Family medicine
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Improving the quality of care in residencies is critical for the profession and for our discipline, but how to do this on a large scale is unclear. The purpose of the I³ collaborative was to assess the feasibility of a regional quality improvement collaborative limited to residencies and to improve significantly dramatically the quality of care for diabetes and congestive heart failure. ⋯ A regional strategy is feasible and can strongly support quality improvement; investment in residency redesign can reduce total cost of care.
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Expanded competencies in population health and systems-based medicine have been identified as a need for primary care physicians. Incorporating formal training in preventive medicine is one method of accomplishing this objective. ⋯ Incorporation of formal preventive medicine training into family medicine education is a viable way to use a structured format to expand competencies in population medicine for primary care physicians. This type of training, or modifications of it, should be part of the debate in primary care residency redesign.
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Extending the residency curriculum to 4 years has been proposed as a logical innovation in response to the Future of Family Medicine Report given the increasing complexity of medical care and reduction in available training time due to duty hour restrictions. Middlesex Hospital, a participant in the P⁴ Initiative, is the first family medicine residency program to require a comprehensive 4-year curriculum for all residents. ⋯ Transition to a comprehensive 4-year curriculum has been successful and has provided many benefits to our learners, practice, and educational program. Our graduates are substantially better prepared for practice.