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if you can't keep up with the changes in best practice after graduating from residency, you will be practicing out-of-date medicine within five years (heck, probably within five months).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.