Amanda Weidner

INFLUENCING STUDENT SPECIALTY CHOICE: THE 4 PILLARS FOR PRIMARY CARE PHYSICIAN WORKFORCE DEVELOPMENT

Medical students choose a career in family medicine based on the combined influence of many factors. A framework (pipeline, process of medical education, practice transformation, and payment reform) based on the Four Pillars for Primary Care Physician Workforce Development1 provides a logical basis to address student interest in family medicine. Individual departments of family medicine (DFMs) have variable influence and ability to affect these pillars and subsequent student career choice. While the 4 pillars may imply equal impact of each factor on specialty choice, this commentary describes the differential influence of each, and opportunities for greatest return on investment to best meet the nation’s urgent health care needs.

PUTTING THE FOUR PILLARS FOR PRIMARY CARE PHYSICIAN WORKFORCE INTO PRACTICE LOCALLY

The United States faces a shortage of 25,000 primary care physicians (PCPs) by 2025.[1][1] This report is a guide for departments of family medicine for developing local strategies ( ) to increase the PCP workforce, framed around the

Evolving competencies for chairs of departments of family medicine.

The rapidly changing environments of academic health centers (AHCs) are demanding adaptation to new roles for Chairs of Departments of Family Medicine (DFMs). Over a decade ago, the Association of American Medical Colleges identified 3 overarching areas of skills for Department Chairs: (1) managing conflict, (2) performance evaluation, and (3) managing diversity.1 Grigsby described the need for a “future-oriented” Chair with ability to shift the focus from personal to others’ success, to develop realistic business plans, to be resilient, and to be a team leader.2 In 2013 Kastor asserted that the job of the Chair of a Department is now something new: that of a change agent, with loss of autonomy over budgetary management, and with more business responsibilities than the traditional focus on academic advancement.3 In addition to the roles of promoting diversity, managing conflict, and performance evaluation, the skills of leadership and change management are increasingly important to Family Medicine Chairs. Largely subspecialty-based AHCs have not historically embraced substantial roles for primary care disciplines. Even the smaller, community-based medical schools have often not included the primary care departments in significant economic decisions related to medical practice. In recent years, however, with the movement from volume- to value-based health care, AHCs and smaller medical school practice plans are calling on family medicine to develop new primary care networks on which they need to survive economically in the new world of health care delivery. The leaders of DFMs, and in particular the Chairs, are being asked to lead significant change within environments that are often resistant to such change. The Association of Departments of Family Medicine (ADFM), witnessing substantial turnover in Chairs over the past few years, has identified the development of new chairs as a high strategic priority. As ADFM’s Leadership Development Committee began to consider key competencies for Chairs, it became apparent that a number of the competencies needed by Chairs are also competencies of successful senior leaders within DFMs, many of whom may someday find themselves in a chair role. Through an iterative process, whereby input on key competencies has been received from participants of various ADFM leadership development sessions, an evolving set of competencies for Chairs of DFMs has emerged. Four major areas of competencies have been defined: Leadership (eg, strategic planning, building a team, leading/managing change) Administrative/management (eg, finances, human relations) Personal development and management (eg, understanding your role, managing calendar, resiliency, and self-care) Managing external relationships (eg, understanding where the department fits into institutional culture, external entities) In planning a preconference for new chairs, senior leaders and ADFM fellows at the 2015 ADFM Annual meeting, registrants ranked Leadership as the competency area of highest need. Of the 8 specific competency areas under the heading of “Leadership,” the preconference participants identified 3 as most important for their development: (1) building and sustaining a leadership team (including working effectively with an administrator partner); (2) leading and managing change (including having a framework and tools around meeting design, delegation, and group decision-making); and (3) understanding and changing department culture (including legacy issues). As ADFM continues to explicate the evolving list of competencies for chairs, we will work closely with other partners, such as the Society of Teachers of Family Medicine (STFM) through the Leading Change Curriculum initiative. We will use our list of competencies to guide training development in our own ADFM Fellowship, in our work with ADFM member chairs and in working with senior leaders in DFMs. The ADFM Leadership Development committee is also tying key resources to the competencies and will be housing these resources on an open-access site so that all who are interested can view them. The current version of the competencies can be found at: http://adfm.org/Members/NewChairs. Change is calling those of us in academic family medicine to respond not only to departmental needs but to much broader system needs. Chairs of DFMs must be equipped to answer this call through leading at many institutional levels while leading their own faculty and departments through uncertain times. An important element of facing these challenges is understanding family medicine’s position of power and relevance within the larger environmental context. As challenged recently, Chairs of Family Medicine must find meaning in answer to a fundamental question: “Are we institutional leaders who happen to be family physicians, or are we family physicians who happen to work at academic health centers?”4

Interprofessional education: a webinar featuring case examples.

Interprofessional Education (IPE) is a goal many of us in academic medicine strive for, but the true outcome of training in a way that transcends disciplinary boundaries, both in the classroom and in in clinical environments, remains a challenge. ADFM held a webinar in September to address critical challenges of executing IPE, including: stakeholder buy-in; curriculum development; venues for teaching; financing; relationship management; defining roles and responsibilities of learners and teachers; and interface with regulatory bodies. The roughly 30 webinar participants were equally split among family medicine department chairs, family medicine department administrators, family medicine faculty, and individuals in other academic roles. The majority (62%) were from allopathic medical schools, with another 15% each from Large Regional Medical Centers or “other” settings, and the final 8% from academic health center residency programs. The vast majority (91%) had IPE as part of the curriculum with the majority of these experiences noted as a combination of elective and required. Over three-quarters of participants reported that they were directly involved in IPE at their home institutions. The webinar was moderated by Denise Rodgers, MD, Vice Chancellor for Interprofessional Programs at Rutgers Biomedical and Health Science, and featured innovative IPE case studies from 4 institutions, presented by professionals representing family medicine, pharmacy, and nursing: Christine Arenson, MD and Christine Jerpbak, MD, Sidney Kimmel Medical College, Thomas Jefferson University; Brian Prestwich, MD, Keck School of Medicine of University of Southern California; Dan Mickool, MS, RPh, University of New England; Carolyn Rutledge, PhD, FNP-BC, Old Dominion University. In addition to addressing the common list of challenges, each presenter described the numbers and types of students and residents participating in the IPE, as well as the number and types of educational offerings, and whether they are required or elective. The individual presentations were prepared according to a standard template and a list of resources was developed. These resources and presentations, as well as a video of the webinar, can be found on the ADFM website at: http://www.adfammed.org/Members/Webinarsresources. On the website, the webinar reached far more than just the real-time participants, with over 150 “unique” visitors during the 2 weeks following the webinar, many of whom visited the site multiple times. Participants’ questions during the course of the presentations pertained to the following issues: (1) financial stability and sustainability; (2) students/learners as “change agents” and the notion that they “eat this up”; (3) using real clinical sites for learning as opposed to simulation; (4) taking advantage of opportunities in IPE for scholarship and telehealth/distance learning; (5) leadership development and teaching learners what it means to work as a team, not just to form teams; (6) addressing professional biases about hierarchy on teams; (7) logistical challenges of scheduling with physical distances between learners’ professional schools (one area where distance learning can be very helpful); and (8) tools for assessing teamwork. Dr. Rodgers summarized several important points for everyone moving towards IPE within their own institutions. First, the biggest issue confronting IPE is financial support and sustainability, as creating a stable and effective program is resource intensive. Grants are an important source of funding, but we need to consider whether programs can be sustainable when grant funds are gone—and need to figure out ways to bring in IPE innovations that are cost- and time-effective. Second, ensure that IPE is seen as critical in a number of clinical settings, not just ambulatory care. Including IPE in the inpatient setting is extremely important, although it may be the most difficult to carry out. Third, there are research questions we should be addressing in our work around IPE. How much IPE is enough? At what point do we introduce IPE so that students’ appreciation for working as members of a team is maintained throughout their clinical careers? How will we measure whether or not our interventions on the educational side mattered? How do we overcome the logistical challenges? Which IPE experiences are best? Finally, Dr. Rodgers noted that moving students into hospital settings where they see less-than-ideal examples of interprofessional communication and collaboration undermines the education received on the importance of working in interprofessional teams and how to be collaborative across professions. Although we are beginning to see some evidence that the introduction of IPE into an institution may actually cause the faculty and the clinicians to look at how well they are collaborating interprofessionally in their own clinical practices, a larger question remains about how raising student expectations about team performance may influence those who are teaching them to perform better as members of teams. More broadly, this also raises the issue of the integration of interprofessional practice, both its importance and the “how.” ADFM plans to hold a follow-up webinar in the spring focusing on the issues around interprofessional practice.

WHERE WE’VE BEEN & WHERE WE WANT TO GO: ADFM’S 40TH BIRTHDAY MEETING

ADFM celebrated its 40th “Birthday” at our annual Winter meeting in Washington, DC with champagne, cake, singing and dancing, the return of 20 former members to help us reminisce, and reflection on where we have been and where we should be going. As incoming President Kevin Grumbach, MD,

FINDING AND MAINTAINING THE JOY IN WHAT WE DO: THE 2017 ANNUAL ADFM WINTER MEETING

“Joy and Effectiveness in the Work of Family Medicine: Now and in The Future” was chosen as the 2017 ADFM Winter Meeting theme to encourage department Chairs and Administrators to reflect on the important and meaningful work across the continuum of an academic department. Concern about the

ADFM IS TURNING 40

The Association of Departments of Family Medicine (ADFM) is turning 40 next year! Founded in April 1978 with Paul Young, MD, as the first ADFM President, ADFM’s founding vision was to organize departments of family medicine to lead transformation of medical education, research, and health care to

THE LAST 5 YEARS OF THE MU/ADFM NEW CHAIRS WORKSHOP

Leaders in academic medicine are confronted with constant change. Chairs in family medicine, often instrumental during this dynamic time, require training to be successful leaders. First started in the 1990s, there was a hiatus in the University of Missouri (MU) workshops until 5 years ago when the

THOUGHTS AND THEMES FROM THE 2016 ADFM WINTER MEETING.

Are we Luddites? How can we “recalibrate”? What is a more pressing need in our Departments than producing outstanding family doctors? How can we bring joy back to clinical practice? These questions are a few among many that stimulated our thinking during ADFM’s 2016 Annual Winter meeting. A

BUILDING RESEARCH CAPACITY IN DEPARTMENTS OF FAMILY MEDICINE: PEARLS FROM NAPCRG 2013

One of the ongoing goals of the ADFM research committee is to assist chairs in building research capacity in family medicine departments. As a part of this effort, there were 3 separate events at the 2013 North American Primary Care Research Group (NAPCRG) annual meeting focusing on this issue. The first event was actually 9 events—“mini-consultations” given by chairs with research experience to those working to develop research within their departments. The second was a 90-minute session called “Secrets of My Research Success,” during which 3 experienced and successful family medicine researchers told their stories and answered questions from an engaged group of about 70 participants. Finally, approximately 17 Canadian and US family medicine chairs in attendance at NAPCRG conducted their customary NAPCRG joint meeting, and the focus was building research capacity. We (J.H., T.K.) had the privilege of attending all 3 sessions and would like to share the take-away lessons. These lessons are for both department chairs and aspiring researchers.