive, clinically competent care;
• community-focused population health;
• relationship-based communication;
• collaborative team-based leadership;
• adaptive lifelong learning;
• values-driven professionalism; and
• technology integration.

“Based on the input that has been received, including during the Starfield Summit, those seven themes start to define family medicine,” Mitchell said. “Certainly, they will define training for family medicine in the future.”

One of the questions debated at the Starfield Summit and discussed in the Family Medicine special issue is the need to balance standardization and innovation. Mitchell said the new requirements will set the same core values for all residency programs but will aim to “give programs more flexibility to teach in ways that meet community needs.”

For example, Mitchell said some residents have difficulty reaching the required 1,650 continuity patient encounters currently required at the family medicine practice site.

“Likely, how we quantify experience in the family medicine practice is going to be redefined,” Mitchell said. “How do we count resident experience in ways other than 1,650 face-to-face visits? That will be a big change.”

Under the current requirements, residents must have in-patient pediatric experience, but that also could change.

“Where a resident gets that experience — recognizing, stabilizing and managing sick children — might vary based on the resources of the program,” Mitchell said.

Another current requirement that may change is the supervision of maternity care.

“I believe the emphasis on the ‘family experience’ of maternity and newborn care will remain,” Mitchell said. “It’s possible that the requirement for a family physician to provide resident supervision might become more flexible.”

Adequate faculty resources remain a concern, and the need will increase as the new requirements are rolled out, she said.

“Programs will need to implement more robust competency-based education and continuous improvement processes,” Mitchell said. “Also, the call for teaching adaptive lifelong learning will mean there’s a bigger need for reflective learning and coaching time for faculty and learners. Overall, I’m excited to see that the new residency standards will maintain core family medicine values while allowing flexibility in the training according to the needs of communities.”