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P4 Participating Residency ProgramsFamily medicine residencies participating in P4
will endeavor to teach future doctors how to build a personal medical
home where patients experience seamless, coordinated care. By implementing
more progressive curricula that focus on futuristic ways of caring for
patients, budding family physicians will learn how to elevate levels of
patient care and satisfaction prior to completing residency. Residencies
participating in the P4 initiative include: Baylor HCHD Family Medicine Residency Program Residency Director: Fareed Mahmood Khan, MD Innovation:The Baylor College of Medicine Family Medicine Residency and its Northwest Community Health Center (NWCHC) / Harris County Hospital District (HCHD) Track was established in 1997 to train family physicians who have an interest in providing health care to indigent and underserved populations in urban, rural and international settings. The Program's P4 innovations expand on its mission to create family physicians with expertise in caring for underserved populations by implementing modifications that reorder residents training and provide earlier and more frequent experiences in urban-underserved, community-based clinics. Residents are placed in practice-learning teams, in which they learn about the Patient Centered Medical Home concept and acquire skills and knowledge of chronic illness and preventive care for their patients. They then evaluate their current practice at NWCHC and implement enhanced clinical practice design changes and strategies to improve patient care outcomes for both chronic care and preventive care. patient care. Residents also have the option of engaging in community assessment and intervention projects that enhance the resident physician's understanding of the complex relationship between the health of an individual and the community in which they live. This training approach will help residents function more effectively in the complex health care system and prepare them for future leadership roles within the family medicine specialty
Cedar Rapids Medical Education Foundation Residency Director: Anne Sullivan, MD Proposed Innovation: The Cedar Rapids Medical Education Foundation began in 1971 and was one of the first family medicine residencies in the upper Mid-West. The Program's main P4 innovation will change the traditional training to a non-rotational format. Residents will train in collaborative teams using community resources and support to prevent and mange chronic diseases. Residents will become experts in managing the 20 medical conditions that make up 80 percent of their patients' needs and concerns while using just-in-time evidenced based resources to manage the others. Our innovative electronic resources allow patients to request online appointments, enter symptoms online before their office visits, perform Virtual Office Visits and obtain prescription refills. In addition, our system allows residents to employ customized evaluations, schedules and procedure documentation. These innovations will allow residents to measure outcomes and be accountable for the changes in practice those outcomes demand to better meet the health needs of the community.
Christiana Care Health System Family Medicine Residency
Program Residency Director: Lisa Maxwell, MD Proposed Innovation: The Christiana Care Family Medicine Residency Program serves Delaware and its surrounding communities. The Program emphasizes the cornerstones of family medicine - ongoing comprehensive health care for patients of all ages, management of patients in an office setting, preventive health care, nursing home care, home visits, hospice care and inpatient care when necessary. As part of the P4 initiative, the Program will implement a patient-centered curriculum focusing on medical care that occurs outside of the hospital. Resident physicians will follow faculty physicians throughout their training, using a mentor model that maximizes personal attention to the education of each resident. The content and process of the curriculum will allow residents to structure portions of their training to focus on their particular areas of interest. The proposed patient-centered curriculum will take advantage of teams to provide care and support learning in a variety of training sites that offer a medical home for patients, including suburban, urban, private practice and Federally Qualified Health Center sites. These experiences will increase and diversify residents' ambulatory training and develop important skills to help them implement the medical home concept when they enter practice.
Hendersonville Family Medicine Residency Program Residency Director: Geoffrey L. Jones, MD Proposed Innovation: The Hendersonville Family Medicine Residency Program is offered through the Mountain Area Health Education Center (MAHEC) and Pardee Hospital, both in North Carolina. The Program is the rural track of the MAHEC Family Medicine Residency Program. For P4, the program will create a network of dramatically redesigned, high-tech rural practices to support continuity of patient care. Residents are expected to demonstrate markedly improved clinical outcomes and enhanced attitudes and skills to support successful careers in rural medicine. To implement its P4 innovations, the Program has selected three solo rural practices located within 20 miles of its community. Each practice will adopt a high-end Electronic Health Record (EHR) system and receive training and access to a variety of practice process enhancements. At least one resident will be assigned to each practice/community and will maintain part of their continuity outpatient practice at that site. Each resident also will complete a two-year community leadership project.
John Peter Smith Hospital Family Medicine Residency
Program Residency Director: Daniel Casey, MD
Lehigh Valley Family Medicine Residency Program Residency Director: Julie A. Dostal, MD
Loma Linda University Family Medicine Residency
Program Residency Director: Jamie Osborn, MD
Middlesex Hospital Family Medicine Residency Program
Proposed Innovation: The Middlesex Hospital Family Medicine Residency Program provides superior education to 24 residents in a community where Family Medicine is the foundation of the health care delivery system. It is based at one of the nation’s leading community hospitals which has been honored with both Top 100 and Magnet Hospital status. Because Family Medicine is the only residency program at Middlesex Hospital, our residents do not compete with other learners for either teaching time or patient care experiences. As part of the P4 initiative Middlesex Hospital offers a unique four year curriculum to better prepare graduates to provide comprehensive care in an increasingly complex health care environment. The curriculum includes six additional core rotations beyond the traditional 3 year model, office practice in a "New Model" medical home, and five Tracks of Excellence that allow residents to develop in depth knowledge in Maternal/Child Health, International/Community Health, Geriatrics/Palliative Medicine, Integrative Medicine, or Faculty Development, with the option of a Masters degree or additional certifications. From their first day our residents serve as the personal physician for a panel of their own patients, with a strong emphasis on continuity of care in the office, hospital, home, nursing home, and community. Our three model offices are located in urban, suburban, and rural locations and serve 30,000 patient visits each year. Our 13 full-time highly experienced faculty physicians are deeply committed to teaching and serving as role models to residents, who are viewed as our junior partners in practice. Middlesex Hospital is a modern, 275-bed, community hospital serving an extremely diverse population of over 250,000. One of the Middlesex Health System's primary care practices is a TransforMed National Demonstration Project site for Family Medicine office transformation. The hospital operates three emergency satellite facilities and a modern outpatient diagnostic and treatment center. The medical staff is outstanding, and committed partners in the education of residents. For more information, please contact: Alan Douglass, MD, Director
Tufts University Family Medicine Residency at Cambridge
Health Alliance Residency Director: Gregory Sawin, MD, MPH
Tufts has titled its P4 innovations "the Residency ReVISION Project." There are five major initiatives currently underway: 1) a truly competency-driven approach to teaching and assessment of learning, 2) the development of a longitudinal, rather than block, curriculum in the second and third years of residency, 3) a focus on creating physicians who are masters of information, 4) the development of 12 Areas of Concentration, and 5) a focus on developing executive skills necessary for the new model of care that are typically taught to business executives but critical for the development of all leaders. We are employing adult model learning methods, learner-centered competencies and training primarily in the family medicine center practice rather than in the traditional hospital setting, reflecting real-world modern practice. In addition, one of our project's premises is that a future family physician's training should be provided predominately by family physician faculty rather than specialists to assure the development of professional identity, a patient-centered and cost effective approach to care, and improved patient outcomes. Residents are required to demonstrate competency in faculty-developed "basic skills qualifications (BSQs)" during their first year of residency and before graduation will have completed our internally-developed competency modules or "merit badges", each with a set of measurable goals and objectives in specific subject areas important to a well-trained family physician. An on-line resident portfolio tool will help direct and track learning objectives.
University of Colorado Family Medicine Residency
Program Residency Director: Daniel Burke, MD
University of Missouri-Columbia Family Medicine
Residency Residency Director: Erika Ringdahl, MD
University of Rochester Family Medicine Residency
Program Residency Director: Stephen Schultz, MD
Waukesha Family Medicine Residency Program
Proposed Innovation: Affiliated with the Medical College of Wisconsin and Waukesha Memorial Hospital, the Waukesha Family Medicine Residency Program is nationally known for being technologically advanced. Each resident receives a laptop and personal digital assistant (PDA) to help them optimize patient care. The Program offers a strong emphasis in obstetrics and gynecology. The Program's P4 innovations include a unique and flexible option for residents to decide whether to complete a three-year residency in which they pursue a "major," such as women's health or sports medicine, or a four-year residency in which they pursue a "mastery" with extra credentials, such as a master's degree in public health (MPH) or business administration (MBA). All residents will complete a core curriculum in family medicine during the first 19 months of the program. Residents will then be able to create individualized educational plans that will allow them to pursue specific areas of interest.
West Virginia University Rural Family Medicine Residency
Program Residency Director: David A. Baltierra, MD Proposed Innovation: The WVU Rural Family Medicine Residency at Harpers Ferry was designed to nurture and educate residents in the unique rural setting of the panhandle of West Virginia. Historically, the focal point of resident teaching has been a freestanding, state-of-the art family medicine clinic with more than 20,000 patient visits annually. The Program's P4 innovations aspire to redesign family medicine training by placing resident physicians and their patients in a high-tech, medical home setting featuring enhanced continuity of care that extend the traditional boundries to include hospitals, nursing facilities, and, eventually, new technologies that will allow patients to communicate with their doctors electronically at a convenient time from a preferred location. Care will occur during or after hours, in groups, in the community, and with physician teams that are focused on chronic disease management and patient safety. The Program will also examine how best to assist students to enter residency at a higher competency level by providing rural scholars additional clinical experiences in the fourth year of medical school.
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Gerald "Jay" Fetter |
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Proposed Innovation: The John Peter Smith
Hospital Family Medicine Residency program trains more family physicians
than any hospital in the United States, offering its residents a diverse
patient population and allowing them to care for complex and multiple
conditions. This innovative Program will offer to increase the length
of its family medicine residency to an optional four years by integrating fellowship
training into the residency. It will add more in-depth training in maternal-child
care, rural medicine, sports medicine, geriatrics, global medicine, hospital medicine, and general family medicine.
Training in all areas will emphasize preventive and chronic care management.
The Program's P4 curriculum will provide its residents with
a greater depth and breadth of experience while preserving the valuable
family medicine skill set.
Proposed Innovation: The Lehigh Valley Family
Medicine Residency Program is located at one of Pennsylvania's largest
teaching hospitals. The Program gives residents flexible rotation schedules
and also allows them to customize their education to pursue areas of personal
interest within the specialty. The Program's P4 innovations
focus on teaching residents the core competencies of family medicine through
a curriculum that blends traditional learning with active patient care.
Residents and faculty will work collaboratively in community practice
settings emphasizing family medicine in the first year, reducing time
spent in the acute hospital setting and increasing flexibility in resident-driven
learning experiences. The Program's innovations will facilitate the professional
development of graduates deeply grounded in family medicine with strong
core knowledge and skills in population health, chronic disease management,
office procedures and behavioral and integrative medicine. Residents will
become leaders with skills in collaboration, information management, critical
thinking, life-long learning and self care.
Proposed Innovation: The Loma Linda University
Family Medicine Residency Program describes itself as a "unique family,
where the excellence of a rigorous university meets the personalized and
friendly small-town community hospital." More than just "practicing"
medicine, the program strives to make a difference by meeting the needs
of its patients with continuity of care and compassion. The Program has
proposed a four-year curriculum with an integrated master's degree in
public health (MPH). The new curriculum will give residents the choice
of two tracks of care – Lifestyle Medicine, which prevents illness
through healthy living, or Global Health, teaching doctors to work with
underserved patients cross-culturally. Special teaching will include how
to motivate patients to make healthy choices, to improve the systems doctors
use, and to develop leadership skills. The Loma Linda's P4
innovations aspire to produce family physicians who are better equipped
to treat the whole person at all levels within the community.
Proposed Innovation: Last year the Tufts
University Family Medicine Residency joined with Cambridge Health Alliance,
a Harvard Medical School affiliated, award-winning public health system
consisting of three community hospitals and over 20 primary care practices
serving seven urban communities north of Boston. The residency moved into
a new state of the art Family Medicine Center in June 2007, a facility
designed with Future of Family Medicine goals in mind such as computer
work stations for each resident, an electronic health record system, clinical
team meeting space, and group visit space. The residency and Family Medicine
Center are located in Malden, a socio-economically, racially, and culturally
diverse community located six miles north of Boston.
Proposed Innovation: The University of Colorado
Family Medicine Residency Program is the latest adaptation in a 60 year
history of training primary care physicians. The Program offers two educational
training tracks. The University Hospital track is centered in the Stapleton
community, the largest urban renewal project in the United States that
has the stated goal of being the healthiest community in the United States.
The Denver Health track provides patient care in a federally qualified
community health center which is part of Denver Health's fully integrated
safety-net health care system. For its P4 initiative,
the program will implement a new curriculum focusing on chronic disease
management, cutting edge information systems, health behavior change,
community integration, and leadership in the specialty of family medicine.
Curricular changes include instituting family medicine intensive teaching
blocks preceding first year hospital rotations, establishing a Medical
Home Curriculum, and reorganizing the residency curriculum so that residents
have an experience focused on caring for their own panel of patients during
the second half of residency. The Program is working to extend the first
part of residency into the fourth year of medical school, to provide additional
time during residency to master the skills of instituting and managing
a medical home. 
Proposed Innovation: As P4 partners,
the University of Missouri will study both the content and length of residency
training. We will study the benefits and drawbacks of a fourth year curriculum
that overlaps with the senior year of medical school. Fourth year medical
students rotate on our services, develop their continuity practice, and
attend our educational sessions. Early completion of some of our residency
requirements in medical school allows additional elective time for residents
to better prepare for their future practice. Our P4 curriculum for all
of our residents will emphasize concepts of a patient-centered medical
home, innovative use of the electronic health record, and improved management
of chronic illnesses. We will also significantly increase the amount of
time first-year residents spend caring for patients in the family medicine
clinic, and prioritize small group learning over traditional lectures.
Residents and patients will act as partners in the implementation and
evaluation of the new program. 
Proposed Innovation: The University of Rochester
boasts the third oldest family medicine residency program in the country.
The Program focuses on caring for underserved patients in and around Rochester,
N.Y. For its P4 innovation, the Program will implement and
compare two approaches to teaching new and innovative practice models:
redesigning one of the four existing residency practices within our current
practice, and establishing a new teaching "Ideal Micro Practice" (IMP).
The IMP is a model developed by the Institute of Healthcare Improvement
that is small, with low overhead (15-30 percent). Therefore, clinicians
are able to spend more time with patients. The Program will locate its
IMP in an inner-city neighborhood to test whether it is a viable model
to serve the urban underserved. Both approaches will initially focus on
three chronic diseases (asthma, diabetes and depression) as well as three
preventive services (breast, cervical and colorectal cancer screening).
Residents will learn the Plan-Do-Study-Act (PDSA) model. Then, working
with all members of their practice team, residents will develop and implement
quality improvement projects.
P4
Project