Substantial evidence suggests that active learning is superior to passive learning, but most CME and residency didactics currently emphasize passive learning. How can residencies provide an active, experiential learning environment? What new teaching technologies will improve outcomes for residency education?

Where should residency training occur? Family physicians are distributed broadly and must take care of all communities. Where should residencies be located?

What is the right duration for family medicine training. Since 1969, Family Medicine residency training has been 3 years. Is that still appropriate? Should we consider including a formal period after residencies in the way of other specialties?

More broadly, how should family medicine residencies implement more fully competency-based education?

Competency-based medical education for residents has been most completely developed in surgical specialties, but how should it be operationalized in a generalist discipline like Family Medicine, given the hundreds of identifiable competencies in managing patients with a single disease? What is the right balance between experience/time—for example, counting weeks of curriculum or numbers of visits (counting numbers) and explicit of specific clinical competencies?

October 1, 2020
Paul Lazar, MD

In family medicine residency settings, we have not been able to do much team based care because of resource limitations, and the fact that if we have other learners see patients without residents the residents can’t get their 1650. So we end up treating the few PA and NP students we get the same as medical students, and the residents don’t really learn anything different than how they were taught.

In the world of practice, when you look at the masthead of a letter from a primary care group (single specialty or mixed) there are almost always both physicians and NP/PA’s on the letterhead.

Here’s a radical idea. Since so much of primary care is actulaly being provided by NP’s and PA’s, why don’t we actually train them to do it by admitting them to Family Medicine Residency alongside the resident physicians? We have a good model for training ambulatory based practitioners, and we could start to better define team roles–including having the resident extenders maintain chronic illness registries and do the outreach and follow up– and teach team leadership if the residents had a team that didn’t just consist of other residents. 1650 would obviously have to be adjusted to allow the resident physician to count some visits by NP/PA for which they provided medical supervision.

January 14, 2021
Patrick Sweet, MD

Training tracks in family medicine similar to what is seen in Canada would be great for our future. Otherwise future graduates will just become inbox managers whose main goal is to connect patients to other doctors (or midlevels many times) to definitively manage medical issues. Although this supports the 9-5 lifestyle that many who chose family medicine crave, it undercuts the roots of our profession. There should be OB track, Procedures track, EM track to represent areas many of us practice. There should als be a primary care manager track. This should only be a 2 year residency as is the case for Canada. Everyone is happy, the 9-5ers, the adrenaline junkies and the procedurally inclined.

Alas this will never happen here. Too many benefit from the current referral geared system and ABMS designed way to manage the various guilds into staying in their predetermined lanes.

January 15, 2021
Michael NIziol

There is absolutely no need for 12 years of education to produce a competent Family Doc. I was a dual Chemistry and BIo major. I did the Krebs cycle 35 times – never used it once – Schrodinger Wave equation was fascinating – but doesnt get much use in front line medicine. Here is the issue – you encumber people with loans and loss of time unnecessarily. A competent Family Doc can be produced in 6-8 years. Now you have an individual with fewer loans and 4-6 extra years to work ( or possibly retire) MY two neighbors just retired at age 55 after teaching Health – between them they bring home 170 K per year in retirement benefits. They had every weekend every summer every holiday off worked about 6 hours per day never worked an evening or night I am 65 – still working – worked every summer many holidays many weekends many nights and will be lucky if I bring home 40 K per year in retirement benefits at age 70. I use to teach students but stopped – one asked me if I would do it again. I had to say honestly – no – you can have a much easier more enjoyable life teaching etc. and oh by the way – Docs strolling around with an instrument made in the 17th century as their main tool (stethoscope) is an utter embarrassment to the profession – everyone should be well trained in sonography – thats where time should be spent anatomy meds etc… Forget College feeder programs – develop your own system grabbing students right out of high school tons of other ideas but have to go – good luck

January 19, 2021
Walter Franz, MD

I would extend training in residency to 4 years.

This would allow in depth training in hospital care, or OB or focus on outpatient practice/ER etc.

I believe this would only strengthen our specialty and attract more residents into same.