Competency-based education in family practice.

BACKGROUND AND OBJECTIVES: Since their inception, family practice residency programs have been designed on a rotation-based format. It has been assumed that by having residents rotate through a series of educational experiences, they would assimilate the skills necessary to effectively serve as a family physician. An alternative approach is based on the attainment of competency, rather than on the completion of a set of experiences. This method of education is known as competency-based education, mastery learning, or, more recently, outcomes-based assessment. Within family medicine, there is a strong interest in the application of competency-based education to family practice residency training. In response to the growing need to discuss these and other related issues, the Society of Teachers of Family Medicine (STFM) Board created the Task Force on Competency-based Education. Its mission is to disseminate this educational theory to STFM's membership. This article reviews the theory of competency-based education, describes development of a competency-based curriculum model, and discusses the academic issues surrounding adaptation of this form of education to family practice residency programs.

Family practice graduate medical education and hospitals' patient care costs in New Jersey.

BACKGROUND: More generalists are needed for the American health care system. Will training these practitioners add to hospital costs? Although graduate medical education has been shown to add to hospital patient care costs, the authors questioned whether this were true for the hospital training of family physicians. METHOD: Based on data supplied by 12 participating New Jersey hospitals with family practice residencies, inpatients in 1991 were separated into three categories by the teaching status of their attending physicians: family practice, other teaching, non-teaching. The hospitals were stratified into two types for analysis: seven community and five multiresidency hospitals. Average cost (per case-mix--neutral case) was found for each category of patients within medical, surgical, pediatric, and obstetrical classes. RESULTS: Among community teaching hospitals, the mean case-mix--adjusted cost per case for inpatients associated with family practice training was 6.3% less than that for inpatients with an equivalent case mix not associated with family practice training. Among multiresidency teaching hospitals, there was no difference between mean costs for inpatients associated with family practice training and non-teaching patients. The mean cost for inpatients associated with graduate medical training other than family practice was 8% higher than that for non-teaching inpatients. CONCLUSION: These findings suggest that family practice residencies do not add to the direct inpatient costs of teaching hospitals, and in certain instances may even reduce hospital patient care costs. In times of increasing cost consciousness in health care and medical education, this provides a further rationale for institutions to sponsor graduate training in family practice.

Testing a model of academic career development.

This study, based on a survey of current faculty members, confirms the previously proposed professional identity model of Knopke and Anderson. This model had predicted that personal and resident learner issues would be influential aspects of a faculty member's professional developmental needs and that during the initial years as a faculty member the influence of institutional issues would be less important. The study found that major concerns of new faculty members appeared to be: 1) acting as a role model; 2) developing teaching skills; and 3) maintaining clinical competency. New faculty were more likely to emphasize issues dealing with resident-faculty relationships if they came directly out of training programs than if they came out of practice settings. The study also demonstrated that the majority of family medicine faculty no longer came from private practice, and that a significant number now come directly from training programs.