Lawrence Family Medicine Residency Transition to a Four Year Program
(an ACGME Length of Training Pilot Program)
Wendy Brooks Barr MD, MPH, MSCE; Whitney LeFevre, MD; Clark Van Den Berghe, MD; Joseph Gravel MD
Lawrence Family Medicine Residency, Greater Lawrence Family Health Center, Lawrence, MA
• Family Medicine Length of Training Pilot (FMLTP).
• Developed by the ACGME Review
Committee in Family Medicine (RC-FM), in
conjunction with the American Board of
Family Medicine (ABFM)
• Goals:
• To find innovative methods to prepare
Family Physicians to “serve as highly
effective personal physicians in a high
performance health care system.”
• Inform whether four years should become
the standard length of training in Family
Medicine
• Evaluation method: Match and compare
selected programs with a group of existing
three-year programs
• Evaluation Team: Oregon Health and
Science University
• Timeline:: Selected 2013, evaluation
through 2019
• Selected 4 Year Residency Program:
•
•
•
•
•
•
•
•
•
•
Mid Michigan Medical Center-Midland (Michigan)
Middlesex Hospital FMR (Connecticut)
John Peter Smith Hospital (Texas)
Oregon Health and Science University Program
(Oregon)
Lawrence Family Medicine Residency
(Massachusetts)
University of Nevada, Reno (Nevada)
National Capital Consortium (Virginia)
US Naval Hospital Camp LeJeune (North Carolina)
US Naval Hospital Camp Pendleton (California)
US Naval Hospital Jacksonville (Florida)
1. Development of competencies in all aspects of PCMH in our NCQA Level 3 Family
Medicine Center through immersion in and graduated responsibility for management of the
medical home. Including:
a. team-based care
b. population medicine
c. community health
d. information mastery
e. chronic disease management
f. practice-based improvement
g. leadership
2. Increased depth of experience in core clinical aspects of Family Medicine, particularly
essential in low resource clinical environments, with development of added competencies key
to the care of underserved populations.
3. Increased opportunity for residents to develop additional competencies in areas of
personal interest through the expansion of areas of concentration (AOCs).
4. More meaningful and longitudinal community experiences which will serve as a foundation
for substantive community involvement for residents throughout their careers.
1. Successful recruitment of high quality residents
into the program as measured by:
• 100% Match Rate
• Increased number of US medical seniors applying to the
program
• Matched residents with higher achievements
USMLE Step 2 scores
R1 In-training Exam Scores
National Medical Student Recognitions (AOA, Gold
Humanism, Pisacano)
2. A high level of resident achievement in residency
as measured by:
• Initial ABFM Certification Exam scores
• Community involvement during residency
• Completion of QI and scholarly activity projects
3. A high percentage of graduates reporting:
•
•
•
•
Leadership roles in CHCs
Leading QI projects in their practices
Working in HPSA or international sites
Practicing full-spectrum family medicine
Applicant Metrics By Recruitment Year
1000
900
800
700
600
500
400
300
200
100
0
Total Applicants
US Grads
Avg Matched Step2
R1 ITE Score
2009 (Class of 2010 (Class of 2011 (Class of 2012 (Class of 2013 (Class of 2014 (Class of
'13)
'14)
'15)
'17)
'18)
'19)
• Changing to required 4 year curriculum has not hurt recruitment
• Trend towards more total applicants and US medical school seniors
• Trend toward higher R1 ITE scores and no change on Step 2 Scores of matched
applicants
www.postersession.com
Lawrence Family Medicine Residency Transition to a Four Year Program
(an ACGME Length of Training Pilot Program)
Wendy Brooks Barr MD, MPH, MSCE; Whitney LeFevre, MD; Clark Van Den Berghe, MD; Joseph Gravel MD
Lawrence Family Medicine Residency, Greater Lawrence Family Health Center, Lawrence, MA
GOALS: Provide residents with opportunities to
develop advanced competency in an area of
interest. Develop resident skills in self-directed
learning and promote the practice of life-long
learning and skill development.
R1
R2
Global Health
Advanced Surgical
Maternity Care
Integrative Medicine
Phase 1
AOCs
HIV
R3
R4
Adult Medicine
(10 wks)
Adult
Medicine
(4 wks)
ICU
(4 wks)
AM NF Maternity Care MC/PD NF Pediatrics Surgery
(2 wks)
(6 wks)
(4 wks)
(4 wks) (2wks)
AM NF
(4 wks)
Maternity
Care
(4 wks)
MC/PD
NF
(2 wks)
Adult Medicine AM MC MC/PD NF Pediatrics
NF (2 wks) (4 wks)
(6 wks)
(4 wks)
(2 wks)
Adult
Clinic
FM
MC/ Peds
Medicine NF MC PD NF ED Chief/PCMC
(2 wks) (2 wks)
(2
wks)
(2 wks)
(4 wks)
(6 wks)
Peds
PD Neo
ED
(2 wks) (2wks)
ED
(4 wks)
Outpatient Longitudinal
(14 wks)
ED
(2 wks)
(4 wks)
UMASS
Sports
Med
(4 wks)
Outpatient Longitudinal
(16 wks)
Outpatient Longitudinal
(10 wks)
Outpatient Longitudinal
(20 wks)
Spanish/
Spanish Intro to Vacation
Elective
FM
(4 wks)
(2wks)
(4 wks)
Longitudinal
AOC
(4wks)
Longitudinal
AOC
(4wks)
AOC
(4 wks)
AOC
(8 wks)
Elective Vacation
(4 wks) (4 wks)
Elective Vacation
(4 wks) (4 wks)
Elective Vacation
(2 wks) (4 wks)
(Active)
Academic/Faculty
Development
Health Systems Leadership
Sports Medicine
Women’s Health
Behavioral Health
Phase 2
AOCs
(In Progress)
Addiction Medicine / Pain
Management
Outpatient Longitudinal Curriculum Content by Year of Training
R1: Gynecology, Orthopedics/Sports Med, Geriatrics, Behavioral Health, PCMH, Outpatient Pediatrics,
Community Medicine
R2: Gynecology, Orthopedics/Sports Med, Surgery, Dermatology, Geriatrics, Palliative Care, PCMH,
Community Medicine
R3: Behavioral Health, HIV, Addiction Medicine, PCMH
R4: Geriatrics, Integrative Medicine, Subspecialty Care, Dermatology, Adolescent Medicine, Outpatient
Pediatrics, PCMH, Community Medicine,
Innovation
Area
PCMH
Group Visits
New / Additional Training
R4 “Clinic Chief” block experience;
progressive leadership within
clinical teams
Lead at least 3 cycles of group
visits in 2 clinical areas
HIV
Required experience with HIV-care
management team
Addiction
Medicine
Required experience in addiction
medicine/chronic pain
Mental
Health
Enhanced focus on team-based
behavioral health management
Underserved Longitudinal experiences; focus on
Care
social determinants of health during
R1 “education week”
Community Longitudinal involvement with
Medicine
defined community in Lawrence
Information
Mastery
Enhanced didactics; skill tasks in
clinical experiences
Leadership
Increased advocacy efforts;
progressive clinical leadership
Research
Increased curricular time; more
research methodology training
Population
Medicine
Review community and patient
data; design, implementation and
evaluation of interventions based
on population data
Core longitudinal experiences in
proven integrative modalities
Hospitalist
Integrative
Medicine
www.postersession.com