The American Board Of Family Medicine Towards National

The American Board Of Family Medicine Towards National Implementation of Residency Redesign : An Update for FMLC Warren P. Newton, MD, MPH Recovering Residency Director President & CEO, ABFM February 11, 2023

The American Board Of Family Medicine Thanks to all of you! It takes a village to redesign residencies

Faculty Time Dedicated to Education Update 2/11/23 In summer, ACGME FM Review Committee recommended .25 FTE/core faculty dedicated to education. ACGME refused. In October, all family medicine organizations requested reconsideration. In addition, AFMRD and an open letter from PDs/core faculty protested the ruling. In November, ACGME Board reconsidered. Last weekend, ACGME kept first part of promise, shortened timeline. FM RC will now propose standards for faculty time. ACGME leadership has proposed FM go back to Pre 6/19 standards. After public comments, will go back to ACGME BOD by June, with proposed onset 7/24. Pre-2019 standards: .6 FTE/core faculty, including precepting.

Family Medicine Context “We got this ” Now with 761 Residencies, approximately 15,000 Residents and legacy of 3 major national/regional trials of clinical and educational transformation of residencies (I3, P4, Length of Training) plus Clinic First Close collaboration between ABFM and FM RC has eliminated disparities in ABFM board certification rates for IMGs, Blacks, Hispanics and Native Americans FM Residents start board certification in residency—90% complete activities and exam by end of residency Family Medicine is only specialty which collects outcomes of all residents after 3 years (the AFMRD/ABFM Graduate Survey)

Major Revision of Residency Standards 2020-2022 ACGME Scenario Planning: The Future of Family Medicine. https://journals.stfm.org/familymedicine/2021/may/ 36 Articles – Evidence for Transformation

Residency Transformation Key Elements in Major Revision The Practice is the Curriculum Engagement in Communities--Social Determinants of Health and Disparities Residency Learning Networks Implement CBME, dropping many count and hour requirements Individual Learning Plans and More Flexibility for Residents and Residencies Dedicated Faculty Time for Teaching

Keep in mind the “Why” The health of Americans is worsening: lifespan shortening, cost increasing and disparities We believe that well trained family physicians in communities in the right kind of practices can make a difference.

Why CBME? CBME in Family Medicine starts with “end in mind”: Focus on what patients and society need--first contact, continuity, comprehensiveness and coordination Moves beyond “exposure” to “evidence” Expects residents to co-create their education Makes ongoing faculty development and CQI essential If done right, can help drive broader residency redesign

Reviewing the Dialogue on CBME ABFM Summer 2022 survey: all residencies use milestones; 40% use Entrustable Professional Activities (EPAs)-- we need to think in both languages ABMS/ACGME Summit in August: August LCME review of Draft Specialty Plan for Implementation Family Medicine Review Committee outcomes document is great start and has been improved by input: Based on FMAH EPAs ACGME Core Competencies 12 67 competencies listed in new standards—more practical! Comprehensiveness is foundation of training; permits leadership role for family physicians in healthcare of the future

Now what? Using the core outcomes, ACGME will develop the data systems to allow them to accredit residencies, and ABFM will define what will be necessary for individuals to be Board Certified FMLC will continue the conversation of the CBME conference about: Assessment Framework Education Strategy Faculty Development Strategy IT infrastructure/tools the specialty will need

How to get there Balancing standardization and flexibility Perfect is the enemy of the good in assessments Repurpose what we already have; add creatively Make it simple, give programs options, see what works How education happens must be part of the design— formative, real time, handheld. Build learning community—evaluate assessments and rotation redesigns, build learning networks, using meetings and journals/peer review to spread and improve tools Have patience! The Review Committee will have grace. We should also.

Taking Advantage of Diversity: Dialogue this Spring Take advantage of our spring meetings- Family Medicine RC – 1/26-28/23 ABFM – 1/28-2/1/23 AAFP Commission on Education – 2/3-5/23 Winter FMLC – 2/8-11/23 ADFM – 2/22-25/23 AFMRD Residency Leadership Summit – 3/1-5/23 ACOFP—3/29-4/2/23 STFM – 4/29-5/3/23 Others? AIRE: “Quantum Leap” Innovations How will we involve residents? Not about them, without them.