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P4 Participating Residency Programs

Family 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
Houston, Texas

Residency Director: Fareed Mahmood Khan, MD
Sponsoring Institution: Baylor College of Medicine

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
Cedar Rapids, Iowa

Residency Director: Anne Sullivan, MD
Sponsoring Institution: Cedar Rapids Medical Education Foundation

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
Wilmington, Delaware

Residency Director: Lisa Maxwell, MD
Sponsoring Institution: Christiana Care Health System

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
Hendersonville, North Carolina

Residency Director: Geoffrey L. Jones, MD
Sponsoring Institution: Mountain Area Health Education Center

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
An Affiliate of UT Southwestern Medical School
Fort Worth, Texas

Residency Director: Daniel Casey, MD
Sponsoring Institution: John Peter Smith Hospital/Tarrrant County Hospital District

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.


Lehigh Valley Family Medicine Residency Program
Allentown, Pennsylvania

Residency Director: Julie A. Dostal, MD
Sponsoring Institution: Lehigh Valley Hospital and Health Network

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.


Loma Linda University Family Medicine Residency Program
Loma Linda, California

Residency Director: Jamie Osborn, MD
Sponsoring Institution: Loma Linda University

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.


Middlesex Hospital Family Medicine Residency Program
Middletown, Connecticut

Residency Director: Alan Douglass, MD
Sponsoring Institution: Middlesex Hospital

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
Family Medicine Residency Program
Middlesex Hospital
90 South Main St. Middletown CT 06457
(860) 358-6469
Visit our website at


Tufts University Family Medicine Residency at Cambridge Health Alliance
Malden, Massachusetts

Residency Director: Gregory Sawin, MD, MPH
Sponsoring Institution: Cambridge Health Alliance

Tufts University Scool of MedicineProposed 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.

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
Denver, Colorado

Residency Director: Daniel Burke, MD
Sponsoring Institution: University of Colorado

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.


University of Missouri-Columbia Family Medicine Residency
Columbia, Missouri

Residency Director: Erika Ringdahl, MD
Sponsoring Institution: University of Missouri

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.


University of Rochester Family Medicine Residency Program
Rochester, New York

Residency Director: Stephen Schultz, MD
Sponsoring Institution: University of Rochester School of Medicine

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.


Waukesha Family Medicine Residency Program
Waukesha, Wisconsin

Residency Director: Michael F. Mazzone, MD
Sponsoring Institution: Waukesha Memorial Hospital

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
Harpers Ferry, West Virginia

Residency Director: David A. Baltierra, MD
Sponsoring Institution: West Virginia University

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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