ACGME Changes Let Residents ‘Become Doctors We Want to Be’

AAFP News: What are you most excited about in the new program requirements?

Beverly Onyekwuluje, M.D., graduating third-year resident at Northwestern’s Delnor Family Medicine Residency and resident member of the AFMRD Board of Directors: I’m really excited about customizing learning opportunities to get what you want out of residency. The additional elective time allows you to tailor your education to what you think you’ll do in the future. If I were a resident with these new requirements coming out, I definitely would have tailored my time to leadership. I’m also very interested in education. So I would have done more electives, like precepting. This is a way for you to explore your interests and make them stronger.

Echo Buffalo-Ellison, M.D., rising second-year resident at the University of Virginia Family Medicine Residency and member of the Society of Teachers of Family Medicine Antiracism Task Force: I definitely agree with the point on flexibility. I think it gives residents more opportunities to develop and explore their professional identities, which a lot of times seem to be more developed after residency. I think that given more time to develop their interests, residents are going to have to rely on their mentors and advisors more to help walk them through that process. I think that that’s a great opportunity for residents to establish relationships, not only with faculty in their own department but family physicians or other specialists who aren’t part of their own programs who are out working in the community.

AAFP News: How are you going to take advantage of these changes?

Anderson: I plan on working in an academic medical institution, both inpatient and outpatient, and doing an ultrasound fellowship. So I’m looking to build a longitudinal curriculum for myself in ultrasound and other fields and to create an elective where I can do a lot more procedures. That way I’ll be a more skilled inpatient physician. I’m looking to pursue new interests that weren’t necessarily built into our program. So I’m trying to think of, OK, when I’m “attending Dr. Anderson,” what types of things do I want to be able to do? What types of things do I want to bring to a program? Because of that I’m pursuing doing multiple different procedures. So by building longitudinal experiences I’m able to do that, including a lot more contraceptive care. Specifically, even bringing in training in vasectomies during residency, which in our institution isn’t something that any of our family physicians currently do, is going to be a great thing that I don’t think I would have been able to do without the changes.

Buffalo-Ellison: I’m a rising PGY2, and this whole year is just giving me a lot of different experiences. One of the things that I came in thinking I would not like so much but ended up falling in love with was deliveries. I am going to use this next year, and the increase in elective time, to try to incorporate more pregnancy care into my continuity panel. I’m doing a longitudinal elective with some of our OB faculty. I’m also very interested in antiracism health equity work. So getting a chance to explore that more in depth with adequate time through electives is going to be really helpful. Having the time to do more research and scholarly activity is something that I’m also interested in.

Onyekwuluje: Being a graduating PGY3, I’m looking back at my residency career and thinking, ‘What would I do with these requirements?’ And I think these requirements would be a great opportunity to work on those weaknesses and areas of growth. I’m thinking with the community that I’m going to be in — I’m going to work for a value-based care company — practice management and issues with health equity are really important. So I would do rotations to work on those, so I can be better as a clinician once I graduate. I would also probably use that opportunity to work with my advisors and see if there are areas that they feel that I would need help on and use that elective time to work on that. I see this as a really great opportunity for growth so you can build those weaknesses and become the fullest family physician.

AAFP News: How will these changes influence your ability to care for your program’s community and/or your future patients?

Buffalo-Ellison: I’ll tie it back to my newfound interest in pregnancy care because one of the new requirements is more specific for OB care after residency. It takes the questioning out on whether or not you need to do an OB fellowship to do certain things or whether or not you can use your elective time to build your skills in residency and not have to do a fellowship in order to have things like hospital privileges to do deliveries.

In my program, we are at a larger academic institution with a lot of other residents in other specialties. I think what the new requirements will do is give us a chance as family medicine to have a greater opportunity to develop our own identity. Here at my health care system, we have a lot of different interests that our faculty are pursuing. We have someone here that specializes in obesity medicine. We have a faculty member who is really into ultrasound. Someone else runs an entire clinic dedicated to transgender and LGBTQ health. Those opportunities are very specific to our program, so I think giving residents the time to be more involved in that will really set family medicine apart and will really allow our faculty to be more satisfied with what they do, knowing that they’re able to interact with residents and show them what they do on a day-to-day basis. I think that it would prepare us as residents to go out into the world, wherever we go, and be able to see all kinds of people, treat all kinds of different diseases and work within different kind of systems.