3 questions to ask prospective family medicine residencies

This time of year I get a lot of questions from fourth-year medical students about applying to residency. So, here’s my answer to the question, “What should I look for in a good family medicine (FM) residency program?”

It’s FM, so everyone (for the most part) is going to be nice, friendly, and welcoming when you go to visit. They will show you a curriculum that’s in line with the Accreditation Council for Graduate Medical Education (ACGME) regulations. They will take you out for a nice meal and show you the town.

So, what separates the wheat from the chaff? Here’s what you want to ask about above and beyond your questions about the call schedule and available electives.

1. “How do you teach evidence-based medicine (EBM)?” A top-notch residency program will have a formal EBM curriculum with sessions on a regular basis. This curriculum should teach you how to independently read and interpret the medical literature. There is no more important skill than this to be successful after graduation; if you can’t keep up with the changes in best practice after graduating from residency, you will be practicing out of date medicine within five years (heck, probably within five months).

2. “Is the office I’ll be working in an NCQA-certified patient-centered medical home?” Forward-thinking family medicine residency offices subscribe to the PCMH model and have gone through (or are, at least, in the process of going through) the rigorous process to prove that they are coordinating care effectively for patients by tracking referrals and tests, offering after-hours care, and connecting with patients asynchronously (usually via patient portals). You want to learn how to work in a PCMH because, chances are, you will be working in one – and leading one – after graduation.

3. “How do you teach patient safety and quality improvement (QI)?” Understanding that medical errors are the result, ultimately, of system problems, and not just individual mistakes, is a critical concept for 21st century doctors. Good systems buffer individual mistakes. How is the residency program training future family docs to lead in building these buffers?  What kinds of QI projects are residents involved with? Residents should be leading QI teams to improve office efficiency, reduce error, and improve the patient experience in the residency office — and your residency should train you how to do it.

Medical knowledge is not enough for 21st century family doctors. Without the above skills, your practice will be out of date, doctor-centered (instead of patient-centered), and error prone. A good residency program should have formal curricula in place to ensure that you graduate with these skill sets. A program not committed to those ideals, that is superficially addressing these concepts but not orienting their care model around them, will leave you woefully unprepared to provide optimal care to your future patients.

Jennifer Middleton is a family physician who blogs at The Singing Pen of Doctor Jen.

Comments are moderated before they are published. Please read the comment policy.

  • HJ

    I spent some time in a PCMH and found it really wasn’t patient centered at all. During the 18 months I was treated at the PCMH, I saw five different providers for a single problem.

  • LeoHolmMD

    If you are teaching EBM, you will be avoiding the PCMH. See literature.

    • southerndoc1

      Bingo!

  • Close Call

    Ugh. Working in PCMH? No! They should be teaching them how to run a successful private direct primary care practice. When I hear a medical student talking in their interviews about PCMHs, I just want to groan. They have no sense of health care financing, and they certainly haven’t read the literature on PCMHs, which are expensive bureacratic sink holes with inconsistent outcomes.

    • LeoHolmMD

      DPC is being ignored in teaching programs. Sad.

  • T H

    How about Q#1 being
    “Can you assure me a broad medical experience in the hospitals where there are more than just FM residents?”

    Because all too often, FM gets shoved to the side by the attendings when there are other residents (i.e. their own specialty) around. NICU rounds were Oh-So-Not-Good because of the attending staff.

    And instead of NCQA/PCMH/QI, ask “How do you teach the business of medicine?” If the answer is ‘We don’t’ – find a different place. If the answer is not ‘We work with both DPC and PCMH models’ – find a different place. If a program cannot provide both experiences, then it needs to broaden its horizons.

    ESPECIALLY in Family Medicine, our docs are not little cookie-cutter worker bees who just go to clinic and start grinding out patient encounters.

    • NPPCP

      If you interview for ANY RESIDENCY that pushes PCMH – get the he** out of there. I really don’t know if there are any left that don’t indoctrinate the FM residents. Our NP colleagues need to wake up as well and stop being “pyramid builders” in this scam as well. On other thing – anytime a family medicine graduate reads a positive PCMH article that is positive toward this scheme, they will notice one of two things: 1) the author is faculty at a residency program or directly receives their paycheck from a PCMH funded organization; 2) the author or their organization received a massive grant from somewhere to “set up” a PCMH. When reading articles, find the “zebras” where authors are not on the teat of PCMH. You will find a completely different opinion, dare I say it, EVERY TIME.

      • LeoHolmMD

        Good point. I have not seen much ” buy in” from NPs.

      • ninguem

        ^^^ What NP said ^^^

  • rbthe4th2

    “Understanding that medical errors are the result,
    ultimately, of system problems, and not just individual mistakes, is a
    critical concept for 21st century doctors. Good systems buffer
    individual mistakes. How is the residency program training future family
    docs to lead in building these buffers? What kinds of QI projects are
    residents involved with? Residents should be leading QI teams to improve
    office efficiency, reduce error, and improve the patient experience in
    the residency office — and your residency should train you how to do it.”

    I’ve been in situations, as have others, where there are individual mistakes and a system problem in “buffering” that up. I’m not talking about obvious let me sue you people. I’m talking about mistakes where the doctor involved should recognize the issue, admin also, and work with the patient to an equitable solution. That does not mean dumping the patient, or dumping on the patient. Far too often it does.

    There is also not an effort at all to include patients in terms of working with these residents, attendings and admin to make things a better place to learn and fix things.

  • ninguem

    Are you taught any procedures?

    Are you taught to actually DO things?

    How about those questions?

Most Popular