8/3/18

1

Enhancing the Resident’s Experience in the FMP

AFMRD Clinic First CollaborativeFM National Innovation in Continuity Clinic Experience (FM-NICCE)

W. Fred Miser, MD, MA, FAAFPPresident, AFMRDAugust 18, 2018

Impact of continuity and the FMP experience in preparation of family physicians – Clinic First

Ignite Speaker - Kevin Grumbach, MD

Detailed report available at:

www.aamc.org/buildingblocksreport

10+3 Building Blocks of High-Performing Primary Care

Resident Scheduling

Resident Engagement

Resident Worklife

“Clinic First”

8/3/18

2

AFMRD’s Road to Clinic First Collaborative• Sep 7, 2017 – BoD Discussion

– Fits in our Strategic Plan

– Investigate Collaboration with UCSF

CEPC – Dr. Steve Brown

• Oct 17, 2017 – BoD Discussion

– Reviewed agreement, budget

– Call for applications to programs

• Nov 14, 2017 – BoD Discussion

– One year initiative

– 38 programs applied for 18 slots

– Approved budget $142,000 –

Special Purpose Fund

– One face-to-face meeting and six

Webinars led by CEPC

AFMRD Clinic First Collaborative18 Programs

8

Univ Arizona COM South Campus, Tucson AZBeaumont Health, Troy MINY Med College, Hoboken NJSt Joseph, Mishawaka, INUniv Mass Worcester, MAProvidence—Prov Park/MSUCHM MIChrist Hospital, Univ Cincinnati, OHVentura County, Ventura, CAStanford Health, San Jose, CAUniv of Florida, Gainesville, FLCascades East – OHSU, Klamath Falls, ORUniv Arizona, Tucson, AZFranciscan Health, Indianapolis, INUniv of MN, Duluth MNThe Ohio State Univ, Columbus, OHCentral Maine, Lewiston, MESt Peter, Chehalis, WATulsa Med Ed Foundation, Tulsa, OK

AFMRD Clinic First CollaborativeFace-to-Face Meeting

• Feb 26-27, 2018 Kansas City, MO– CEPC – Tom Bodenheimer,

Marianna Kong, Margae Knox– 60 participants from 18 programs– Bonding, Group Activities– Overview, Scheduling, Team-Based

Care, Resident Engagement, Population Management

– Homework assignments– Eval 8.5-8.9 (0-10)

AFMRD

Resident Scheduling

Resident Engagement

Resident Worklife

Online Community/Portal

AFMRD Clinic First CollaborativeWebinars

• March 7, 2018• May 23, 2018• July 18, 2018• September 12, 2018• November 7, 2018• January 16, 2019

• Recorded for future access• Best practices shared• Areas addressed to date

– Scheduling– Continuity of Care– Access with Continuity

• AFMRD BoD Considers this a Success!• Many programs interested in

joining the collaborative• Do we offer Round 2?

AFMRD Clinic First CollaborativeNext Steps

Cost $129,880CEPC Contract $83,000In-Person Mtg $46,883

Does NOT include AFMRD staff time, etc

8/3/18

3

• Time in the office• Continuity of care• Access• Resident Wellness• Resident Satisfaction• Patient Satisfaction

Resident Scheduling IssuesFMP Inpatient Care

Our Residents• March 25, 2018 PDW Meeting• ABFM Update

Resident Scheduling Issues

Questions from the audience regarding resident schedules resulting in being in the office

< 40 weeks each year

Residents must be scheduled to see patients in the FMP site for a

minimum of 40 weeks during each year of the program. (Detail)

Resident Scheduling Issues

…. Residents must be scheduled to see patients in

the FMP site for a minimum of 40 weeks during each year of

training.

2+2; 1+1+1+1; 3+3 Formats • What if….

• Want to encourage those programs that want to be innovative in resident scheduling

• But, there are standards• Dialogue ensued over next few

weeks

Resident Scheduling IssuesProposed 5-Year Pilot Project

• Programs that wish to be innovative with their schedules that would result in the resident NOT being in the office for at least 40 weeks each year (but would have positive effects otherwise such as improvement in resident satisfaction with the office, improved continuity of care, etc)

• Petition ABFM for approval waiver of 40 week per year minimum requirement in the office• Only programs in good standing with the ACGME (fully accredited NOT on probation) could apply• Need to….

1. Demonstrate # of overall training sessions would be equivalent as if they were in the office at least 40 weeks2. Assure each resident has at least 1650 face-to-face visits in the office by the time of graduation3. Demonstrate they meet all other ACGME program requirements

• Pilot for 5 years, with mid-way audit of participating programs are meeting the requirements, with evaluation at the end of the pilot

Resident Scheduling IssuesProposed 5-Year Pilot Project

• Call for applications – April 10, 2018 – April 20, 2018• Applications reviewed by 3 AFMRD BoD members• 25 programs successful applications• April 25, 2018 - Letter sent to ABFM requesting waiver• AFMRD Task Force charter completed• April 28-30, 2018 – ABFM BoD approved pilot project for 25

programs; letter sent to programs May 15, 2018

Resident Scheduling IssuesProposed 5-Year Pilot Project

8/3/18

4

FM National Innovation in Continuity Clinic Experience (FM-NICCE)

25 Programs

19

12 Clinic First7 Academic Health Centers7 Community Based, Med School Admin10 Community Based, Med School Affiliated1 Military

• Task Force – 7 PDs + AFMRD Staff• Teleconferences– June 7, 2018– June 17, 2018– July 17, 2018– July 31, 2018

• Description of resident schedule changes

FM National Innovation in Continuity Clinic Experience (FM-NICCE)

• Shared waiver notification• Continuity Measurement• Patient visit numbers• Weeks present in the FMP• No. sessions each week• Resident satisfaction survey• Patient satisfaction survey

Clinic First CollaborativeFM National Innovation in Continuity

Clinic Experience (FM-NICCE)