Wednesday, July 23, 2014

MS4s: what to look for in FM residency programs

This time of year I get a lot of questions from fourth-year medical students about applying to residency. So, here's my answer to "What should I look for in a good Family Medicine (FM) residency program*?"

It's FM, so everyone (for the most part) is going to be super-nice, friendly, and welcoming when you go to visit. They will show you a curriculum that's in line with the ACGME (Accreditation Council on Graduate Medical Education) regulations. They will take you out for a nice meal and show you the town.

So, what separates the wheat from the chaff? The men/women from the boys/girls? The *insert your favorite cliche here*? Here's what you want to ask about above and beyond your questions about the call schedule and available electives:

1. "How do you teach evidence-based medicine (EBM)?"
A top-notch residency program will have a formal EBM curriculum with sessions on a regular basis. This curriculum should teach you how to independently read and interpret the medical literature. There is no more important skill than this to be successful after graduation; if you can't keep up with the changes in best practice after graduating from residency, you will be practicing out-of-date medicine within five years (heck, probably within five months).

2. "Is the office I'll be working in an NCQA-certified Patient Centered Medical Home?"
Forward-thinking Family Medicine residency offices subscribe to the PCMH model and have gone through (or are, at least, in the process of going through) the rigorous process to prove that they are coordinating care effectively for patients by tracking referrals and tests, offering after-hours care, and connecting with patients asynchronously (usually via patient portals). You want to learn how to work in a PCMH because, chances are, you will be working in one - and leading one - after graduation.

3. "How do you teach patient safety and quality improvement?"
Understanding that medical errors are the result, ultimately, of system problems, and not just individual mistakes, is a critical concept for 21st century docs. Good systems buffer individual mistakes. How is the residency program training future family docs to lead in building these buffers?  What kinds of QI projects are residents involved with? Residents should be leading QI teams to improve office efficiency, reduce error, and improve the patient experience in the residency office - and your residency should train you how to do it.

Medical knowledge is not enough for 21st century family docs. Without the above skills, your practice will be out of date, doctor-centered (instead of patient-centered), and error prone. A good residency program should have formal curricula in place to ensure that you graduate with these skill sets. A program not committed to those ideals, that is superficially addressing these concepts but not orienting their care model around them, will leave you woefully unprepared to provide optimal care to your future patients.

Do you agree? Did I leave anything off the list?

* Frankly, I think these general attributes apply to all residency specialties, though some specialties participate in the Patient-Centered Specialty Practice accreditation instead of "Patient Centered Medical Home" for question #2.

Tuesday, June 24, 2014

To blog or not to blog?

I confess that it's been awhile since I posted here.
I confess that this has happened before.
Should I throw in the towel? End the blog? Force myself to crank out posts?

I feel like I still have a lot to say, and I'm trying to figure out why I haven't been here much lately. True, my work with American Family Physician is taking up the time I used to spend on this blog. True, I am in the middle of yet another job transition. True, most days I'm just running on autopilot, ticking the boxes of responsibilities, waiting for my life to fall back into some semblance of normalcy.

I should know better by now! As much as I long for stability, I am coming to grips with the fact that these are not givens in academic medicine. Virtually all of the classmates I trained with have gone through at least one (if not two or three) job transitions in the last five years. Medicine is trying to reinvent itself, and we are all trying to figure out what role we want to play.

And yet, again, I am not comfortable divulging all of the gory details regarding my latest career upheaval. I wish, sometimes, that I was as brave as those medical bloggers who share so much of their personal life. Alas, I am not and will not be them. I don't want this blog to die, yet I don't know how to keep it alive when I am unwilling to share the stories that are consuming me right now.

I know that there are many medical bloggers who are busier than I am and make time for their blogs. It is true that I am not prioritizing this blog as I once did. I'd like to believe that I will again in the future, but will anyone still be around to read it when I do?

Do I put the blog on life support or hospice?

Friday, May 16, 2014

After the conference

I attended the Society of Teachers of Family Medicine (STFM) annual meeting last week, and, as usual, I left with a lot of great ideas and inspirations for things to try in our residency program and in my practice. Unfortunately, I have yet to review those ideas and inspirations and do anything with them, which is also as usual. I hate to think that everything from that conference will quickly be lost if I don't apply it, but I know from past experience that it will.

Attending conferences is a great way to learn from others, gain new skills, and expand your horizons. I love the networking and inspiration I also often come away with after attending a Family Medicine conference. I just wish I could figure out a way to not lose all of that great energy and motivation once I get back to the daily routine at home.

I think I'm making some strides. For the last couple of years, I've live-tweeted every session I attend at a conference. Not only does that help disseminate ideas outside of the physical conference, but it also leaves me with virtual notes of everything that I thought was interesting that I can review afterwards. The piece that is missing is making the time to do after I leave.

So, this year, I'm blocking out time in my schedule next week to review all of those tweets and compile a "to do" list from what I learned. In the future, I should probably block that time out before I even leave. I'm working hard to be a lot more deliberate about how I spend my time anyway (fodder, perhaps, for a future post!), and this approach seems to fit into that general idea pretty well. But I'd definitely welcome any and all suggestions!

After all, I invested too much time and energy into attending to lose all of those good ideas.