Title VII and the development and promotion of national initiatives in training primary care clinicians in the United States.

The Title VII, Section 747 (Title VII) legislation, which authorizes the Training in Primary Care Medicine and Dentistry grant program, provides statutory authority to the Health Resources and Services Administration (HRSA) to award contracts and cooperative agreements aimed at enhancing the quality of primary care training in the United States.More than 35 contracts and cooperative agreements have been issued by HRSA with Title VII federal funds, most often to national organizations promoting the training of physician assistants and medical students and representing the primary care disciplines of family medicine, general internal medicine, and general pediatrics. These activities have influenced generalist medicine through three mechanisms: (1) building collaboration among the primary care disciplines and between primary care and specialty medicine, (2) strengthening primary care generally through national initiatives designed to develop and implement new models of primary care training, and (3) enhancing the quality of primary care training in specific disease areas determined to be of national importance.The most significant outcomes of the Title VII contracts awarded to national primary care organizations are increased collaboration and enhanced innovation in ambulatory training for students, residents, and faculty. Overall, generalist competencies and education in new content areas have been the distinguishing features of these initiatives. This effort has enhanced not only generalist training but also the general medical education of all students, including future specialists, because so much of the generalist competency agenda is germane to the general medical education mission.This article is part of a theme issue of Academic Medicine on the Title VII health professions training programs.

An evaluation of immunization education resources by family medicine residency directors.

BACKGROUND AND OBJECTIVES: Immunization is a rapidly evolving field, and teachers of family medicine are responsible for ensuring that they and their students are knowledgeable about the latest vaccine recommendations. METHODS: A survey was mailed to 456 family medicine residency directors across the United States to obtain their evaluation of immunization resources developed by the Society of Teachers of Family Medicine's Group on Immunization Education. Frequencies, measures of central tendency, and differences between responses from 2001 to 2005 were analyzed. RESULTS: Directors of 261 (57%) family medicine residencies responded, with >80% reporting satisfaction with immunization teaching resources. The popularity of bound resources decreased from 2001 to 2005, while immunization Web sites increased in importance. The journal supplement, "Vaccines Across the Lifespan, 2005" was less frequently read in 2005 than its predecessor published in 2001, but quality ratings remained high. Use of the Web site, www.ImmunizationEd.org, and the Shots software for both desktop and handheld computers has increased since their creation. CONCLUSIONS: Electronic immunization teaching resources are increasingly popular among family medicine residencies. As the field continues to change, the use of electronic resources is expected to continue, since they are easily updated and, in the case of www.ImmunizationEd.org and Shots software, are available free of charge.

Family medicine curriculum resource project: overview.

In 2000, the Health Resources and Services Administration, in the interest of fostering curriculum reform in medical schools, awarded a 4-year contract to the Society of Teachers of Family Medicine to develop a curricular resource. The contract directed development of a multi-part resource aimed at (1) preclerkship prerequisites for third-year clerkships in collaboration with internal medicine and pediatrics, (2) the family medicine clerkship, (3) post-clerkship preparation for residency training, and (4) specific special topic areas of importance to the government. The Family Medicine Curriculum Resource (FMCR) was produced by primary care educators, with day-to-day direction from an executive committee and overall oversight by an advisory committee. The FMCR was built around a theoretical framework to link medical student competencies with the Accreditation Council for Graduate Medical Education (ACGME) competencies for residency training. Considerable energy throughout development of the FMCR was devoted to obtaining input from potential end-user audiences through an active dissemination effort.

Family Medicine Curriculum Resource Project: the future.

Under contract to the Health Resources and Services Administration (HRSA), the Society of Teachers of Family Medicine (STFM) created an undergraduate medical education curricular resource designed to train physicians to practice in the 21st century. An interdisciplinary group of more than 35 educators worked for 4 years to create the Family Medicine Curriculum Resource (FMCR). By consensus, the Accreditation Council for Graduate Medical Education (ACGME) competencies were adopted as the theoretical framework for this project. The FMCR provides materials for the preclerkship years, the third-year family medicine clerkship, the postclerkship year, and faculty development, as well as guidance for integrating topics of special interest to the federal government (such as, geriatrics, Healthy People 2010, genetics, informatics) into a 4-year continuum of medical education. There are challenges inherent in implementing each component of the FMCR. For example, can the ACGME competency-based approach be adapted to undergraduate medical education? Can the densely packed preclerkship years be adapted to include more focused effort on developing these competencies, and whose job is it anyway? What is "core" to being a competent clinician, and what information can be obtained when needed from medical informatics sources? Will family medicine educators embrace the FMCR recommendations for their third-year clerkships? Will exit assessment of the competency levels of graduating medical students be achieved, and can it make them more capable residents? Can faculty in different clinical and educational settings integrate the teaching of "how to learn" into their repertoire? How will faculty development innovation progress in a time of increasing emphasis on clinical productivity? Developing a common language and adoption of core competencies for all levels of medical education is imperative in a society that is focusing on improving health care quality and outcomes. The FMCR Project has developed a curricular resource to assist medical educators in this task. The challenge for the future is to measure how the FMCR is used and to ascertain if it has an influence on better patient and system outcomes.

Protecting participants in family medicine research: a consensus statement on improving research integrity and participants' safety in educational research, community-based participatory research, and practice network research.

Recent events that include the deaths of research subjects and the falsification of data have drawn greater scrutiny on assuring research data integrity and protecting participants. Several organizations have created guidelines to help guide researchers working in the area of clinical trials and ensure that their research is safe and valid. However, family medicine researchers often engage in research that differs from a typical clinical trial. Investigators working in the areas of educational research, community-based participatory research, and practice-based network research would benefit from similar recommendations to guide their own research. With funding from the US Office of Research Integrity and the Association of American Medical Colleges, we convened a panel to review issues of data integrity and participant protection in educational research, community-based participatory research, and research conducted by practice-based networks. The panel generated 11 recommendations for researchers working in these areas. Three key recommendations include the need for (1) all educational research to undergo review and approval by an institutional review board (IRB), (2) community-based participatory research to be approved not just by an IRB but also by appropriate community representatives, and (3) practice-based researchers to undertake only valid and meaningful studies that can be reviewed by a central IRB, rather than separate IRBs for each participating practice.

The Future of Family Medicine: a collaborative project of the family medicine community.

BACKGROUND: Recognizing fundamental flaws in the fragmented US health care systems and the potential of an integrative, generalist approach, the leadership of 7 national family medicine organizations initiated the Future of Family Medicine (FFM) project in 2002. The goal of the project was to develop a strategy to transform and renew the discipline of family medicine to meet the needs of patients in a changing health care environment. METHODS: A national research study was conducted by independent research firms. Interviews and focus groups identified key issues for diverse constituencies, including patients, payers, residents, students, family physicians, and other clinicians. Subsequently, interviews were conducted with nationally representative samples of 9 key constituencies. Based in part on these data, 5 task forces addressed key issues to meet the project goal. A Project Leadership Committee synthesized the task force reports into the report presented here. RESULTS: The project identified core values, a New Model of practice, and a process for development, research, education, partnership, and change with great potential to transform the ability of family medicine to improve the health and health care of the nation. The proposed New Model of practice has the following characteristics: a patient-centered team approach; elimination of barriers to access; advanced information systems, including an electronic health record; redesigned, more functional offices; a focus on quality and outcomes; and enhanced practice finance. A unified communications strategy will be developed to promote the New Model of family medicine to multiple audiences. The study concluded that the discipline needs to oversee the training of family physicians who are committed to excellence, steeped in the core values of the discipline, competent to provide family medicine's basket of services within the New Model, and capable of adapting to varying patient needs and changing care technologies. Family medicine education must continue to include training in maternity care, the care of hospitalized patients, community and population health, and culturally effective and proficient care. A comprehensive lifelong learning program for each family physician will support continuous personal, professional, and clinical practice assessment and improvement. Ultimately, systemwide changes will be needed to ensure high-quality health care for all Americans. Such changes include taking steps to ensure that every American has a personal medical home, promoting the use and reporting of quality measures to improve performance and service, advocating that every American have health care coverage for basic services and protection against extraordinary health care costs, advancing research that supports the clinical decision making of family physicians and other primary care clinicians, and developing reimbursement models to sustain family medicine and primary care practices. CONCLUSIONS: The leadership of US family medicine organizations is committed to a transformative process. In partnership with others, this process has the potential to integrate health care to improve the health of all Americans.

Immunization education among family practice residency programs.

BACKGROUND AND OBJECTIVES: The dynamic nature of immunization schedules, shortages, and administration techniques makes keeping up to date with current national recommendations difficult and necessitates periodic evaluation of immunization teaching resources. METHODS: This study surveyed family practice residency program directors in 1998 to assess their satisfaction with immunization teaching resources and interest in new resources. Subsequently, with funding from the Centers for Disease Control and Prevention, the Society of Teachers of Family Medicine Group on Immunization Education developed a series of educational materials devoted to educating family physicians about immunizations. In 2001, residency directors were surveyed again to evaluate the educational resources. RESULTS: Most program directors reported satisfaction with resources currently available to them for teaching residents about childhood immunizations, but about half (41% in 1998 versus 55% in 2001) agreed that keeping up to date on childhood immunizations was difficult. The corresponding figures for adult immunizations were 27% in 1998 and 36% in 2001. Pocket-size immunization schedules were ranked highly important (53% in 1998 versus 45% in 2001). Many would use handheld computer immunization schedules (53%). Although satisfaction with available resources did not increase following introduction of a newly developed journal supplement and Web site, the limited response received was favorable. CONCLUSIONS: Immunization teaching materials developed by family physicians, especially those that make use of evolving technologies, can be useful resources for individuals teaching family practice residents and for keeping up to date on recommendations for immunizations.