Implementation and preliminary outcomes of the nation's first comprehensive 4-year residency in family medicine.

BACKGROUND Extending the residency curriculum to 4 years has been proposed as a logical innovation in response to the Future of Family Medicine Report given the increasing complexity of medical care and reduction in available training time due to duty hour restrictions. Middlesex Hospital, a participant in the P⁴ Initiative, is the first family medicine residency program to require a comprehensive 4-year curriculum for all residents. METHODS Over a 4-year time frame, the program transitioned from 8-8-8 to 6-6-6-6 staffing. The existing 3-year educational core of the program was left intact, and six additional core rotations and 7-month tracks of curricular enhancement were added. The residency practice transformed to a Patient-centered Medical Home (PCMH). RESULTS Transition to a 4-year residency curriculum has proved smooth. Our funding model is sustainable, and practice income has increased. We have had no difficulty maintaining accreditation despite an innovative curriculum. A 4-year curriculum has resulted in substantially increased applicant interest and improved Match rates. The introduction of tracks has appealed to residents and has generated many positive spin-offs to the educational program as a whole. Transition to a PCMH has been of great value to both our patients and our learners. CONCLUSIONS Transition to a comprehensive 4-year curriculum has been successful and has provided many benefits to our learners, practice, and educational program. Our graduates are substantially better prepared for practice.