Information technology has been recognized as a key driver in an initiative that examines innovation in family medicine residency training.
The P4 (Prepare the Personal Physician for Practice) or Residency Demonstration Initiative is a six-year national demonstration project that was launched in 2007 by the American Board of Family Medicine and the Association of Family Medicine Residency Directors, in cooperation with TransforMED, an affiliate of the American Academy of Family Physicians. The goal of P4 is to prepare medical students to provide patient-centered medical care, using a team-based approach. Out of more than 80 residency programs, 14 were chosen to participate in the initiative.
“Thirteen of the 14 P4 residency programs have an electronic health record, some with several years’ experience already. Yet, nearly all the residency programs have had to invest in time and personnel resources to extract reports from the EHR to do regular audit and feedback for learning and documenting quality of care,” says Patrice Eiff, MD, P4 evaluation team co-investigator.
Tufts University Family Medicine Residency at Cambridge Health Alliance in Malden, Mass., is part of the initiative. TUFMAR calls its P4 initiative “the Residency ReVISION Project,” and one of its focuses is on helping physicians become masters of information. Joseph W. Gravel, Jr., MD, residency director, says an electronic health record system helps achieve that goal.
“It is incredibly important that our physicians are using EHRs because so much of what we are doing is data driven. We couldn’t do this initiative without an EHR,” he says.
Another component of TUFMAR’s P4 initiative ischanging residents’ training from a hospital setting to an office setting. Gravel says most of the residents’ third year is spent in an office to help better train them for how they will deliver care when they leave. He says being able to connect with other providers through an EHR makes this model workable and allows residents to use evidence-based tools at the point of care.
The University of Missouri-Columbia Family Medicine Residency in Columbia, Mo. is also participating in the initiative. As part of its initiative the program increased the amount of time first-year residents spend caring for patients in the family medicine clinic.
In the old model, first year residents weren’t spending much time in the clinic, says Residency Director Erika Ringdahl, MD. But with the new model, she says they are getting out there early and establishing continuity of care for their patients, which she says would not be possible without an EHR.
“We wanted to immerse them in the Patient Centered Medical Home and the EHR is a big part of that,” she says. Residents carry laptops with them and are able to be ’virtually present for their patients’, Ringdahl says. This virtual presence allows residents to assume full responsibility for their patients, which she says provides better care for patients and a better learning experience for residents.
