Alan K. David

Task Force Report 2. Report of the Task Force on Medical Education

BACKGROUND For family physicians to be prepared to deliver the core attributes and system services of family medicine in the future, especially within the New Model of family medicine that has been proposed, changes will need to be made in how family physicians are trained. This Future of Family Medicine task force report presents a plan for implementing appropriate changes in medical school and residency programs. METHODS As a foundation for the development of specific recommendations on medical education, this task force reviewed relevant findings from research conducted for the Future of Family Medicine project and presents an historical perspective of the specialty. We addressed accreditation criteria for family medicine residency programs and examined various relevant projects and programs, including the Academic Family Medicine Organizations/Association of Family Practice Residency Directors Action Plan, the Residency Assistance Program Criteria for Excellence, the Accreditation Council for Graduate Medical Education Outcome Project, the Family Medicine Curriculum Resource Project, and the Arizona Study of Career Selection Factors. The task force relied on the Institute of Medicine report, Health Professions Education: A Bridge to Quality, as a foundation for proposing a new vision and mission for family medicine residency education. MAJOR FINDINGS The training of future family physicians must be grounded in evidence-based medicine that is relevant to the care of the whole person in a relationship and community context. It also must be technologically up to date, built on a solid foundation of clinical science, and strong in the components of interpersonal and behavioral skills. Family physicians must continue to be broadly trained and have the competencies required to practice in a variety of settings. It is important that training in maternity care and training in the care of hospitalized patients continue to be included in the family medicine residency curriculum, but programs must be allowed to tailor that curriculum to be compatible with educational resources and individual trainee needs. CONCLUSION Given the changes taking place in the specialty and within the broader health care system, it is clear that the traditional family medicine curriculum, although successful in the past, cannot meet the needs of the future. The educational process must train competent family physicians who will provide a personal medical home for their patients, a key concept that must be an integral part of whatever new systems are designed. Such competency will require family physicians who understand and practice process-oriented care, who utilize the biopsychosocial model to create superb physician-patient relationships, who actively measure outcomes, and whose practices are driven by information system access to evidence-based principles of care.

Preparing the Personal Physician for Practice (P4): Residency Training in Family Medicine for the Future

### Historical Roots When Family Medicine became a specialty in 1969, residency training was established as being 3 years in duration based largely on 2 significant reports, both commissioned by the American Medical Association Council on Medical Education and published in 1966. The Millis

Education of Students and Residents in Patient Centered Medical Home (PCMH): Preparing the Way

The American Academy of Family Physicians, in conjunction with the American Academy of Pediatrics, American College of Physicians and the American Osteopathic Association published Joint Principles for the Medical Education of Physicians as Preparation for Practice in the Patient Centered Medical

The Complexion of Collaboration: An Overview of the Psychologist-Physician Relationship

The core of the collaborative enterprise between psychologists and primary care physicians is the patient encounter. Individual cases provide opportunities for physicians and psychologists to collaborate effectively; the focus of such collaborations must always remain on the health and well-being of the patient. Any number of collaborative models may be used, depending on the specific situation and specific conditions of the collaboration, coupled with the needs of the patient. Collaboration may range from informal consultation, to formal consultation, to coprovision of care, to cotherapy between physician and psychologist. As an introduction to this special issue, this article outlines these models of collaboration, as well as the importance of agreed-upon goals, ongoing communication, and problem solving to address barriers between collaborative partners.

Adult medicine training experiences in a small-town family practice residency.

PURPOSE To document the adult medicine experiences of family practice residents training in a small rural hospital. METHOD The authors tracked all inpatient admissions and consults for the first year of a newly accredited family practice residency program, located in a small-town, 80-bed hospital. They analyzed the data for volume of admissions, sources of admissions, diagnoses, lengths of stay, and ICU experience. RESULTS The residents saw a significant volume of patients, encountered a wide variety of diagnoses, and had ample opportunities for learning, in spite of the small number of occupied beds. CONCLUSION Family practice residents in small hospitals can have sufficient inpatient training experiences in adult medicine. The authors believe that the Accreditation Council for Graduate Medical Education should encourage the development of residency programs in rural communities by simplifying the accreditation documentation requirements for smaller hospitals.

From the Association of Departments of Family Medicine: Interprofessional Education

The proposed Liaison Committee on Medical Education (LCME) Accreditation Standard ED-19-A states: “The core curriculum of a medical education program must prepare medical students to function collaboratively on health care teams that include other health professionals. Members of the health care teams from other health professions may be either students or practitioners.”

The biopsychosocial model in medicine: lost or reasserted?

The biopsychosocial model, which has extraordinary merit for explaining and predicting health and well-being, has had relatively limited acceptance over the past 25 years. There may be a variety of reasons for this, but the forces that shape medical education must be taken into account if the biopsychosocial model is to be more fully accepted than it is currently. Two factors, medical school financing and medical school curricula, that are influenced by powerful forces within medical education are examined. Unless these forces are moved in a direction to benefit from the biopsychosocial model, it is unlikely that this important contribution will be fully acknowledged.

ADFM’S 2013 WINTER MEETING FOCUS: MOVING TO VALUE-BASED HEALTH CARE

The 2013 ADFM Winter Meeting’s theme was Leading in the Time of Transition from Volume-Based to Value-Based Health Care. At the core of the meeting’s program was a day-long session facilitated by Harold Miller, Executive Director of the Center for Healthcare Quality and Payment Reform, who

Principles and Applications

ion In computer science, abstraction means hiding information. In CSS, abstracting from the world “reality”—whether directly experienced (observing a riot downtown) or indirectly learning about it (reading history)—is a process involving stimulus signals, perceptions, interpretation, and cognition. CSS relies on several sources for abstracting key entities, ideas, and processes from raw stimulus signals from the real world. These sources span a hierarchy in terms of their social scientific status. At the very top of the hierarchy are social theories with demonstrable validity 10A little-known fact among many social scientists is that the theory of mechanics in physics is built around the abstraction of singleand two-body problems. Already three-body problems are hugely difficult by comparison; and, most interesting, N -body problems defy mathematical solution in closed form. 11Interestingly, humanistic fields such as music and ballet also use systems of specialized notation, far beyond what is used in traditional social science. In music, Guido d’Arezzo [b. A.D. 991 (or 992), d. 1050] is considered the founder of the modern music staff; in ballet, Rudolf von Laban [b. 1879, d. 1958] invented the symbolic system known as “labanotation” (Morasso and Tagliasco 1986). 2.7 Abstraction, Representation, and Notation 37 in terms of formal structure (internal validity) and empirical observation (external validity). Not all existing social theories meet these stringent requirements, although an increasing number of them do as research progresses. Examples of social theories that meet internal and external validity standards include Heider’s Theory of Cognitive Balance in psychology, Ricardo’s Theory of Comparative Advantage in economics, and Downs’s Median Voter Theory in political science, among others. Social theories are abstractions that point to relevant social entities, variables, and dynamics that matter in understanding and explaining social phenomena. A second source of abstraction consists of social laws. Examples of social laws include the Weber-Fechner Law in psychometrics, the Pareto Law in economics, and Duverger’s Law in political science. Theories explain; laws describe (Stephen Toulmin 1967).12 Some of the most scientifically usefully social laws can be stated mathematically, as in these examples. Social laws also contain relevant entities, variables, and functional relations for describing social phenomena. A third source of abstraction consists of observations that can range from formal (e.g., ethnography, content analysis, automated information extraction, text mining, among others) to informal (historical narratives, media, and other sources about social phenomena). Observations of social phenomena can describe actors, their beliefs, social relations, and other features ranging from individual to collective. Finally, a fourth source of abstraction consists of computational algorithms capable of emulating social phenomena, as in artificial intelligence (AI). Artificial (i.e., not really human) algorithms do not claim to be causal in the same sense as social theories. They “work,” but without causal claims in the same sense as social theories. They are efficient, in the sense that they (sometimes) can closely replicate social phenomena. AI algorithms are typically (and intentionally) efficient and preferably simple; extreme parsimony in this case comes at the expense of realism. Examples of AI algorithms include Heatbugs (Swarm, NetLogo, MASON), Boids (Reynolds 1987), and Conway’s (1970) Game of Life. In spite of their lack of social realism, AI algorithms can be useful sources for abstracting social entities, ideas, or processes because they can highlight features that either elude theories or are hard to observe. An example would be the agglomeration patterns generated in a Heatbugs model, as a function of varying parameters of “social” interaction among the set of agents, or the role of apparent “leadership” in a flock of boids.

ADFM's 2013 winter meeting focus: moving to value-based health care.

The 2013 ADFM Winter Meeting’s theme was Leading in the Time of Transition from Volume-Based to Value-Based Health Care. At the core of the meeting’s program was a day-long session facilitated by Harold Miller, Executive Director of the Center for Healthcare Quality and Payment Reform, who