Blogs

Having visited north, west, east, and south thus far in my travels for AFMRD, I stayed close to center for my final visits as its 2024-25 president. In February, I met with Morgan Schiermeier, MD, program director (PD) at Capital Regional Medical Center(CRMC) Family Medicine residency in Jefferson City, MO on what also happened to be the Missouri Academy of Family Physicians advocacy day in the state capital. Stopping by the advocacy event en route to Dr. Schiermeier, I found CRMC residents in attendance. We briefly discussed the critical role family physicians play in educating legislators on health care policy. Upon learning I was heading to their clinic, ...

Off-the-Beaten-Path at the 2024 AAFP NCFMRS With the bittersweet farewells to graduates in June and welcomes to interns in July behind me, I was excited to head toward Kansas City for AAFP’s National Conference of Family Medicine Residents and Students. Like many of you, in between recruiting sessions, I enjoyed fellowship with faraway PD friends whom I tend to see only once or twice a year. However, this year, I also felt like I explored more of the hidden work that the academic family medicine community completed at NCFMRS and some of the non”convention”al locations in Kansas City. Here are some of the things you may not have seen while in KC! FM-AIRE ...

Many of our graduates go into hospitalist medicine for multifold reasons like quality of life and flexibility. One reason has been frustration with the clinic experience - high volume, multiple problems, 15-minute slots without time to precept, disorganized workflow, poor follow-up and conflicting demands from other rotations. With a physician shortage of 35%, we hoped Clinic First Collaborative would give us tools to address this. There were some obstacles to changes implemented, like external rotations resenting need for more clinic and administrative time. However, we felt overall support was present and reflective of the concerns our larger medical community ...

As one of the few family medicine residency programs to utilize a longitudinal schedule, our primary goal in the Clinic First program is to improve resident predictability in the family medicine continuity clinic (FMC). Secondary objectives include a more well-defined patient panel and improved coverage of asynchronous work. In our longitudinal schedule, residents change rotations every one to two weeks, and as such, their office schedule changed at the same interval. Resident time in the outpatient clinic was based on availability after all inpatient, call, and rotation-specific time slots were addressed. As a result, there was little predictability in ...

HELLO FROM KINGSPORT, TN! Our team for the clinic first collaborative consisted of: Gary Michael, Chief Medical Officer for the Department of Family Medicine, Billy Buselmeier, Assistant Program Director, and Kelly Kahle, one of our chief residents who is now faculty at the program. Our aims for entering the Clinic First collaborative were two-fold. First, to improve our resident numbers as in the last few years we have had increasing difficulty reaching our required 1650 outpatient visits. This was placing undue burden on our soon to be graduating third year residents and created a stressful, volume focused atmosphere at the end of the year. Second, ...

The University of Missouri first joined Clinics First for the February 2019 meeting. We had spent the previous two years really focusing on the experience of our residents on our inpatient service. We noticed an increase in the number of our residents who were pursuing careers as hospitalists, primarily because they enjoyed their time in the hospital more than their time in clinic. We decided we wanted our continuity clinics to be the place where residents got the best education and most looked forward to going. One of the benefits of attending the Collaboration meeting in Kansas City was learning that we were already doing a number of things that Clinic First ...

When we started the AFMRD Clinic First Collaborative our three main goals were to improve scheduling of residents in clinic to optimize continuity and resident engagement, improve empanelment and engage residents in clinic transformation. We have made great strides in all our goals thanks to the clear roadmap created by the collaborative and the building blocks for providing excellent care and training. We first learned about the two plus two mini block schedules at our kick off conference. This concept fit our current model perfectly as we already had a similar version of this for our third-year residents. It made perfect sense for the resident to be completely ...

While we have always had a very strong residency, our inpatient experience has always been exceptional and our outpatient experience has always been the “left overs”. Over the last few years, we have made great strides, moving our Family Medicine Center onto our hospital campus, instead of a half hour drive from our hospital, and then expanding our Center to include more patient rooms, more staff, and an improved waiting room. But we still craved more innovation and improved experiences for our residents, our staff and our patients. When we heard about the Clinic First Initiative, we knew it was a great way to continue to improve our outpatient experience! ...

Franciscan Health Family Medicine Residency Program applied for the collaborative to gain insight into overcoming some of the challenges we experience particularly in our outpatient clinic. However, we nearly failed miserably at our first task to simply bring a “token” that represented our program. We are a community based program in Indianapolis (racing capitol of the world), and we forgot to bring a hot wheels race care as our memento. So, at 9 pm on the eve of our first meeting, we bought a Legos race car from Walmart with a team member pulling an all-nighter to construct our prized token. We found the collaborative to be enlightening while at the same ...

Everyone agrees, things could definitely be better … Jessie Pettit, program director In the spring of 2015, our residency program prioritized working with our clinic leadership to improve our resident and faculty ambulatory experience. The year prior, our office developed a comprehensive, multidisciplinary Quality Improvement Team to provide meaningful data about patient outcomes to measure and address the quality of care delivered by our practice. While this change helped the program to educate residents about population health and provide comparisons of care, our residents were still dissatisfied with excessive administrative tasks. To address these issues, ...

Ventura County Medical Center (VCMC) applied to the collaborative with an initial goal of evaluating the feasibility of a clinic first model for scheduling and curriculum design. After the initial meeting in Kansas City we were inspired by some of the great ideas put forth by other programs in the interest of improving their resident’s clinical experience. While we have not yet fully adopted a clinic first model, we find ourselves better informed as we go forward. We have made recent strides in better evaluating continuity, better ability to track outcome metrics and provide feedback to clinicians and staff. We have encountered several obstacles along ...

Participants: Yo Kondo, MD (Clinic Director and Core Faculty) Preston Stephens, MD (R3 Chief Resident) Jeremy Eaton, DO (APD and Core Faculty) We often joke among the faculty that any practice/policy/situation no matter how irritating, fantastic or broken that persists for 3 years of training becomes dogma. After all- any resident who was involved in the process that put it in place is long gone. Even those faculty who were not there have forgotten why it exists. As such, at times, it is possible to ignore the giant pink elephant in the room. Resident continuity may have been the largest pink pachyderm we had. We all know it is an issue. We all know that ...

Central Maine Medical Center Family Medicine Residency has a long history of using “Clinic as the Driver” to guide our education. Historically, this has included several areas of improvement including: the creation of clinical teams, a simplification of clinic schedules, a consistent resident half day in the clinic, and the introduction of a clinical huddle and brief didactic sessions. In addition, we developed an outpatient family medicine rotation that featured a slowed down clinical schedule to allow for more teaching via small group sessions on various Family Medicine topics. Our inpatient service was also modified to implement alternating weeks (inpatient/outpatient) ...

I became program director in July 2017 and one of my top priorities was to improve our residents’ clinical experience. Too frequently I heard our residents remark about how strong we were in inpatient while stating how much they disliked clinic. They felt like they never knew the patients on their schedules, didn’t have enough time to complete notes or paperwork before rushing off to their next assignment, and felt the nurses and staff weren’t very helpful. I chose family medicine after spending my third-year medical clerkship with a family medicine physician who knew his patients, had great support from his staff, and ran an efficient clinic. Why couldn’t we ...