What is a family medicine (FM) residency?

What is a Family Medicine Residency?

A family medicine residency is a 36-month graduate medical education program that trains physicians to provide comprehensive, continuous, coordinated, and patient-centered care across all ages and clinical settings, combining supervised clinical rotations in multiple specialties with longitudinal family medicine-specific training in outpatient continuity clinics. 1, 2

Program Structure and Duration

• The standard training period is 3 years (36 months), which the vast majority of residents (93.7%) consider ideal or appropriate for developing competency in family medicine 3
• Training consists of two main components: block rotations through various specialty services (such as internal medicine, pediatrics, obstetrics, surgery, emergency medicine) supervised by specialists, and longitudinal family medicine-specific training supervised by family medicine faculty 2, 4
• Residents maintain continuity outpatient clinics throughout their training, seeing their own panel of patients regularly, though only 40.8% of programs maintain truly continuous family medicine outpatient clinics 3

Core Educational Components

Clinical Training Elements

• Residents must achieve competency in the four foundational principles: comprehensiveness (caring for patients of all ages with diverse conditions), coordination (managing care across multiple providers and settings), continuity (maintaining ongoing relationships with patients), and patient-centeredness (incorporating patient values and preferences) 2
• Clinical rotations expose residents to specialty-specific knowledge while the family medicine center serves as the primary learning environment where residents integrate this knowledge into comprehensive primary care 4
• Procedural training includes gastroscopy (desired by 72.5% of residents), abdominal ultrasonography (65.2%), and pain management techniques (46.4%) as the most sought-after skills 3

Didactic Curriculum

• Educational conferences should include journal reviews (prioritized by 81% of residents), staff lectures (73.2%), and clinical topic reviews (73.2%) as the most valuable formats 3
• Patient education must be taught longitudinally throughout all 36 months, with didactic hours supplemented by opportunities to attend patient education conferences and participate in community education projects 1
• Residents learn to assess patients' readiness to learn, adapt education to cultural backgrounds and comprehension levels, and document educational efforts in specific terms 1, 5

Practice-Based Learning Systems

Patient Education Infrastructure

• Programs must maintain organized supplies of patient education materials (written, audiovisual, computer-based) appropriate for the reading levels and cultural diversity of the patient population, with frequently used materials kept in examination rooms 1
• Residents develop systems to facilitate use of patient education materials in office practice and involve office staff in assisting with patient education delivery 1, 5
• Training includes developing patient education handouts and protocols, evaluating commercial resources, and selecting instructional materials appropriate for patients' readiness to learn 1

Quality Improvement and Safety Training

• Residents learn to implement medication reconciliation processes at every patient encounter, creating accurate lists of all medications to identify discrepancies and prevent errors 5
• Training includes establishing monitoring systems during high-risk care transitions (hospital admissions, transfers, discharge) and developing performance metrics for tracking clinical outcomes and adherence to evidence-based guidelines 5
• Programs teach residents to conduct comprehensive medication reviews annually for patients on multiple medications, evaluating drug-drug interactions and potentially inappropriate medications 5

Team-Based Care Development

• Residents learn to design clear role definitions for practice team members (nurses, health educators, dietitians, administrative staff) with appropriate task delegation systems 5
• Training includes implementing expanded roles for allied health professionals, such as pharmacist-led chronic care management and nurse-led patient training 5
• Residents participate in regular multidisciplinary case discussions to review complex patients and develop strategies for implementing best practice standards 5

Faculty and Program Implementation

Teaching Environment

• Faculty and preceptors must include patient education as an integral part of each patient encounter to model appropriate behavior for residents, with educational issues incorporated into rounds and precepting discussions 1
• Programs are encouraged to form patient education committees comprising residents, faculty, staff, patients, and community members to design systems for incorporating patient education into model office practices 1
• Faculty demonstrate commitment by including patient education issues in direct resident teaching, with questions about educational matters as part of ongoing case discussions 1

Community Integration

• Programs should maintain current lists of community resources available to supplement patient education provided in the family practice center and promote resident familiarity with these resources 1
• Residents participate in health education presentations to community groups and engage in population health initiatives 1, 5
• Training includes creating culturally appropriate resources that address language barriers, health literacy levels, and ethnic diversity 5

Chronic Disease Management Training

• Residents develop care pathways distinguishing between well-controlled patients (managed in general practice) and higher-complexity patients requiring specialist input or shared care arrangements 5
• Training includes implementing case management systems ensuring continuity across hospital, home, educational, and therapeutic settings, with designated coordinators for medically complex patients 5
• Residents create individualized patient-held medication plans with specific drug information, usage instructions, and regular review schedules 5

Patient-Centered Communication Skills

• Residents learn shared decision-making approaches that elicit patient preferences, values, and priorities regarding treatment options and level of involvement in care 5
• Training includes behavioral counseling frameworks such as the 5A model (assess, advise, agree, assist, arrange) to address medication adherence and health behavior change 5
• Residents develop systems for identifying and addressing barriers to adherence, including patient-related, clinician-related, drug-related, health system, and sociocultural factors 5

Program Variations and Quality Considerations

• Significant variation exists between programs: 7.9% of hospitals do not have residents see hospitalized patients, 6.5% do not maintain outpatient clinics, and secondary hospitals provide less frequent outpatient education and article-writing seminars compared to tertiary hospitals 3
• Some programs have experimented with longitudinal curricula where residents are based in the family practice center nearly every day rather than completing traditional block rotations, though evidence for superiority of this approach remains unproven and some studies suggest block rotations may result in better knowledge acquisition 4
• Newer training models include month-long team-based PCMH (Patient-Centered Medical Home) block rotations with progressive responsibility levels, incorporating quality improvement activities, interdisciplinary teamwork, and population health management 6

Supporting Organizations and Resources

• Key organizations provide resources and support innovation: the Society of Teachers of Family Medicine, American Academy of Family Physicians, Association of Family Medicine Residency Directors, and American Board of Family Medicine have developed resources including Residency Program Solutions, National Institute for Program Director Development, and Family Medicine Residency Curriculum Resource 2
• The Residency Review Committee for Family Medicine of the Accreditation Council for Graduate Medical Education provides the requirements for training throughout the years 2