Early Career Outcomes of Family Medicine Residency Graduates Exposed to Innovative Flexible Longitudinal Tracks

摘要

The Preparing the Personal Physician for Practice (P4 ) project used a case series design to study innovations in the content, length, structure, and location of residency training in 14 geographically diverse family medicine programs between 2007 and 2012. We aimed to explore how offering flexible longitudinal tracks (FLT) affected graduates’ scope of practice, particularly in maternal child health (MCH), which included at least 17 months of focused training that increased each year over 4 years. Methods: We administered a cross-sectional survey to graduates of P4 residencies approximately 18 months after they completed training (2011–2014) and compared graduates of the John Peter Smith (JPS) Family Medicine Residency MCH FLT to all other P4 graduates. Results: The overall response rate was 81.8% (365/446). JPS graduates who completed the flexible MCH track (n=15) compared to all other P4 graduates (n=332) were more likely to deliver babies (13/15, 86.7% versus 48/324, 14.6%) and perform C-sections as the primary surgeon (12/15, 80.0% versus 15/322, 4.7%). Additional areas of expanded scope associated with the MCH track included endoscopy (4/15, 26.7% versus 10/323, 3.1%), the care of hospitalized adults and associated procedures (central lines, eg: 8/15, 53.3% versus 47/322, 14.6%), and the care of hospitalized children (13/15, 86.7% versus 111/323, 34.4%). Conclusions: Graduating from the JPS MCH FLT was associated with a higher provision of maternal, child, and ill adult patient care services, including associated procedures.