The Voice is Heard

By consensus, the most important place for the directors' new voice to be heard was on the Residency Review Committee for Family Practice. This committee of the Accreditation Council for Graduate Medical Education (ACGME), with representatives from the AMA, AAFP, and ABFP along with a resident, is responsible for accrediting residency programs. Not surprisingly, the directors felt they should be represented on the RRC. This goal had been strongly articulated from the beginning of discussions to form an organization.

Perry A. Pugno, MD, was asked to provide several alternatives as logos/seals for the newly formed organization. In 1991, the seal was officially adopted. The four quadrants refer to the primary elements of the program director's job -- education, clinical medical practice, administration, and scholarly research and writing.

In January 1991, the group was able to provide a list of several program directors for consideration for a seat on the RRC-FP. When Dr. Layton met with the AAFP Commission on Education in February, the commission agreed to take into consideration particularly directors from community-based programs when filling vacant positions. While no seat would be assigned to directors, nominations would regularly be sought from AFPRD members.

A year later, Don McHard, M.D., a program director from Phoenix, Arizona, joined the RRC-FP as the nominee of the AAFP. By May 1995, four members of the committee, including its chair, David Holden, MD, and former president of AFPRD, Stephen Brunton, MD, were community hospital residency program directors.

Of course, the RRC-FP was not the only group with which directors sought dialogue and participation. Almost immediately after AFPRD was formed, it assigned liaisons to the Family Practice Working Party, the Residency Assistance Program (RAP) Project Board, the AAFP Commission on Education, the AAFP Student Interest Task Force, and the Association of American Medical Colleges / Forum on the Transition from Medical School to Residency. Eventually, it would take part in the Academic Family Medicine Organizations (AFMO) as well.

"AFPRD has served as a successful mechanism for family medicine group unity," says Dr. Haley. "This was one of the roles originally envisioned for the group."


The organization has also been a "model for organizational consensus building," says Dr. Pugno, both within itself, as an "opportunity for program directors to get on their soapbox," and among the family of organizations.

All these networking activities have contributed to the significant and concrete participation of program directors in a variety of activities within the first few years of the group's existence. For example, in 1992 AFPRD was asked to nominate program directors for the Home Study Self-Assessment Advisory Board. Ultimately, all members of this board were selected from AFPRD nominees.

In 1993 AFPRD members approved a series of principles for reform of the "Special Requirements for Residency Training in Family Practice." These rules determine a program's accreditation and cover items such as the number of faculty, size of the family medicine center, resident rights, and curriculum. The four most important issues dealt with in the reform document, as outlined by Dr. Saultz in Highlights (Aug. 15, 1993) were:

  1. The requirements should define curriculum areas in terms of what family physicians do, not by the names of other specialties, e.g., care of children, rather than pediatrics. 
  2. The requirements should identify family medicine faculty as primary teachers for all curricular areas. 
  3. Arbitrary time limits should be eliminated from various curricular areas. 
  4. Programs should begin to move toward a competency-based curriculum, rather than a time-based one.

The reform suggestions were submitted to the RRC-FP, as well as the STFM, AAFP, and ADFM. By mid-1995 the RRC-FP had drafted its revised document, including many of the AFPRD suggestions. The draft was submitted to the organizational parents of the RRC-FP: the ABFP, AMA, and AAFP for final comments before being submitted to the Accreditation Council for Graduate Medical Education for approval.

In the past, the RRC-FP had been open to suggestions from program directors for requirement revisions. However, this time the group was able to take a proactive stand to make its members' view known early in the process. It was for just such actions that the AFPRD was formed.

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