Family medicine residency education: connecting the future to the past.

When family medicine became a specialty in 1969, the new residency programs contained two central innovations in generalist medical education: an expansion of the rotating internship of 12 months to a full 36 months and a foundation of experience with continuity of care training in model family medicine centers. With the Future of Family Medicine project, we are now reexamining our models of clinical practice and medical education. In doing so, it is instructive to examine the principles and process by which family medicine started and to interpret present challenges in this historical context. Much has changed in the past 36 years. The first Residency Review Committee (RRC) requirements for family medicine were two pages in length, and the current proposed revision is now 40 pages. In 1969, most residents were allowed only 2 weeks vacation in the first 2 years, with some programs allowing 3 weeks by the third year. Today, 4 weeks of vacation per year is common. In 1969, there were no requirements in sports medicine, geriatrics, gynecology, or women's health, and curricula in such areas as domestic violence and HIV/AIDS did not exist, let alone be a mandatory part of the curriculum. Within the last several years, the practice of unlimited work hours per week for residents has evolved to a mandated 80-hour workweek with reporting mechanisms in place to enforce this requirement. The dilemma has become " How do we teach more, and how do the residents learn all of this with essentially less time? " Better technology with computerized and individualized Web learning is helpful. But, it does not replace individual resident-patient interactions, review of those interactions, discussions of problem solving/management, and learning at the point of care. We have been adamant about refusing to give anything up during our entire 36-year history, and most of us still insist that there must be consistency in what our residents learn, with only minor options for flexibility in the process of residency education. The Future of Family Medicine report on residency education made this statement: Innovation in family medicine residency programs will be supported by the RRC for Family Practice through 5–10 years of curricular flexibility to permit active experimentation and ongoing critical evaluation of competency-based education, expanded training programs, and other strategies to prepare graduates for the New Model. The discipline should actively experiment with 4-year residency programs that include additional training to add value …