Lawrence Family Medicine Residency Transition to a Four Year Program (an ACGME Length of Training Pilot Program) Wendy Brooks Barr MD, MPH, MSCE; Whitney LeFevre, MD; Clark Van Den Berghe, MD; Joseph Gravel MD Lawrence Family Medicine Residency, Greater Lawrence Family Health Center, Lawrence, MA 1.Development of competencies in all aspects of PCMH in our NCQA Level 3 Family Medicine Center through immersion in and graduated responsibility for management of the medical home. Including: a.team-based care b.population medicine c.community health d.information mastery e.chronic disease management f.practice-based improvement g.leadership 2.Increased depth of experience in core clinical aspects of Family Medicine, particularly essential in low resource clinical environments, with development of added competencies key to the care of underserved populations. 3.Increased opportunity for residents to develop additional competencies in areas of personal interest through the expansion of areas of concentration (AOCs). 4.More meaningful and longitudinal community experiences which will serve as a foundation for substantive community involvement for residents throughout their careers. Family Medicine Length of Training Pilot (FM- LTP). Developed by the ACGME Review Committee in Family Medicine (RC-FM), in conjunction with the American Board of Family Medicine (ABFM) Goals: To find innovative methods to prepare Family Physicians to “serve as highly effective personal physicians in a high performance health care system.” Inform whether four years should become the standard length of training in Family Medicine Evaluation method: Match and compare selected programs with a group of existing three-year programs Evaluation Team: Oregon Health and Science University Timeline:: Selected 2013, evaluation through 2019 Selected 4 Year Residency Program: Mid Michigan Medical Center-Midland (Michigan) Middlesex Hospital FMR (Connecticut) John Peter Smith Hospital (Texas) Oregon Health and Science University Program (Oregon) Lawrence Family Medicine Residency (Massachusetts) University of Nevada, Reno (Nevada) National Capital Consortium (Virginia) US Naval Hospital Camp LeJeune (North Carolina) US Naval Hospital Camp Pendleton (California) US Naval Hospital Jacksonville (Florida) Applicant Metrics By Recruitment Year Changing to required 4 year curriculum has not hurt recruitment Trend towards more total applicants and US medical school seniors Trend toward higher R1 ITE scores and no change on Step 2 Scores of matched applicants 1.Successful recruitment of high quality residents into the program as measured by: 100% Match Rate Increased number of US medical seniors applying to the program Matched residents with higher achievements USMLE Step 2 scores R1 In-training Exam Scores National Medical Student Recognitions (AOA, Gold Humanism, Pisacano) 2.A high level of resident achievement in residency as measured by: Initial ABFM Certification Exam scores Community involvement during residency Completion of QI and scholarly activity projects 3.A high percentage of graduates reporting: Leadership roles in CHCs Leading QI projects in their practices Working in HPSA or international sites Practicing full-spectrum family medicine

Lawrence Family Medicine Residency Transition to a Four Year Program (an ACGME Length of Training Pilot Program) Wendy Brooks Barr MD, MPH, MSCE; Whitney LeFevre, MD; Clark Van Den Berghe, MD; Joseph Gravel MD Lawrence Family Medicine Residency, Greater Lawrence Family Health Center, Lawrence, MA GOALS: Provide residents with opportunities to develop advanced competency in an area of interest. Develop resident skills in self-directed learning and promote the practice of life-long learning and skill development. Phase 1 AOCs (Active) Global Health Advanced Surgical Maternity Care Integrative Medicine HIV Academic/Faculty Development Health Systems Leadership Sports Medicine Women’s Health Phase 2 AOCs (In Progress) Behavioral Health Addiction Medicine / Pain Management Hospitalist R1 Adult Medicine (10 wks) AM NF (2 wks) Maternity Care (6 wks) MC/PD NF (4 wks) Pediatrics (4 wks) Surgery (2wks) Outpatient Longitudinal (14 wks) Spanish Elective (2wks) Spanish/ Intro to FM (4 wks) Vacation (4 wks) R2 Adult Medicine (4 wks) ICU (4 wks) AM NF (4 wks) Maternity Care (4 wks) MC/PD NF (2 wks) PD (2 wks) Neo (2wks) Peds ED (2 wks) ED (4 wks) Outpatient Longitudinal (16 wks) Elective (4 wks) Vacation (4 wks) R3 Adult Medicine (6 wks) AM NF (2 wks) MC (2 wks ) MC/PD NF (4 wks) Pediatrics (4 wks) ED (4 wks) UMASS Sports Med (4 wks) Outpatient Longitudinal (10 wks) Longitudinal AOC (4wks) AOC (4 wks) Elective (4 wks) Vacation (4 wks) R4 Adult Medicine (4 wks) FM NF (2 wks) MC (2 wks) MC/ PD NF (2 wks) Peds ED (2 wks) Clinic Chief/PCMC (6 wks) Outpatient Longitudinal (20 wks) Longitudinal AOC (4wks) AOC (8 wks) Elective (2 wks) Vacation (4 wks) Outpatient Longitudinal Curriculum Content by Year of Training R1: Gynecology, Orthopedics/Sports Med, Geriatrics, Behavioral Health, PCMH, Outpatient Pediatrics, Community Medicine R2: Gynecology, Orthopedics/Sports Med, Surgery, Dermatology, Geriatrics, Palliative Care, PCMH, Community Medicine R3: Behavioral Health, HIV, Addiction Medicine, PCMH R4: Geriatrics, Integrative Medicine, Subspecialty Care, Dermatology, Adolescent Medicine, Outpatient Pediatrics, PCMH, Community Medicine,