Family medicine
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This paper reflects a vision of how family medicine residency training will be redesigned to prepare graduates to meet the health care needs of their patient populations and regional communities. Family physicians are needed to serve as personal physicians and as the patient's usual source of care, as recognized in historic documents that have defined the specialty's enduring role in society as the foundation of the health care system. Modern residency practices will include residents as junior partners and members of multidisciplinary faculty teams. ⋯ Also included will be emerging expectations of family physicians, including team roles, expanded care through telehealth and patient portals, identifying and intervening in modifiable social determinants of health, addressing structural racism, closing gaps of inequitable care for their patient populations, managing addiction as a treatable chronic illness, improving performance through clinical data registries, personalized medicine, and leadership. Wellness and assurance of a satisfying career will be a priority focus of preparation for career-long practice. Residents will become competent in the comprehensive scope of practice needed to serve in the role of continuous personal physician on multidisciplinary teams that serve as the usual source of care for populations in regions where the residencies are located.
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Tensions have always existed between innovation and standardization in family medicine, due to the need for rapid responses to changing health issues while ensuring proficiency. For innovation in residency training to be successful, standardization of milestones and frameworks as well as outcomes of residency education are needed and must be clear and rely on measurable effectiveness standards. ⋯ Taken together, these recommendations represent a vital interplay between cutting-edge innovation and thoughtful standardization using collaboration to graduate residents ready to provide optimal care in their communities, both now and into the future. All stakeholders in the discipline must undertake strategic and deliberate planning designed to adjust direct and indirect costs of residency training to support these recommendations.
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Graduate medical education (GME) occurs during and is a crucial step of the transition between medical school and clinical practice. Residency program graduates' abilities to provide optimal patient care, act as role models, and demonstrate excellence, compassion, professionalism, and scholarship are key elements and outcomes of successful GME programs. In order to create and maintain the training environment that leads to such outcomes, programs must continually review and revise their patient care and educational activities. ⋯ Compliance with these requirements is necessary but not sufficient if faculty and residents want to achieve the goal of residency training in terms continually improving and optimizing the care they provide to their patients and communities. For overall program improvement to truly occur, the patient care, scholarship, and community activities of current residents and graduates must be assessed and used in program improvement activities. Appropriately applied to programs and using these assessments, quality improvement principles and tools have the potential to improve outcomes of patient care in residents' current and future practice and improve programs in educating residents.
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Because graduate medical education (GME) is largely publicly funded, it should be judged on how well it addresses the public's health needs. However, the current system distributes GME resources inequitably by specialty and geography, and neglects to focus on training physicians adequately in the care of populations while reducing health disparities. Instead, GME continues to concentrate training in hospital-based academic centers and in subspecialties, which often exacerbates disparities in health outcomes and access to care. GME can be more socially accountable by shifting incentive structures to support primary care, creating more equitable distribution of residency slots and funding, and promoting training programs that focus on social and structural determinants of health.