National initiative aims to transform family medicine practice

The Tufts University Family Medicine Residency at Cambridge Health Alliance in Malden, Mass., has been chosen to participate in a national endeavor designed to change the way family physicians are trained to practice medicine.

The P4 initiative could bring about historic change in the way family physicians practice medicine. © MARIO VILLAFUERTE/GETTY IMAGES

The Preparing the Personal Physician for Practice (P4) initiative has the potential to bring about considerable change in the content and structure of family medicine training. Findings from the project are expected to guide future revisions in accreditation to ensure America’s family doctors are proficient in using the most up-to-date tools and technologies to better serve their patients.

The Association of Family Medicine Residency Directors (AFMRD) and the American Board of Family Medicine have pledged nearly $1.75 million to fund the initiative, in which 14 residency programs across the country have been invited to participate. The P4 initiative is being done in collaboration with TransforMED, the American Academy of Family Physicians’ practice redesign initiative.

“We are very pleased to be selected for what will most likely be considered a historic event in the evolution of family medicine graduate medical education training,” said Dr. Joseph Gravel, assistant clinical professor of public health and family medicine and director of the Tufts residency program.

There are 450 family medicine training programs in the United States. Eighty programs submitted proposals for P4, and 14 were selected. “While many family medicine residency programs are taking new and progressive approaches to physician training, the 14 residencies participating in the P4 initiative will highlight innovations taking place in residencies across the country,” said Dr. Samuel M. Jones, president of AFMRD and co-chair of the P4 steering committee.

“Instead of implementing the changes so-called experts prescribe, P4 relied on the imagination and judgment of family medicine residency directors and their staffs,” said Dr. Larry Green, co-chair of the P4 steering committee. “It is our hope that by encouraging change by innovation, as opposed to dictating change, the P4 initiative will give birth to a new and progressive way of training family physicians to be personal doctors.”

“The 21st-century physician must have the technical knowledge and expertise to provide personalized, high-quality care in an information-age environment,” Jones said. “I am confident P4 will guide us to a more forward-thinking graduate medical education curriculum that will empower America’s future family doctors to provide the kind of efficient, top-quality, convenient care our patients deserve.”

The proposed innovations vary among the 14 participating residencies. Tufts has titled its P4 innovation the “Residency ReVISION Project,” which will include restructuring the curriculum to emphasize information mastery, innovative learning methods, learner-centered competencies and training in the family medicine practice rather than in the traditional hospital setting. Graduates will be required to demonstrate competency in 24 areas.

This May, the P4 residencies will hold their first joint meeting to fine-tune their proposed innovations. Contingent upon funding and organizational support, they will spend the next five years developing, implementing and testing their innovations, and sharing the results with the medical community. During the project, they will undergo detailed evaluation and assessments by a research team from the Oregon Health & Science University.