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Transforming Primary Care Residency Training: A Collaborative Faculty Development Initiative Among Family Medicine, Internal Medicine, and Pediatric Residencies

Carney, Patricia A. PhD; Eiff, M. Patrice MD; Green, Larry A. MD; Carraccio, Carol MD, MA; Smith, David Gary MD; Pugno, Perry A. MD, MPH; Iobst, William MD; McGuinness, Gail MD; Klink, Kathleen MD; Jones, Samuel M. MD; Tucker, Leslie; Holmboe, Eric MD

doi: 10.1097/ACM.0000000000000701
Innovation Reports

Problem The scope and scale of developments in health care redesign have not been sufficiently adopted in primary care residency programs.

Approach The interdisciplinary Primary Care Faculty Development Initiative was created to teach faculty how to accelerate revisions in primary care residency training. The program focused on skill development in teamwork, change management, leadership, population management, clinical microsystems, and competency assessment. The 2013 pilot program involved 36 family medicine, internal medicine, and pediatric faculty members from 12 residencies in four locations.

Outcomes The percentage of participants rating intention to implement what was learned as “very likely to” or “absolutely will” was 16/32 (50%) for leadership, 24/33 (72.7%) for change management, 23/33 (69.7%) for systems thinking, 25/32 (75.8%) for population management, 28/33 (84.9%) for teamwork, 29/33 (87.8%) for competency assessment, and 30/31 (96.7%) for patient centeredness.

Content analysis revealed five key themes: leadership skills are key drivers of change, but program faculty face big challenges in changing culture and engaging stakeholders; access to data from electronic health records for population management is a universal challenge; readiness to change varies among the three disciplines and among residencies within each discipline; focusing on patients and their needs galvanizes collaborative efforts across disciplines and within residencies; and collaboration among disciplines to develop and use shared measures of residency programs and learner outcomes can guide and inspire program changes and urgently needed educational research.

Next Steps Revise and reevaluate this rapidly evolving program toward widespread engagement with family medicine, internal medicine, and pediatric residencies.

Supplemental Digital Content is available in the text.

P.A. Carney is professor of family medicine and of public health and preventive medicine, Oregon Health & Science University, Portland, Oregon.

M.P. Eiff is professor and vice chair, Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.

L.A. Green is professor of family medicine, University of Colorado, Denver, Colorado.

C. Carraccio is vice president, Competency-Based Assessment Program, American Board of Pediatrics, Chapel Hill, North Carolina.

D.G. Smith is director of graduate medical education, Abington Memorial Hospital, Abington, Pennsylvania, and clinical associate professor of medicine, Temple University School of Medicine, Philadelphia, Pennsylvania.

P.A. Pugno is vice president for education, American Academy of Family Physicians, Leawood, Kansas.

W. Iobst is vice president of academic affairs, American Board of Internal Medicine, Philadelphia, Pennsylvania.

G. McGuinness is executive vice president, American Board of Pediatrics, Chapel Hill, North Carolina.

K. Klink is medical director, Robert Graham Center, Washington, DC.

S.M. Jones is program director, Virginia Commonwealth University–Fairfax Residency Program, Fairfax, Virginia.

L. Tucker is vice president of policy, American Board of Internal Medicine, Philadelphia, Pennsylvania.

E. Holmboe is senior vice president of milestone development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois.

Funding/Support: The PCFDI pilot program is being conducted by Oregon Health & Science University pursuant to contract HHSH250201200023C with the U.S. Department of Health and Human Services, Health Resources and Services Administration.

Other disclosures: None reported.

Ethical approval: This project, including all evaluation activities, received an exemption from Oregon Health & Science University’s institutional review board in accordance with 45CFR46.101(b)[1] (IRB#9227).

Disclaimer: The views expressed are those of the authors and do not represent the views of the U.S. Department of Health and Human Services, Health Resources and Services Administration.

Supplemental digital content for this article is available at

Correspondence should be addressed to Patricia A. Carney, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., MC: FM, Portland, OR 97239; telephone: (503) 494-9049; e-mail:

© 2015 by the Association of American Medical Colleges