Family Medicine Residency

The University of Colorado Family Medicine Residency program provides an integrated curriculum for Family Medicine Residents throughout their three years of training. The training involves didactic presentations, projects on the patient-centered medical home (PCMH) and community topics, and active involvement in PCMH components of the residency’s practices. This includes working with interdisciplinary teams, PCMH leadership, and performing quality improvement and population management projects. The curriculum has a strong community involvement component and significant emphasis on patient self-management support and health behavior change counseling.

As one of the Preparing the Personal Physician for Practice (P4) demonstration sites, this curriculum redesign is based on the hypothesis that graduates of the program will have an increased likelihood of introducing PCMH features into their future practices.  This is grounded in the premise that to be a twenty-first century family physician, as envisioned in the Future of Family Medicine report, residents need to be versed in three major areas:  (1) Health Behavior Change, (2) Community Integration, and (3) the PCMH Model.  In order to integrate these curricular threads, there was a need to change the structure of the program so that all three years were more efficient, intentional, and longitudinal. The results of this curriculum redesign includes three new learning intensive months within the first year, a re-sequencing of second year rotations to enhance continuity and practice involvement in the latter portion of that year, introduction of a six-week PCMH block, a revamped community medicine curriculum, and continued PCMH skill building throughout the third year.

The work began by changing the intern rotational schedule. It was determined that the traditional method of farming out interns to various clinical training sites in a randomly assigned order was not the most efficient method of teaching.  In the program’s former model, interns were assigned a different placements each month with little to no preparation. The new program facilitates resident learning by creating grouped rotations preceded by intensive learning months, which were named Chautauquas (a reference to the adult learning model that became popular in the late 1800s). Chautauquas occur in July, November, and May of the intern year. During these months, residents engage in core medical topic and procedural review, hands on workshops, inpatient work, and longitudinal learning and projects in PCMH fundamentals, community integration, health behavior change, evidence-based medicine projects, and physician wellness. 

Each intensive learning month has a theme that is then followed by rotations in that theme.   For example, in July, the interns focus on medicine, surgery and emergency medicine review and are placed in those rotations in the following three months.  Likewise, in November, residents focus on obstetrics and pediatrics before they start those rotations.  The final Chautauqua emphasizes intensive care, orthopedics, and outpatient topics including Comprehensive Care Model fundamentals before starting those rotations.

In looking at how to transform the second year of training, it was determined that to be effective PCMH leaders, residents would need a more consistent presence in an outpatient clinic and a more intensive experience in PCMH concepts.  However, the post-graduate year 2 (PGY2) schedule is full of rotations including intensive care unit and inpatient pediatrics that pull the residents away from the family medicine center and limit their ability to engage in their primary care practices.  Therefore, rotations were rearranged to allow the difficult to schedule rotations with call responsibilities to be completed at the beginning of the year, leaving the second half of the PGY2 year and much of the PGY3 year with rotations that were more amenable to consistent resident scheduling in the their outpatient practices and availability for PCMH-focused teaching.

In order to give residents intensive time to learn PCMH concepts and deeply engage in clinic-wide PCMH activities, a six week PCMH Block in the spring of the PGY2 year was created.   The block is hallmarked by frequent half-days in outpatient practices and fixed times for dedicated PCMH activities each week.  Didactic training includes completing specific modules in core concepts such as PCMH Basics, population management, quality improvement, care coordination, team approach, leadership, and self-management support.  All residents participate in hands-on PCMH related activities during the Block.  To give residents an experience in true care coordination and team based care, a multidisciplinary care management team was created, which works with the emergency department and inpatient teams to create care plans for the most complex patients.   During the Block, residents are also active in practice improvement efforts of their clinics, working with active staff on quality improvement projects and on the clinic’s NCQA PCMH recognition application. 

The program reflects a commitment to community integration from the half-day dedicated to community learning and activities each week during the PCMH Block.  Residents engage in didactics on health disparities and environmental effects on health as well as participate in longitudinal school-based projects.

Continued involvement in the clinic’s journey to becoming a full-fledged PCMH is encouraged by creating a longitudinal PCMH experience in the third year of training.  For seven of their last twelve months, senior residents engage in a full day of PCMH activities including quality improvement, care management, and community integration projects twice per month.  Also introduced is the clinic-based “PCMH Leadership Month”, during which time residents take leadership of their class-specific quality improvement and population management projects and participate in a LEAN process improvement event.