An Update on ABFM Competency Based Board Eligibility and Residency Redesign

Warren P. Newton, MD, MPH

President & CEO, ABFM

ADFM Educational Transformation Committee

November 16, 2023

​

The American Board Of Family Medicine

Objectives

• Review rationale and expectations for Competency Based ABFM Eligibility
• Describe initial steps in residency redesign, including assessments residencies currently using and other residency outcomes data
• Most important: input on future of residency education; highlight where departments can contribute…

​

Remember the Why…

Family Medicine Residency Redesign – Key Elements

• The Practice is the Curriculum
• Community Engagement to address disparities and social determinants of health
• Residency Learning Networks
• Flexibility for residencies and residents
• Competency Based Medical Education
• Faculty Time for Education

One of many goals: means to the end…

Family Medicine Resideny�Core Outcomes

• “Start with the end in mind”
• Based on FM EPAs
• Driven by ACGME FM RC and ABFM, with input from FM organizations, including ADFM
• Called them “core outcomes”, similar to EPAs
• There are 12…
• This set of core outcomes will drive ACGME WebAds, resident and faculty survey and ABFM requirements for board eligibility

Competency Based Board Eligibility: ABFM Strategy for Implementation

• Starting next June, we will ask program directors to attest that each resident has completed residency and that they are competent in specific outcomes required for 2024 as requirement for Board Eligibility
• We assume that CCCs will be involved
• Start with 5 outcomes and build over 3 years
• By 2027, we’ll ask PDs to attest to competence in all core outcomes for each resident as a condition of ABFM Board Eligibility

Requirements for 2024

• Practice as personal physicians, providing first contact, comprehensive and continuity care, to include excellent doctor-patient relationships, excellent preventive care , care of chronic disease and effective practice management.
• Diagnose and manage acute illness and injury for people of all ages in the emergency room or hospital.
• Provide comprehensive care of children, including diagnosis and management of the acutely ill child and routine preventive care.
• Develop effective communication and constructive relationships with patients, clinical teams, and consultants
• Model Professionalism and be trustworthy for patients, peers, and communities.

Chosen to underscore breadth of scope and ease transition…

Whence assessments?

• Adjust existing rotation evaluations
• Behavioral health evaluations
• Precepting “shift reports”

Requirements for 2025

• Practice as personal physicians, to include care of women, the elderly, and patients at the end of life, with excellent rate of continuity and appropriate referrals.
• Provide care for low-risk patients who are pregnant, to include management of early pregnancy, medical problems during pregnancy, prenatal care, postpartum care and breastfeeding, with or without competence in labor and delivery.
• Diagnose and manage of common mental health problems in people of all ages.
• Perform the procedures most frequently needed by patients in continuity and hospital practices.
• Model lifelong learning and engage in self-reflection.

Opportunities: define competencies for lower delivery volume residencies, behavioral health, procedures, and lifelong learning/master adaptive learning

We welcome dialogue over the next twelve months…we want to publish next spring.

Requirements for 2026

• Practice as personal physicians, to include musculoskeletal health, appropriate medication use and coordination of care by helping patients navigate a complex health system.
• Provide preventive care that improves wellness, modifies risk factors for illness and injury, and detects illness in early, treatable, stages for people of all ages while supporting patients’ values and preferences.
• Assess priorities of care for individual patients across the continuum of care—in-office visits, emergency, hospital, and other settings, balancing the preferences of patients and medical priorities.
• Evaluate, diagnose, and manage patients with undifferentiated symptoms, chronic medical conditions, and multiple comorbidities.
• Effectively lead, manage, and participate in teams that provide care and improve outcomes for the diverse populations and communities they serve.

• Opportunities: defining competencies in musculoskeletal health, clinical prioritization, undifferentiated symptoms, multiple comorbidities, leading/participating in teams and in communities
• We welcome dialogue in 2024-25…We plan to publish in spring 2025.

Where will assessments come from?

• Your Faculty!
• Start with adapting what currently exists…and then add/innovate
• The perfect is the enemy of the good. Simple, practical, scalable are priorities
• Look for what the STFM CBME Task Force will recommend—both general principles and specifics
• Evaluate and share what works—on PD list serve, and at Residency Leadership Summit, STFM Annual meetings—we need to learn together!
• Urge programs to make the case for what society needs from family doctors…link what you measure to what society needs—and will need.

​

Questions?

The American Board Of Family Medicine

Recapturing Time for Residency Education

SOAR: Outpatient Continuity Care

What do we want?

• 80% of graduates now provide continuity care, 25% including hospital
• 10% become hospitalists; 5-6% full time ED physicians
• This slide shows true for all residencies

​

What does the country need?

SOAR Data: Adult Inpatient Care

• FM has about 10K hospitalists; and also about 25K who are clinically active in hospitals in continuity care

​

• All residencies need to be able to train residents to work in hospitals

Providing Maternity Care

• Obstetric deserts and maternal morbidity/ mortality are growing
• 40% of residencies have not had any graduate deliver a baby in years; new standards address current reality.
• Now need key competencies for both tracks. How can we help address the crisis?

Trends in Continuity and Inpatient Care among Recent Graduates (NGS)

Continuity with hospital

Residency Programs with any Residents Intending to Provide by Year (CERT)

Intention to Practice: Buprenorphine Treatment

Red lines represent intention to practice by the same cohort of graduates

Changes in Burnout Over Time – Longitudinal (NGS to PDS)

27%

34%

31%

8%

What assessments are residencies using?� Attestation Survey: >50% residencies use�(Total=655 Residencies)

What assessments are residencies using?�Attestation Survey: 25-50% residencies…�(Total = 655 residencies )

What assessments are residencies using?� Attestation Survey: <25%�(Total=655 residencies)

How Many? �Number of Assessments at 2023 graduation

655 residencies

Median residency has 50-75 assessments/resident at graduation

Promote Residency Learning Networks

• Evidence Based Intervention, contributor to innovation and wellbeing of faculty and staff…
• Underscored in 7/23 standards
• No single recipe: ideally both practice transformation and CBME components.
• Variety of sponsors possible—AAFP state chapters, large departments, other organizations…

• Goal: all 745+ residencies in some type of network
• Learning the lessons: STFM summit in 4/23 and residency learning collaborative
• ABFM Foundation: RFPs for planning grants/seed funding now active. Departments? Email jfetter@theabfm.org
• “Start where you are and do what is doable”
• RFP for evaluation out soon

​

​

AIRE: What is best training for the personal physician of the future?

• Residents get additional competency from added time; programs get freedom from RC rules in return for submission of outcomes data; ABFM wants evidence to guide duration of residency.
• 8 approved, two in final process and >80 with initial interest
• All must participate in annual collaborative meeting and submit yearly reports; first meeting at NCFPR in August 2023
• Recruitment target this year: 45 programs; can be whole or part residency; Increased faculty time seems to be permissive…
• Contact jfetter@theabfm.org for questions. Will announce evaluation RFP soon…

Learnings so far…

• CBME rather than curricular time is a mindset shift
• 4 year for all residents target Dreyfus level of mastery
• Integrated 3+1 show evidence of increased experience
• Clinical areas for focus so far: sports plus pop health, obesity, lifestyle medicine, integrative medicine, leadership development
• Changing the ACGME process (and culture!)…starting review earlier in process, parallel residency and fellowship process
• What departments can contribute: emphasis on practice as curriculum, rural and frontier, executive leadership, academic leaders

Questions?

The American Board Of Family Medicine