HISTORY

Approaches to merging medical school education with residency training have evolved over the past 25 years. In 1992, the Department of Family Medicine at the University of Missouri (MU) created MU’s first Integrated Residency Program (IRP). Other residency programs soon followed.

Initially residency program participation centered around the primary care specialties- Family Medicine, Internal Medicine, Med/Peds and Child Health with each offering two positions. As the program gained recognition for recruiting outstanding MU students who tend to remain as faculty and/or practice in Missouri, additional departments petitioned for inclusion. Career outcomes data was utilized to support the increase of integrated residency positions from 12 to 15, in 2015.

The integration of graduate training, in combination with the final year of medical school, offers those confident in their specialty choices, and who wish to stay at MU, the opportunity to better use the fourth year of medical school to prepare for residency training.

The program offers the opportunity for students to apply to the residency of their choice outside the Electronic Residency Application Service. Students and programs are required to participate in the National Medical Residency Matching program. The MU residency program provides financial support to each student approximating the cost of the fourth year of medical school tuition in the form of a scholarship, paid after Match Day. The financial support is roughly split between University Healthcare and each department. Since 1993, 250 students have participated in the MU Integrated Residency program.

CAREER OUTCOMES

Those who graduated medical school between 2008-2014 were located through their residency department address listed as they were still residents when the last medical alumni directory was published in 2011. This group represents 96 students of the 250 students and are excluded in the percentages. The following is based off the 154 students who had completed their residencies by 2011. Of these students, 107 currently live in Missouri, translates in to 69 percent of students who have completed their integrated residency. Of the integrated residency graduates, 27 percent are current faculty or have been faculty at institutions nationwide. In regards to the University of Missouri specifically, 21 percent of the integrated residency graduates are current faculty or have been in the past. Based on this data, the program produces a significant number of MU faculty and physicians for Missouri.

STUDENTS (n=22)

Decision To Apply to Integrated Residency Program

How satisfied are you with your decision to apply to the Integrated residency Program? 91% responding are very satisfied, 9% are somewhat satisfied. 100% responding would recommend the program to other students.

Suggestions for Improvement

Earlier awareness of the opportunity.

The University of Missouri Integrated Residency: Program Development, Satisfaction and Career Outcomes

Alison Martin, MEd; Nathan Beucke, MD; Rachel Brown, MD; Andrea Simmons, MA; Jennifer Rachow, BHS

Breakdown of the Integrated Residencies by Specialty

Anesthesiology 8

Child Health 48

Family Medicine 80

Internal Medicine 45

Med/Peds 22

Neurology 4

OB/GYN 8

Pathology 6

PM&R 5

Psychiatry 22

Radiology 1

Surgery 1

METHODS

In order to be considered, applicants apply during the spring of their third year. Interviews are offered following the receipt of these documents: Curriculum Vitae USMLE Step 1 Scores Personal Statement Official Transcript

Family Medicine Model

If the program and student agree to rank to Match, students begin their fourth year of medical school by participating in residency orientation with the incoming traditional first-year residents. The curriculum offers the following opportunities: Attend weekly grand rounds conferences Attend half day per week of resident seminars Spend up to two half days in clinic Six month pairing with faculty member who models patient-centered care Six month pairing with third-year resident with the intent of assuming care for that graduating

resident’s patients May fill a first-year resident position on a number of different inpatient services- prescriptions, orders,

and notes must be cosigned by second or third year resident Rigors of intern year are decompressed over 2 years Ability to use extra elective time to tailor training to individual needs

Integrated Residents

• Of all the Integrated Residents

27%

• Are current faculty or have been faculty at institutions nationwide

21%

• Are current or have been MU faculty

69%

31%

Where Integrated Residents Reside

Missouri

All Other

States

0 10 20 30 40 50 60 70 80 90

Anesthesiology

Child Health

Family Medicine

Internal Medicine

Med/Peds

Neurology

OB/GYN

Pathology

PM&R

Psychiatry

Radiology

Surgery

Integrated Residency Specialties

by Number

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Other

Concerns about Competing- Interviews

Student Debt Concerns

Security/Promised Residency Program

Save on Cost of Relocating

Geographic Location

Scholarship

Strength of Residency Program

Save on Cost of Interview Season

Personal Ties to Columbia

SATISFACTION SURVEYS

PROGRAM DIRECTORS (n=5)

Decision To Participate in Integrated Residency Program

How satisfied are you with your decision to participate in the Integrated Residency Program? Program Directors - 100% responding are very satisfied

Suggestions for Improvement

Need better ways to advertise the availability of Integrated Residency positon early enough to gauge interest.

Hospital should be more willing to fund. It benefits them to have the best residents here and helps them recruit future faculty.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Integrated Residents Contributions to Department

Commitment to Quality Improvement Projects

Other

Commitment to Provide Physicians for Missouri

Commitment to Developing Ones Own Faculty

Loyalty to University of Missouri

Concerns- Matched Applicants v. Known Entities

Familiarity with Applicants

“As I was starting to look at training after med school, I realized I had much more I wanted to get from MU. I wasn't ready to give up the mentors and friends I had made. I felt there was a lot more I could learn here. Plus I want to practice in Missouri. For me staying made sense.

Being an integrated resident allowed me to maximize my 4th year. Instead of spending my time traveling and auditioning at other programs, I was able to go deeper in my learning at MU. I was given more patients, more specific feedback, and was able to do several procedures. Residents took more interest in my training, knowing I would be their intern next year. I got to know nurses, social workers, and pharmacists on a personal level. Basically I had a year to transition into my intern role, rather than the rapid transformation that my non-integrated colleagues experienced.“

Nathan Nolan, PGY-1 Internal Medicine

“I believe the medical school and the state should provide more financial support for this program. It is a proven pipeline to develop outstanding faculty for our medical school and outstanding physicians for our state.”

Erika Ringdahl, MDProfessor of Clinical Family and Community Medicine;

Director of Family Medicine Residency Program

Erika Ringdahl, MD; Robin L. Kruse, PhD, MSPH; Erik j. Lindbloom, MD; Steven C. Zweig, MD, MSPH, The University of Missouri Integrated Residency: Evaluating a 4-year Curriculum, Fam Med 2009; 41(7):476-80.