Six Years' Experience Using Specialty National Residency Index: An Early Dashboard to Document Change Over Time.

BACKGROUND AND OBJECTIVES: A decade ago, the Association of Family Medicine Residency Directors developed the Residency Performance Index (RPI) as a novel dashboard of metrics to support residency programs' quality improvement efforts. Although the RPI has since been discontinued, we sought to identify lessons learned from an analysis of 6 years of data collected while the RPI was in use to inform future quality and accreditation efforts implemented at the national level. METHODS: The RPI collected data from 2012-2017 for nearly 250 distinct family medicine residency programs, identifying strengths and areas for improvement. Eighty-two programs provided data for 3 or more years of measures allowing analysis of improvement trends. RESULTS: For participating programs, aggregate data over 6 years indicated the majority had stable leadership and accreditation. Total family medicine center (FMC) visits by graduates and resident visit demographics were robust. Graduate scope of practice was consistent with nationally publicized trends. Programs hit most aspirational targets more than 40% of the time. However, analysis for those programs with 3 or more years of data revealed that the tool did not result in significant changes for most metrics. Linear regression analysis showed improvements in total patient visits, visits under 10 years of age, and certain procedural competencies for those programs with 3 or more years of data. CONCLUSIONS: The RPI was the first and only nationally utilized family medicine graduate medical education quality improvement tool. Individual programs did not show substantial change in quantifiable metrics over time despite limited evidence of select programmatic improvements. Nationally, aggregated data provided insight into scope of practice and other areas of interest in residency training. Further efforts in provision of residency improvement tools are important to support programs given the increasing complexity and high stakes of family medicine residency education.

Quality assessment and improvement of post graduate family medicine training in the USA.

BACKGROUND: In 2013, the World Organisation of Family Doctors published training standards for post-graduate medical education (GME) in Family Medicine/General Practice (FP/GP). GME quality has not been well-defined, other than meeting accreditation standards. In 2009, the Association of Family Medicine Residency Directors (AFMRD) developed a tool that would aid in raising the quality of family medicine residency training in the USA. OBJECTIVE: We describe the development of this quality improvement tool, which we called the residency performance index (RPI), and its first three years of use by US family medicine residency (FMR) programmes. The RPI uses metrics specific to family medicine training in the USA to help programmes identify strengths and areas for improvement in their educational activities. Our review of three years of experience with the RPI revealed difficulties with collecting data, and lack of information on graduates' scope of practice. It also showed the potential usefulness of the tool as a programme improvement mechanism. CONCLUSIONS: The RPI is a nationwide, standardised, programme quality improvement tool for family medicine residency programmes in the USA, which was successfully launched as part of AFMRD's strategic plan. Although some initial challenges need to be addressed, it has the promise to aid family medicine residencies in their internal improvement efforts. This model could be adapted in other post-graduate training settings in FM/GP around the world.

The Residency Performance Index: An Effort at Residency Quality Assessment and Improvement in Family Medicine.

BACKGROUND: Residency programs are increasingly being asked to defend their quality, and that of the residents they produce. Yet "residency quality" is a construct that has not been well defined, with no accepted standards other than meeting accreditation standards. In 2009, the Association of Family Medicine Residency Directors developed a strategic plan that included the goal of raising the quality of family medicine training. OBJECTIVE: We describe the development of this quality improvement tool, which we called the residency performance index (RPI), and its first year of use by family medicine residency programs. We describe the use of the tool as a "dashboard" to facilitate program self-improvement. INTERVENTION: Using program metrics specific to family medicine training, and benchmark criteria for these metrics, the RPI was launched in 2012 to help programs identify strengths and areas for improvement in their educational activities and resident clinical experiences that could be tracked and reviewed as part of the annual program evaluation. RESULTS: Approximately 100 program directors began using the tool and 70 finished the process, and were provided aggregate data. Initial review of this experience revealed difficulties with collecting data, and lack of information on graduates' scope of practice. It also showed the potential usefulness of the tool as a program improvement mechanism. CONCLUSIONS: The RPI is a new quality improvement tool for family medicine residency programs. Although some initial challenges need to be addressed, it has the promise to aid family medicine residency in its internal improvement efforts.

Impact of proposed institute of medicine duty hours: family medicine residency directors' perspective.

PURPOSE: To examine the opinions of family medicine residency program directors concerning the potential impact of the Institute of Medicine (IOM) resident duty hour recommendations on patient care and resident education. METHODS: A survey was mailed to 455 family medicine residency program directors. Data were summarized and analyzed using Epi Info statistical software. Significance was set at the P < .01 level. RESULTS: A total of 265 surveys were completed (60.9% response rate). A majority of family medicine residency program directors disagreed or strongly disagreed that the recent IOM duty hour recommendations will, in general, result in improved patient safety and resident education. Further, a majority of respondents disagreed or strongly disagreed that the proposed IOM rules would result in residents becoming more compassionate, more effective family physicians. CONCLUSION: A majority of family medicine residency program directors believe that the proposed IOM duty hour recommendations would have a primarily detrimental effect on both patient care and resident education.

Clinical utility of common serum rheumatologic tests.

Serum rheumatologic tests are generally most useful for confirming a clinically suspected diagnosis. Testing for rheumatoid factor is appropriate when rheumatoid arthritis, Sjögren's syndrome or cryoglobulinemia is suspected. Antinuclear antibody testing is highly sensitive for systemic lupus erythematosus and drug-induced lupus. Anti-double-stranded DNA antibodies correlate with lupus nephritis; the titer often corresponds with disease activity in systemic lupus erythematosus. Testing for anti-Ro (anti-SS-A) or anti-La (anti-SS-B) may help confirm the diagnosis of Sjögren's syndrome or systemic lupus erythematosus; these antibodies are associated with the extraglandular manifestations of Sjögren's syndrome. Cytoplasmic antineutrophil cytoplasmic antibody testing is highly sensitive and specific for Wegener's granulomatosis. Human leukocyte antigen-B27 is frequently present in ankylosing spondylitis and Reiter's syndrome, but the background presence of this antibody in white populations limits the value of testing. An elevated erythrocyte sedimentation rate (ESR) is a diagnostic criterion for polymyalgia rheumatica and temporal arteritis; however, specificity is quite low. ESR values tend to correlate with disease activity in rheumatoid arthritis and may be useful for monitoring therapeutic response.