Impact of Educational Format on Learner Commitment to Change and Satisfaction.

INTRODUCTION: The value proposition of CME lies in its ability to elicit change in learners so new knowledge and skills are used to improve patient outcomes. In this study, we test the hypothesis that, in contrast to passive learning, education with an active engagement component has a greater impact on the motivation of learners to make changes in their practice. METHODS: We analyzed nine educational formats produced by the American Academy of Family Physicians. CME program between 2015 and 2017. Postactivity learner evaluations were used to measure both satisfaction and "commitment to change"-the percentage of learners who committed in making a change in their practice as a result of their participation. RESULTS: We found education that was interactive and leveraged elements of social learning theory produced the greatest commitment to change the score. Lower scores were obtained for more passive education formats. By contrast, satisfaction scores were not significantly different between formats. DISCUSSION: Our data demonstrate differences between commitment to change and educational format that could inform how format types might be better used to promote a behavior change. We also demonstrate that learner satisfaction has little or no value as a measure of educational efficacy.

Results of the 2017 National Resident Matching Program® and the American Osteopathic Association Intern/Resident Registration Program.

BACKGROUND AND OBJECTIVES: The purpose of medicine as a profession is to meet the health needs of people and communities. Despite empirical evidence worldwide that an appropriate foundation of primary care in a health care system leads to improved health outcomes, improved experience of health care, a reduction in health disparities, and lower overall cost of care, publicly available data from National Resident Matching Program® (NRMP) and the American Osteopathic Association (AOA) Intern/Resident Registration Program show that PGY-1 family medicine and primary care positions offered in the NRMP Match continue to grow, but are losing ground in comparison to the growth of non-primary care specialties. In ACGME-accredited family medicine programs, DO students have been displacing non-US citizen IMGs while the proportion of US seniors has remained stable over the past decade. The impact of the displacement of non-US citizen IMGs by DO students in ACGME programs is unknown and deserves future research. Continuing trends in the growth of non-primary care specialties should raise great concern that the current primary shortage will be exacerbated, not serving the needs of the population. A major overhaul of the graduate medical education (GME) system is required to align the medical education system with the transformation of the health care system needed to improve quality, population health, and cost control.

Entry of Medical School Graduates Into Family Medicine Residencies: 2016-2017.

BACKGROUND AND OBJECTIVES: This annual report is an expansion on previous reports in this series that provides further evidence that the current medical school system is failing, collectively, to produce the primary care workforce that is needed to achieve optimal health in the United States. Inclusion of data on the performance of DO-granting and international medical schools, creates a more complete and complex picture of the contribution of all medical school types to the primary care workforce that should allow stakeholders to set goals, identify institutions with models from which to learn, and develop strategies for continuous improvement. US MD graduates made up 49% of the entering first-year class of family medicine residencies accredited by the Accreditation Council for Graduate Medical Education (ACGME), a percentage that is not statistically changed from the 11-year average of 46%. Over the same time, the percentage of DO graduates in the entering class has been increasing at an annual rate of 1%, while the percentage of international graduates has been decreasing in a reciprocal manner. Production of family medicine graduates has varied widely between and within medical school types. The number of graduates entering family medicine programs accredited by the ACGME underrepresents the overall family medicine output by US medical schools since up to a third of DO graduates have historically entered residencies accredited only by the American Osteopathic Association. While marked differences between public and private continue among US MD-granting medical schools, the percentages are nearly equal between public and private for DO-granting medical schools, with a slightly higher percentage for private schools.

The American Board of Family Medicine: New Tools to Assist Program Directors and Graduates Achieve Success.

In this commentary we review the improvements in the pass rates for first-time American Board of Family Medicine (ABFM) Certification Examination test takers in the context of new tools and resources for program directors against the backdrop of a changing accreditation system and increased competition for a relatively fixed number of graduate medical education positions in family medicine. While causality cannot be established between the strategic initiatives of the ABFM and higher pass rates, we can all celebrate the new tools and resources provided to residents and program directors, and the improved performance of family medicine graduates on the certification examination.

Results of the 2016 National Resident Matching Program®: 1986-2016: A Comparison of Family Medicine, E-ROADs, and Other Select Specialties.

BACKGROUND AND OBJECTIVES: This article is a continuation in a series of national studies conducted by the American Academy of Family Physicians that reports the performance of family medicine and other primary care specialties in the National Residency Matching Program® (NRMP) Main Residency Match, hereafter called the Match. Match data from 1986-2016 were analyzed to compare the numbers of positions offered and filled in family medicine, other primary care specialties, emergency medicine, diagnostic radiology, ophthalmology, anesthesiology, and dermatology (E-ROAD), and other select specialties. Of the 10 largest specialties defined by the greatest number of positions offered in the 2016 Match, all but one (general surgery) have experienced growth since 1986.Overall, the total number of positions offered in the Match grew by an average of 226 positions per year. At the same time, primary care specialties grew 19 positions per year, and E-ROAD specialties grew by 72 positions per year. The disproportionate growth of subspecialties overall, notably the E-ROAD subspecialties, relative to the modest growth of primary care specialties, makes the goal of better health care harder to achieve. The GME portion of physician workforce pipeline is mismatched to the health needs of the nation, and this mismatch is worsening.

Entry of US Medical School Graduates Into Family Medicine Residencies: 2015-2016.

BACKGROUND AND OBJECTIVES: This is the 35th national study conducted by the American Academy of Family Physicians (AAFP) that reports retrospectively the percentage of graduates from MD-granting and DO-granting medical schools who entered Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residency programs as first-year residents. Approximately 8.7% of the 18,929 students graduating from US MD-granting medical schools and 15.5% of the 5,314 students graduating from DO-granting medical schools between July 2014 and June 2015 entered an ACGME family medicine residency in 2015. Together, 10.2% of graduates of MD- and DO-granting schools entered family medicine. Of the 1,640 graduates of the MD-granting medical schools who entered a family medicine residency in 2015, 80% graduated from 70 of the 134 schools (52%). In 2015, DO-granting medical schools graduated 823 into ACGME-accredited family medicine residencies, 80% graduating from 19 of the 32 schools (59%). In aggregate, medical schools west of the Mississippi River represent less than a third of all MD-granting schools but have a rate of students selecting family medicine that is 40% higher than schools located east of the Mississippi. Fifty-one percent (24/47) of states and territories containing medical schools produce 80% of the graduates entering ACGME-accredited family medicine residency programs. A rank order list of MD-granting medical schools was created based on the last 3 years' average percentage of graduates who became family medicine residents, using the 2015 and prior AAFP census data.

Responses to Medical Students' Frequently Asked Questions About Family Medicine.

This article provides answers to many of the common questions that medical students ask about the specialty of family medicine. It describes the crucial role that family physicians have in the evolving health care environment, the scope of practice, the diverse career opportunities available, the education and training of family physicians, the economic realities of a career in family medicine, why the future is so bright for family medicine, and why family physicians are passionate about their work.

Entry of US Medical School Graduates Into Family Medicine Residencies: 2014-2015.

BACKGROUND AND OBJECTIVES: This is the 34th national study conducted by the American Academy of Family Physicians (AAFP) that reports retrospectively the percentage of graduates from US MD-granting and DO-granting medical schools who entered Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residency programs as first-year residents in 2014. Approximately 8.5% of the 18,241 students graduating from US MD-granting medical schools between July 2013 and June 2014 entered a family medicine residency. Of the 1,458 graduates of the US MD-granting medical schools who entered a family medicine residency in 2014, 80% graduated from 69 of the 131 schools. Eleven schools lacking departments or divisions of family medicine produced only a total of 26 students entering family medicine. In aggregate, medical schools west of the Mississippi River represent less than a third of all US MD-granting schools but have an aggregate rate of students selecting family medicine that is two-thirds higher than schools to the east of the Mississippi. A rank order list of US MD-granting medical schools was created based on the last 3 years' average percentage of graduates who became family medicine residents, using the 2014 and prior AAFP census data. US MD schools continue to fail to produce a primary care workforce, a key measure of social responsibility as measured by their production of graduates entering into family medicine. DO-granting and international medical school graduates filled the majority of ACGME-accredited family medicine first-year resident positions in 2014.

Results of the 2015 National Resident Matching Program:® Family Medicine-A Comparison With 1997 and 2009.

BACKGROUND AND OBJECTIVES: This article is a continuation in a series of national studies conducted by the American Academy of Family Physicians that reports the performance of family medicine and other primary care specialties in the National Residency Matching Program® (NRMP) Main Residency Match, hereafter called the Match. 2015 Match data were compared to 1997, the year of the highest number of family medicine positions offered and positions filled by US seniors in the Match and 2009, the year of the lowest number of family medicine positions offered and positions filled by US seniors in the Match. Despite a 31% growth in the number of US seniors matching into family medicine since 2009, that number remains 39% lower than the number of US seniors matching into family medicine in 1997 (1,422 versus 2,340). There were 442, or approximately 10%, fewer positions offered in all primary care specialties and 1,194 fewer US seniors matching into primary care in the 2015 Match than in the 1997 Match. Primary care specialties were defined by the authors to include family medicine categorical as well as combined programs (family medicine-psychiatry, family medicine-emergency medicine, family medicine-preventive medicine, and family medicine-internal medicine), medicine-pediatrics, medicine primary care, and pediatrics primary care as listed in the NRMP publications. Family medicine offered 80% of all primary care positions in the 2015 Match. Sixty-nine percent of all US seniors matching into primary care in 2015 matched into family medicine residency programs.

Five Key Leadership Actions Needed to Redesign Family Medicine Residencies.

BACKGROUND: New skills are needed to properly prepare the next generation of physicians and health professionals to practice in medical homes. Transforming residency training to address these new skills requires strong leadership. OBJECTIVE: We sought to increase the understanding of leadership skills useful in residency programs that plan to undertake meaningful change. METHODS: The Preparing the Personal Physician for Practice (P4) project (2007-2014) was a comparative case study of 14 family medicine residencies that engaged in innovative training redesign, including altering the scope, content, sequence, length, and location of training to align resident education with requirements of the patient-centered medical home. In 2012, each P4 residency team submitted a final summary report of innovations implemented, overall insights, and dissemination activities during the study. Six investigators conducted independent narrative analyses of these reports. A consensus meeting held in September 2012 was used to identify key leadership actions associated with successful educational redesign. RESULTS: Five leadership actions were associated with successful implementation of innovations and residency transformation: (1) manage change; (2) develop financial acumen; (3) adapt best evidence educational strategies to the local environment; (4) create and sustain a vision that engages stakeholders; and (5) demonstrate courage and resilience. CONCLUSIONS: Residency programs are expected to change to better prepare their graduates for a changing delivery system. Insights about effective leadership skills can provide guidance for faculty to develop the skills needed to face practical realities while guiding transformation.

Entry of US medical school graduates into family medicine residencies: 2013--2014.

BACKGROUND AND OBJECTIVES: This is the 33rd annual report prepared by the American Academy of Family Physicians (AAFP) that reports retrospectively the percentage of graduates from US MD and DO-granting medical schools who entered an Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residency program and covers the period between July 2013 and June 2014. Approximately 8.5% of the 18,384 graduates of US MD-granting medical schools entered family medicine in 2014. Seventy of the 130 US LCME-accredited medical schools produced 80% of the graduates who entered family medicine. Schools that received public funding and schools with a department or division of family medicine had higher percentages of students selecting family medicine. Schools are ranked based upon a 3-year rolling average for the percentage of their graduates who entered family medicine. The West North Central, Mountain, and Pacific regions reported the highest percentages of medical school graduates who were first-year residents in family medicine programs (13.3%, 11.8%, and 11.8% respectively).

Results of the 2014 National Resident Matching Program®: family medicine.

BACKGROUND AND OBJECTIVES: The 2014 National Residency Matching Program® results reveal that the number of family medicine positions offered in the Match® by programs accredited by the Accreditation Council on Graduate Medical Education has increased compared to 2013 (3,132 versus 3,062), while the total of all other primary care specialties combined has remained unchanged (784). The number of US seniors matching into family medicine also increased in 2014 over the prior year (1,416 versus 1,374). The percentage of US seniors who matched into family medicine programs grew modestly in 2014 compared to 2013 (8.6% versus 8.4%). Approximately four out of five primary care positions offered in the Match are in family medicine residency programs (3,132 versus 784). Similarly, three out of four US seniors matching into a primary care specialty match into a family medicine program (1,416 versus 520). By way of comparison, nearly five times the number of US seniors matched into family medicine as compared to medicine-pediatrics, the next largest primary care specialty.

Financing Residency Training Redesign.

BACKGROUND: Redesign in the health care delivery system creates a need to reorganize resident education. How residency programs fund these redesign efforts is not known. METHODS: Family medicine residency program directors participating in the Preparing Personal Physicians for Practice (P(4)) project were surveyed between 2006 and 2011 on revenues and expenses associated with training redesign. RESULTS: A total of 6 university-based programs in the study collectively received $5,240,516 over the entire study period, compared with $4,718,943 received by 8 community-based programs. Most of the funding for both settings came from grants, which accounted for 57.8% and 86.9% of funding for each setting, respectively. Department revenue represented 3.4% of university-based support and 13.1% of community-based support. The total average revenue (all years combined) per program for university-based programs was just under $875,000, and the average was nearly $590,000 for community programs. The vast majority of funds were dedicated to salary support (64.8% in university settings versus 79.3% in community-based settings). Based on the estimated ratio of new funding relative to the annual costs of training using national data for a 3-year program with 7 residents per year, training redesign added 3% to budgets for university-based programs and about 2% to budgets for community-based programs. CONCLUSIONS: Residencies undergoing training redesign used a variety of approaches to fund these changes. The costs of innovations marginally increased the estimated costs of training. Federal and local funding sources were most common, and costs were primarily salary related. More research is needed on the costs of transforming residency training.

Entry of US medical school graduates into family medicine residencies: 2012--2013.

BACKGROUND: Analyzing the US medical school origin of family medicine residents highlights schools, states, or regions that have higher entrance rates into family medicine. METHODS: The American Academy of Family Physicians (AAFP) 2013 Residency Census has a 100% response rate and lists information for family medicine residents who entered training July 2012. MD graduates are verified through medical school registrars or the American Medical Association's Physicians Masterfile data. The American Association of Colleges of Osteopathic Medicine provides data on DO graduates. Three-year rolling averages of graduates entering family medicine are calculated for Liaison Committee of Medical Education (LCME)-accredited medical schools. RESULTS: In July 2012, 3,523 first-year residents entered Accreditation Council for Graduation Medical Education (ACGME)-accredited family medicine residencies. Medical students from LCME-accredited schools account for less than half of the family medicine residents (46%). Public MD-granting medical schools graduate almost threefold more students into family medicine residencies than do private schools (1,101 versus 380). The Mountain, West North Central, and Pacific regions of the United States have the highest percentage of MD graduates (13.5%, 12.3%, and 11.4%, respectively) entering family medicine. Forty-five percent of MD medical students enter a family medicine residency in the state in which they attended medical school. CONCLUSIONS: LCME-accredited medical schools with lower percentages of graduates entering family medicine should examine the economic, environmental, and academic factors that may be causing low numbers of their students graduating and entering family medicine residencies.

Results of the 2013 National Resident Matching Program: family medicine.

BACKGROUND: The percentage of US seniors who chose primary care careers remains well below the nation's future workforce needs. Entrants into family medicine residency programs, along with their colleagues entering other primary care-designated residencies, will compose the primary care workforce of the future. METHODS: Data in this article are collected from the 2013 National Resident Matching Program (NRMP) Main Residency Match and the 2013 American Academy of Family Physicians (AAFP) Medical Education Residency Census. The information provided includes the number of applicants to graduate medical education programs for the 2013--2014 academic year, specialty choice, and trends in specialty selection. RESULTS: Family medicine residency programs experienced a modest increase in both the overall fill rate as well as the number of positions filled with US seniors through the NRMP in 2013 in comparison to 2012. Other primary care fields, primary care internal medicine positions, pediatrics-primary care, and internal medicine-pediatrics programs also experienced modest increases in 2013. The 2013 NRMP results show a small increase in medical students choosing primary care careers for the fourth year in a row. CONCLUSIONS: Changes in the NRMP Match process in 2013 make a comparison to prior years' Match results difficult. Medical school admission changes, loan repayment, and improved primary care reimbursement may help increase the number of students pursuing family medicine.

Results of the 2012 National Resident Matching Program: family medicine.

BACKGROUND: The percentage of US seniors choosing primary care careers remains well below the nation's future workforce needs. Data in this article are collected from the 2012 National Resident Matching Program (NRMP) Main Residency Match and the 2012 American Academy of Family Physicians (AAFP) Medical Education Residency Census, which had a response rate of 100%. The census verified residents who entered training July 2012 from all medical schools. The information provided includes the number of applicants to graduate medical education programs for the 2012--2013 academic year, specialty choice, and trends in specialty selection. Compared with the 2011 Match, family medicine residency programs filled 35 more positions (with 18 more US seniors) through the NRMP in 2012. In other primary care fields, 31 more primary care internal medicine positions (20 more US seniors), two fewer positions in pediatrics-primary care (one less US senior), and 18 fewer positions in internal medicine-pediatrics programs (33 fewer US seniors) filled. The 2012 NRMP results indicate a small increase in medical students choosing primary care careers for the third year in a row; however, students continue to show an overall preference for subspecialty careers.

Entry of US medical school graduates into family medicine residencies: 2011--2012.

BACKGROUND: This study reports on the number of graduates entering family medicine residencies in 2011 from allopathic, osteopathic, and international medical schools. Allopathic graduate data come from medical school registrars or the American Medical Association Masterfile. The 2012 family medicine residency program director census, with a response rate of 100%, verified residents who entered training July 2011 from all medical schools. Approximately 8.4% allopathic medical school's graduates of the 17,478 graduates (July 2010 to June 2011) were first-year family medicine residents in 2011, compared with 8.0% in 2010 and 7.5% in 2009. The percent of medical school graduates entering family medicine from each of the allopathic schools was calculated and averaged over 3 years to diminish 1-year fluctuations. Allopathic medical schools' 3-year average percentage of graduates who entered family medicine residency programs in 2011 ranged from 0.6% to 21.4%. Compared to 2010, osteopathic graduates in Accreditation Council for Graduate Medical Education-accredited family medicine residencies (21.5%) increased 2.8% from 2010, whereas international medical graduates (32.1%) decreased 3.4%. An increasing trend is seen in the number of allopathic graduates entering family medicine residencies. Osteopathic and international graduates' entry to residency appears inversely related. As medical schools emphasize social accountability to improve the health of communities, higher family medicine graduation rates may occur. Initiatives in medical school admissions may increase the number of medical students more likely to select family medicine careers.