Overview - Bringing About Changes in Residency Training & Continuing Education
Future of Family Medicine Report Overview
Medical education, both for students and practicing physicians, is key to ensuring the adoption and success of the proposed New Model of care. The education of family physicians is and has always been one that emphasizes a process: problem definition/prioritization within the physician-patient relationship. Unlike other medical specialties, family medicine is not defined by a specific disease, organ or body system, by the age or sex of the patient population served or by the setting in which care is provided. Rather, the family physician's knowledge, skills and approach enables him or her to care for all ages, both sexes and address a range of conditions and illnesses in multiple settings.
Residency Training/Education
Building on the proposed New Model of care, the mission for family medicine residency education must be to create a flexible model that trains family physicians to consistently deliver patient-centered care and lead an interdisciplinary team, emphasizing the biopsychosocial model, cultural proficiency, evidence-based practice, quality improvement, informatics and practice-based research. Looking to the future, family physicians must have not only the requisite skills in diagnosis, treatment and performance of procedures, they also must demonstrate competencies in managing relationships, information and processes.
Changing demographics
Changes in residency education need to reflect the changing environment in which most family medicine graduates will work: fewer are going into solo practice, only about one third provide maternity care and many provide little or no inpatient care. The training of future family physicians must be grounded in evidence-based medicine that is relevant to the care of the whole person in a community context. Residency training must be technologically up-to-date, built on a solid foundation of clinical science, and strong in the components of interpersonal and behavioral skills including cultural competency.
Practice management
As health care becomes more complex and medical care becomes more interdependent, family physicians of the future will need to be experts at integrating all aspects of care. They will need more in-depth training in practice management, particularly involving electronic medical records and other information system applications. Given the commitment in family medicine to a biopsychosocial model of care, family physicians will have a special role in promoting better integration of medical and mental health services.
Team approach
Family physicians will need to learn to work in teams and promote interdisciplinary collaboration in patient care, research and education. To do so will require special skills in the areas of teamwork, collaboration, organizational management and leadership.
Community focus
Residency programs will need to reemphasize the teaching of community medicine and strengthen the close connection between family medicine and public health agencies and strategies. They will also redefine the focus on family in broader terms by placing the primary emphasis on the impact of the family on the health of the individual patient and secondary emphasis on treating the entire family unit as patients.
Research
Participation in the generation of new knowledge and research must become integral to the activities of all family physicians and should be incorporated into family medicine training. In addition to incorporating practice-based research into the values, structures and processes of family medicine, departments of family medicine must make a commitment to engage in collaborative research that produces new knowledge about the origins of disease and illness, how health is gained and lost, and how the provision of health care can be improved. To make such research a reality, a national entity should be established to lead and fund research on the health and health care of whole people.
Student interest
To address declining interest in the specialty among students, the family medicine organizations should engage family physicians across the country to identify and actively mentor youth who have the potential to become future family physicians.
Life-Long Learning
The formal process of lifelong learning for family physicians also will need to be redesigned. A continuing developmental approach should focus on the family physician as person, as practicing professional and as creator/facilitator of the patient care environment. The traditional approach has assumed that once the residency program is completed, a family physician enters a state of personal and professional proficiency requiring only maintenance. In reality, all professionals, including physicians, continuously develop, grow and change throughout their careers. A developmental approach is essential to address adequately the personal attributes that are so important in the New Model of care.
The goal of continuing education will not simply be to improve physician knowledge and skill, but to change physician and practice behavior and thereby improve patient outcomes. With a goal of improved patient outcomes, the following three components must be included in family physicians' continued development: standardized electronic information systems, evidence-based review and practice-based research, and a self-assessment system of both personal skills and practice outcomes in comparison with one's peers.