Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_2725_Библиотеки_им_академика_М_И_Перельмана.pdf
The North American Primary Care
Research Group: Unlocking Scholarship
Through ANetwork ofSupport
forFamily Medicine Residency
Programs
StephenK.Stacey, WendyB.Barr, andDianeM.Harper
7
Key Points
• Team-based science provides new insights into better
patient care.
• The culture of curiosity and inquiry must start early in life
and be sustained through residency and professional
careers.
• Residents and the faculty who teach them must be
scholars.
• The Accreditation Council for Graduate Medical
Education (ACGME) requires every resident to participate in scholarly projects (ideally as part of interdisciplinary teams) and for residency programs to learn
collaboratively with other programs.
• Mentors for scholarly work can network between residency programs.
• NAPCRG is an organization that promotes and supports
primary care research in North America and the world.
• NAPCRG collaborates with ADFM, ABFM, AAFP,
STFM, and CAFM.
S. K. Stacey
La Crosse-Mayo Family Medicine Residency, Mayo Clinic Health
System, La Crosse, WI, USA
e-mail: stacey.stephen@mayo.edu
W. B. Barr
UMass Chan Lahey Regional Medical Campus,
Burlington, MA, USA
Tufts University School of Medicine, Boston, MA, USA
D. M. Harper (*)
University of Michigan, Ann Arbor, MI, USA
e-mail: harperdi@med.umich.edu
Why Are All Family Medicine Residencies
Required toSupport aCulture ofInquiry?
The ability to reect, identify knowledge gaps, seek solutions, test solutions, and change behavior is a goal of a
mature family physician. Residency faculty take on the role
of helping residents develop these mature skills, which family medicine residency graduates need to support lifetime
learning. Effective multi-competency, multi-faceted graduate medical education is not simple or easy to accomplish.
Learners graduating from medical school must complete
straightforward tasks and pass a variety of examinations.
Learners graduating from residency must lead teams, solve
complex population health problems, and advance their
practice while medical knowledge changes ever- increasingly.
Residency faculty, led by the program director, must lead
residents in this growth process. In short, residents—and
their faculty—must be scholars.
To encourage scholarship, the Accreditation Council for
Graduate Medical Education (ACGME) requires every resident to participate in scholarly projects (ideally as part of
interdisciplinary teams) and for programs to learn collaboratively with other programs [1]. Learners outside of the USA
often have similar requirements. Meeting these requirements
while training well-rounded clinicians can be daunting, but
family medicine residency faculty are not alone. The North
American Primary Care Research Group (NAPCRG) can
help residency faculty achieve these requirements and train
clinician-scholars.
What Is theNorth American Primary Care
Research Group (NAPCRG)?
NAPCRG is an international primary care research organization that promotes and supports primary care research and
training in the United States, Canada, and many other coun-
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2025
R. Kellerman, G. Irwin (eds.), Graduate Medical Education in Family Medicine, Excellence in Medical Education 2,
https://doi.org/10.1007/978-3-031-70741-4_7
33
34
Table 7.1 NAPCRG mission and vision
Our mission NAPCRG is an interdisciplinary volunteer association committed to nurturing primary care researchers working in partnership
with individuals, families, and communities.
Our vision NAPCRG is the recognized leader of primary care research that improves health and health care for patients, families and
communities.
S. K. Stacey et al.
tries. It was founded over 50years ago to allow practicing
primary care physicians and physician-scientists to discuss
the diseases and medical conditions they saw in their communities. Together, they looked for explanations, tested possible solutions, implemented successful results, and created
a sustaining framework for an inclusive research community.
NAPCRG sought input from patients, who helped focus primary care research concerning community health problems.
This mindset continues today, with a NAPCRG core value of
patient engagement in the research process [2]. Table 7.1
lists the mission and vision of NAPCRG.
NAPCRG is an organization of researchers. It facilitates
training, mentoring, and networking in primary care research
teams that include researchers, patients, and research staff.
Within NAPCRG, researchers have a collaborative environment to gather and discuss critical patient-oriented questions, develop and test hypotheses, and implement and re-test
the results. One of the essential methods for achieving these
goals is to help family medicine residency programs develop
their ability to conduct research and scholarly activities.
NAPCRG accomplishes this through training programs, collaborations, resource development, and three conferences
promoting knowledge dissemination: the fall annual conference that rotates locations between the USA and Canada,
and two spring/summer conferences: the International
Conference on Practice Facilitation (ICPF) and the PracticeBased Research Network Conference (PBRN) (https://nap-
crg.org/conferences/future- conferences/). The fall annual
conference has specic programming to support residents
and their development as scholars. This includes a special
call (usually due in August) for student/resident/fellow
works-in-progress posters that are presented at the meeting
and scholarships to support resident meeting attendance.
Current information about all NAPCRG programs is on
the NAPCRG website (www.napcrg.org), and questions
about how NAPCRG can work with your residency program
should be directed to napcrgofce@napcrg.org.
How toVolunteer withNAPCRG
NAPCRG has several committees that need family medicine
residency program director and faculty involvement. All
committees are open to NAPCRG members. Committees
include Advancing the Science of Family Medicine, the
Governance Committee, the International Committee, the
Program Committee, the Research Advocacy Committee,
and the Awards Committee. Patient representatives participate in the governance of NAPCRG.
There is a specic NAPCRG trainee program for students,
residents and fellows. The Trainee Committee hosts virtual
sessions to engage trainees around high-priority topics in primary care research and provides career pathway support for
those interested in pursuing primary care research. The
Trainee Committee is also charged with bringing ideas and
suggestions to the Board of Directors relevant to improving
the trainee experience at NAPCRG. (https://napcrg.org/
media/2166/napcrg- 2023- committee- descriptions.pdf).
Membership Categories within NAPCRG
There are eight different membership categories with corresponding annual dues that include both student and resident
categories. The program director and faculty membership
are categorized under the physician group heading (https://
napcrg.org/member- center/membership/).
Other Programs that Support Scholarly
Activities inResidency Programs
NAPCRG works collaboratively with other organizations
and programs to promote primary care research. These
include the following.
Council ofAcademic Family Medicine (CAFM)
Education Research Alliance (CERA)
NAPCRG, along with the Society of Teachers of Family
Medicine (STFM), the Association of Family Medicine
Residency Directors (AFMRD), and the Association of
Departments of Family Medicine (ADFM), form the Council
of Academic Family Medicine (CAFM). Together, they
developed the CAFM Education Research Alliance (CERA)
to support family medicine medical education research
across institutions. CERA conducts omnibus surveys of program directors, clerkship directors, department chairs, and
academic family physicians. The surveys provide an organized method for interested members to perform national
surveys and receive structured data ready for analysis to
answer their questions [3]. CERA provides research mentors
to help individuals hone their research questions, decide
7 The North American Primary Care Research Group: Unlocking Scholarship Through A Network of Support for Family Medicine…
35
what they want to measure, and determine how to best measure it. High-quality survey design is one of the most practical research competencies a residency program can teach.
All primary care physicians must be able to articulate a gap
in knowledge, pose measurable questions to answer, create
the scale to measure the responses to the questions, develop
an analysis plan, analyze results, and interpret the ndings
for future action.
There are generally ve CERA surveys conducted each
calendar year—two for Residency Program Directors, one
each for Family Medicine Clerkship Directorsand Family
Medicine Department Chairs, and one for the general members of CAFM organizations (STFM, AFMRD, NAPCRG,
and ADFM). The CERA call for proposals starts in the new
year with a call for survey questions directed to Program
Directors, followed a month later by a call for surveys
directed to Clerkship Directors, then to Department Chairs,
then to the general CAFM membership, concluding with a
summer call directed again to Program Directors (https://
www.stfm.org/publicationsresearch/cera/howtoapply/howtoapply/). An important way for all program directors to sup-
port CERA and resident and faculty scholarships is to
complete their CERA surveys.
able for medical students, residents and practicing physicians on a competitive basis (https://www.graham- center.
org/scholars- fellows.html).
The ABFM Center forProfessionalism
andValue inHealthcare
The ABFM supports the Center for Professionalism & Value
in Health Care (CPV), which focuses on the development of
health policy and quality research. The CPV offers educational programs that support individuals interested in health
policy, health services research, and bringing science and
understanding to daily practice. The CPV co-sponsors, with
the ABFM, a one-year Health Policy Research Fellowship
focusing on research, health policy, and faculty development. The CPV, along with the ABFM Research Division,
also sponsors visiting scholar programs for medical students,
residents, and practicing physicians in Washington D.C. and
Lexington, KY (https://professionalismandvalue.org/work-
with- us/ and https://www.theabfm.org/research- articles/
visiting- scholars- program.
The AAFP Family Medicine Discovers Rapid
Cycle Scientic Discovery andInnovation (FMD
RapSDI)
NAPCRG works with the AAFP on many of its national
research efforts. For instance, the AAFP sponsors the Family
Medicine Discovers Rapid Cycle Scientic Discovery and
Innovation (FMD RapSDI) program, which provides grant
funding and mentorship to support scientic inquiry by practicing family physicians. FMD RapSDI prioritizes projects
that solve “real world” problems in a research-focused manner. NAPCRG encourages these physician-scientists to present their work and learned knowledge at NAPCRG
meetings.
The AAFP Robert Graham Center
The AAFP supports the Robert Graham Center, which operates to enhance the delivery of primary care and improve
individual and population health. This pursuit involves various initiatives that require original research, research dissemination, policy development and advocacy for primary
care. The Graham Center offers the Robert J. Phillips Jr.
Health Policy Fellowship, a one-year program in Washington
D.C. for board-certied family physicians interested in
health policy. A one-month visiting scholar program is avail-
AAFP National Research Network (NRN)
The AAFP National Research Network (NRN) is a group of
primary care practices, family physicians and other individuals who conduct and support family medicine research.
The NRN collaborates closely with the DARTNet Institute,
an organization that conducts research using large healthcare datasets, usually electronically based. The NRN and
the DARTNet Institute collaborate closely with NAPCRG in
its committees and their aligned missions. Residency programs are encouraged to participate with the NRN (https://
www.aafp.org/family- physician/patient- care/nrn.html) and
DARTNet (https://dartnet.info/).
Family Physicians Inquiry Network (FPIN)
The Family Physicians Inquiry Network (FPIN) is an independent organization that offers one of the rst steps a residency can take toward supporting a culture of inquiry. FPIN
provides quality education and professional development for
primary care clinicians to practice evidence-based medicine
and produce scholarship. It works with many family medicine residency programs through publication opportunities,
on-site workshops, and online learning modules that support
education and curricula on evidence-based medicine. (https://
www.fpin.org/) The nal outcome of FPIN is to produce
evidence-based answers to important clinical questions.
36
S. K. Stacey et al.
The Family Medicine Physician-Scientist Pathway (PSP) Program
Physician-scientists integrate unique clinical insights into
research and can help bridge clinical care, research methodologies and scientic discoveries with translation of results
back into practice. Family medicine lags behind other primary care specialties in contributing to empirical research.
Other primary care specialties employ a residency research
pathway to recruit medical students with concurrent interests
in clinical care and a research career, but the specialty of
family medicine has lacked this essential tool.
This pilot program addresses the urgent need to increase:
(1) the capacity in the specialty to develop leaders in academe; (2) the number of independently funded family
physician- scientists who advance high-priority research; and
(3) the capacity to expand the pool of scientically curious,
talented residents. The PSP pilot program will help demonstrate the sustainability of the concept, as well as the feasibility of institutionalizing research as a career path through
family medicine residency programs.
This ABFM-approved pilot program for an extended
length of training is designed to integrate mentored research
training during residency and meet the needs of residents
who wish to pursue a career of independently funded research
without having a “gap” in research training during the years
of clinical residency training [4]. More information can be
found at the ADFM website (https://www.adfm.org/pro-
grams/physician- scientist- pathway/).
NAPCRG Grant Generating Project
This one-year program resides within NAPCRG and recruits
individual physician and non-physician faculty who want individualized attention in grant preparation and submission. The
purpose of the GGP fellowship is for participants to develop
and describe an integrated research project or program relevant to primary care research. This will include being able to
effectively communicate a research agenda in various formats
from written to oral for a range of audiences with varying levels of research experience. The optimal outcome is a submitted grant. (https://www.napcrg.org/programs/
grantgeneratingproject- ggp/projectdesctipion/) Since its for-
mation in 1995, over $1 billion in external funding from federal, state and local government sources as well as foundations
and industry has been awarded to GGP alumni [5].
residency programs (and the individuals within them) to
engage and expand funding and capacity for research.
Mutually benecial interactions among participants under
the BRC umbrella build research collaboration capacity
along with the actual accomplishment of published and presented research and scholarship. The primary methods BRC
uses to accomplish this are educational events, consultations,
and a BRC fellowship program [6]. More information can be
found at the website: https://www.adfm.org/programs/
building- research- capacity- brc/).
NAPCRG: Advocating forCommunity
Programs
Family medicine residency programs are the training
ground for future leaders in healthcare. The journey through
residency involves leading teams, navigating a complex
healthcare system, and building personal expertise amid
evolving medical knowledge. It is a journey of scholarship
built on a rich culture of inquiry. While residency faculty
and program directors lead residents in this journey, many
programs lack adequate internal research support to assist
them. Thankfully, community programs have access to a
robust support network from NAPCRG and other organizations within the family medicine profession. NAPCRG
aims to provide mentorship and advocacy for programs
with few resources and encourages all family medicine
residency programs to reach out for help. NAPCRG aims to
meet the needs of the family medicine residency programs
that do not have the personnel or infrastructure to conduct
scholarly work and works with other family medicine organizations to help provide support in all facets of the research
journey.
Conclusion
There are programs available through NAPCRG and other
CAFM organizations to increase the scholarly activity of all
residency programs regardless of the level of research currently in place. As the specialty of family medicine supports
the move for a greater emphasis on family physicians creating the evidence required to implement improvements in
clinical care, scholarly training in residency will increase to
new levels of rigor.
Building Research Capacity (BRC)
NAPCRG, along with the ADFM, sponsors the Building
Research Capacity (BRC) initiative. BRC aims to provide
opportunities for academic family medicine departments and
References
1. Accreditation Council for Graduate Medical Education (ACGME)
Family Medicine Program Requirements, effective July 1, 2023.
chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://
www.acgme.org/globalassets/pfassets/programrequirements/120_
familymedicine_2023.pdf. Accessed 6 Jan 2024.
7 The North American Primary Care Research Group: Unlocking Scholarship Through A Network of Support for Family Medicine…
37
2. Mainous AG, Brungardt SH. Celebrating 50 years of NAPCRG:
the successful partnership between STFM and NAPCRG. Fam
Med. 2022;54(10):767–8. https://doi.org/10.22454/
FamMed.2022.807469.
3. Seehusen DA, Mainous AG, Chessman AW.Creating a centralized
infrastructure to facilitate medical education research. Ann Fam
Med. 2018;16(3):257–60.
4. Doubeni CA, Davis A, Benson JL, Ewigman B, Committee on
behalf of the ARD.A Physician scientist pathway in family medicine
residency training programs. Ann Fam Med. 2017;15(6):589–90.
https://doi.org/10.1370/afm.2160.
5. Longo DR. Research capacity building in family medicine:
the impact of the grant generating project. Ann Fam Med.
2009;7(6):568–9. https://doi.org/10.1370/afm.1065. PMID:
19901322; PMCID: PMC2775614.
6. Ewigman B, Davis A, Vansaghi T, et al. Building research and
scholarship capacity in departments of family medicine: a new
joint ADFM-NAPCRG initiative. Ann Fam Med. 2016;14(1):82–3.
https://doi.org/10.1370/afm.1901.
The Society ofTeachers ofFamily
Medicine: TheProfessional Home
forFamily Medicine Educators
HeatherL.Paladine
8
Key Points
• STFM is a resource for all faculty who are involved in
graduate medical education, as well as learners who are
planning careers in education.
• STFM offers opportunities for career development, scholarship, and leadership development.
• For new residency faculty, the Residency Faculty
Fundamentals Program provides a foundation of key
information and faculty development.
• Collaboratives are a way to network with other faculty
with similar interests.
The Society of Teachers of Family Medicine (STFM) is the
professional association for family medicine educators.
STFMs mission, “advancing family medicine to improve
health through a community of teachers and scholars” [1],
includes areas of focus in professional and leadership development, workforce recruitment and retention, scholarship,
antiracism and health equity, and advocacy. Membership of
STFM includes physicians, behaviorists, pharmacists, residents, students, and others involved in family medicine
education.
STFM conferences are opportunities for learning, faculty
development, and networking. STFM sponsors three major
conferences annually; the Annual Conference in the spring,
the Medical Student Education Conference in the winter, and
the Conference on Practice and Quality Improvement in the
fall. The Conference on Practice and Quality Improvement
includes a focus on residency practice management and
behavioral health and also includes medical practice team
members as target attendees. All conferences have a process
for attendees to apply to present sessions and posters, and all
are open to both members and non-members to attend.
STFM’s Collaboratives and Special Project Teams allow
members to communicate, network, and build leadership
H. L. Paladine (*)
Center for Family and Community Medicine, Columbia University
Irving Medical Center, New York, NY, USA
skills around areas of common interest related to family
medicine education. Collaborative members connect through
an email listserv, virtual meetings, and in-person meetings
during conferences. There are over 30 current Collaboratives
on topics ranging from Musculoskeletal and Sports Medicine
Education to Minority and Multicultural Health to Planetary
Health. Some Collaboratives focus on members with specic
job descriptions or career paths, such as New Faculty,
Pharmacist Faculty, and Medical Student Educators.
Members can develop new Collaborations with at least 30
members. Becoming a Collaborative leader is one initial step
toward organizational leadership within STFM.
Collaboratives are eligible for grant funding for group projects through the STFM Foundation’s Special Project Fund,
and Collaborative members often work together on research
projects, conference submissions, curricula, and award nominations. Special Project Teams have similar support from
STFM but are designed to be time limited and focused on a
specic project.
STFM offers many fellowships and certicates for family
medicine educators who are interested in faculty development. Many STFM programs focus on education in specic
areas for new faculty or learners. For new faculty who are
residency educators, the Residency Faculty Fundamentals
Program is an interactive online course that takes approximately 35 hours to complete over a 12-month period. For
faculty who are focused on undergraduate medical education, the Medical Student Educators Development Institute
(MSEDI) is an 18-month program that includes virtual and
in-person meetings and a scholarly project. The Behavioral
Science/Family Systems Educator Fellows (BFEF) is a similar one- year program for faculty who are focused on behavioral science teaching. In addition to the fellowship programs,
STFM has education available for members on a number of
different topics, such as advocacy, point-of-care ultrasound
(POCUS), residency recruitment, leading change, and more.
There is also a virtual coaching program that connects a faculty member to a coach for time-limited support focused on
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2025
R. Kellerman, G. Irwin (eds.), Graduate Medical Education in Family Medicine, Excellence in Medical Education 2,
https://doi.org/10.1007/978-3-031-70741-4_8
39
40
H. L. Paladine
a specic problem or goal. STFM has faculty development
programs, including conference attendance scholarships that
are focused on members who have been historically underrepresented in medicine with the goal of providing pathways
for leadership or scholarship development. Many STFM programs target residents and other learners who plan careers in
medical education.
Family Medicine is STFM’s medical education-focused
journal. It is peer-reviewed and publishes research and
reviews on family medicine education and health policy topics, art, and poetry. It is published online 10 times per year.
Peer-reviewed Reports in Medical Education Research
(PRiMER) is a second online journal with a mission of publishing smaller studies and pilot research in the areas of medi-
cal education and health policy. PRiMER also has a goal of
encouraging and developing newer researchers, including
residents and medical students. STFM also supports the
Annals of Family Medicine, which is jointly sponsored by
seven family medicine organizations and focuses on research
related to clinical topics in family medicine. These journals
offer members opportunities for education, publication,
becoming reviewers, and applying to join the editorial boards.
Reference
1. About the Society of Teachers of Family Medicine. https://www.
stfm.org/about/about/aboutstfm/. Accessed 29 Oct 2023.
Part II
Infrastructure for a Successful Family Medicine
Residency Program
Family Medicine Residency Accreditation
GrantS.Hoekzema, ColleenK.Cagno,
andShantieHarkisoon
9
Key Points
• Accreditation is a review process that helps to evaluate,
improve, and recognize a residency program’s compliance with certain standards of education.
• Accreditation improves healthcare by assessing and
enhancing the quality of resident physician education for
the benet of the public.
• Accreditation is not permanent; it requires periodic
renewal to ensure the quality of education is maintained.
• Accreditation by an independent accrediting body is a
statement that a residency program meets a dened level
of educational standards.
• Accreditation of residency training in family medicine
has served to ensure rigorous, standardized training, that
produces competent physicians, regardless of the institution or community in which that training occurs.
• Accreditation relies on the expertise and commitment of
the ACGME Review Committee for Family Medicine, a
body of peer-selected, dedicated volunteers.
• The newest requirements place an increased emphasis on
the practice and community as the curriculum, are less
proscriptive, allow exibility and adaptability to the program’s mission, and are a major shift toward competencybased medical education.
• Continued accreditation is maintained by ensuring compliance with ACGME program requirements as reported
via annual ADS submissions.
G. S. Hoekzema (*)
Department of Family Medicine, Mercy Hospital, Mercy Family
Medicine Residency, St. Louis, MO, USA
e-mail: Grant.Hoekzema@Mercy.Net
C. K. Cagno
Department of Family and Community Medicine, University of
Arizona School of Medicine, Tucson, AZ, USA
S. Harkisoon
Family Medicine Residency Program, Garnet Health Medical
Center, Middletown, NY, USA
• Every element necessary for a successful residency program, as outlined in the accreditation requirements, must
be accounted for in a new program application.
• Establishing a new family medicine program is a vast
undertaking that calls for a detailed business plan to
ensure the successful initiation and sustainability of the
program.
The Evolution ofFamily Medicine Residency
Accreditation intheUSA
The formal training of physicians after graduation from medical school for the purpose of mastering the competencies
and skills to practice medicine independently as well as to
hone the skills needed for specialization in a particular eld
of medicine began with the training of physicians at the
Johns Hopkins Hospital in Baltimore in 1889 by Dr. William
Osler. Physicians lived on the hospital grounds during this
period of training and service, hence the terms “residents”
and “residency” in relation to this training. In 1914, the
American Medical Association (AMA) began publishing a
report on postgraduate medical education called “Hospitals
Furnishing Acceptable Internships for Medical Graduates”.
This represented the rst formal classication of postgraduate medical education in the USA.In 1949, the AMA Council
on Medical Education published its annual listing of
approved allopathic internships and residencies, the last year
that a “general residency” program would be listed.
Thereafter, such training would be designated as a residency
in general practice. This designation would form the roots of
what would eventually become the new specialty of family
practice, recognized by the American Board of Medical
Specialties (ABMS) in 1969, and now recognized as family
medicine. In 1971–1972, the AMA Council on Medical
Education listed 62 approved family practice residency programs, the rst time the specialty of family practice was ofcially included in the AMA’s annual report of internships and
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2025
R. Kellerman, G. Irwin (eds.), Graduate Medical Education in Family Medicine, Excellence in Medical Education 2,
https://doi.org/10.1007/978-3-031-70741-4_9
43
44
G. S. Hoekzema et al.
residencies. That same year, the AMA reported on the activity of the rst residency review committee (RRC) in Family
Practice, now called the Review Committee for Family
Medicine (RCFM). In 1981, the AMA’s Liaison Commission
on Graduate Medical Education (LCGME) transferred the
oversight for residency accreditation to the newly created
Accreditation Council for Graduate Medical Education
(ACGME) which has served as the accrediting body for allopathic graduate medical education ever since [1].
In 1947, the rst osteopathic residencies were granted
accreditation by the American Osteopathic Association
(AOA). The American Osteopathic Board of Family
Physicians (AOBFP), originally known as the American
Osteopathic Board of General Practice (AOBGP), was established in 1972 after being approved by the American
Osteopathic Association Bureau of Osteopathic Specialists
and the AOA.The rst residency of the American College of
Osteopathic General Practitioners (ACGP), the original
osteopathic general practice accrediting organization, was
created in 1974. In 1993, the ACGP ofcially voted to change
the name of the organization to the American College of
Osteopathic Family Physicians (ACOFP). Several months
later, the AOBGP changed its name to the American
Osteopathic Board of Family Practitioners (AOBFP), with a
terminology shift from “general” practitioners to “family”
practitioners. Osteopathic residency programs in family
practice soon followed, shifting from training in general
practice to family practice [2].
In 2015, the ACGME and AOA signed a Memorandum of
Understanding that began the process of merging osteopathic
residencies into the existing ACGME accreditation system,
creating what was termed the Single Accreditation System
(SAS). The RCFM accredited over 120 formerly osteopathically accredited programs, the most of any specialty. Since
its inception in 1971, the RCFM has accredited over 750
family medicine residency programs. The growth in family
medicine training programs has been steady, with periods of
notable expansion, initially in the early 1970s, then in the
1990s and most recently since 2015 due to the addition of
programs formerly accredited by the AOA (Fig. 9.1). A
period of brief decline in residency program numbers
occurred in the early 2000s after a series of poor match outcomes which coincided with the backlash against the “gatekeeper” role of primary care physicians created by the
explosion in managed care health plans in the 1990s. Over
the past 50years, family medicine has grown to become the
medical specialty with the most training programs, eclipsing
Internal Medicine in the 2010s. While internal medicine has
the largest number of residents in training, family medicine
is the second largest with over sixteen thousand residents in
training as of 2023. Coinciding with its importance in training a competent primary care workforce for the entire country, family medicine programs have the most widely
dispersed geographic distribution of residency programs of
any specialty. Programs range in size from small rural training tracks with as few as six residents to urban programs
with more than 70 residents. This variation in size, location,
and educational resources (such as the size of the institution,
number of faculty, and available clinical training sites) has
proved challenging in the accreditation of such a large number of programs.
Several major milestones occurred along the way as part
of the history of family medicine residency program accreditation. The rst set of program requirements in 1969, administered by the LCGME of the AMA, was only two pages long
and consisted of general guidelines for the curriculum, content, and structure of family practice training. A key inclusion in those requirements that has persisted throughout all
subsequent versions of the requirements was the establishment of a model family practice ofce where residents would
Fig. 9.1 Growth of family
medicine residency training
(1969–2022). (From Potts
etal. [5])