Central Maine Medical Center Family Medicine Residency has a long history of using “Clinic as the Driver” to guide our education. Historically, this has included several areas of improvement including: the creation of clinical teams, a simplification of clinic schedules, a consistent resident half day in the clinic, and the introduction of a clinical huddle and brief didactic sessions. In addition, we developed an outpatient family medicine rotation that featured a slowed down clinical schedule to allow for more teaching via small group sessions on various Family Medicine topics. Our inpatient service was also modified to implement alternating weeks (inpatient/outpatient) and a team discharge group we now call “Safely Home.” This concept of “Clinic as the Driver” led to an interest in learning more from others that were applying “Clinic First” concepts to drive residency education.
By joining the AFMRD Clinic First Collaborative we sought to learn more about best practices for team-based care and how to better implement “Clinic First” concepts. Through meetings and webinars we were able to learn about successes and challenges to implementation, which helped us to brainstorm new approaches to how we are educating our residents.
Our program decided to apply for a waiver through the ACGME to allow us to pilot a 2+2 model, in which our PGY2 and PGY3 residents would spend 2 weeks on inpatient, followed by 2 weeks in their outpatient continuity clinic in an effort to have better continuity and less disrupted care in the outpatient setting. Unfortunately, our health care system has had a number of recent challenges which have resulted in a higher than usual turnover of staff and faculty and these plans have been delayed as a result. We did however, see the importance of focused, less disrupted care and committed to eliminating clinic time while residents are on inpatient rotations, which is consistent with the 2+2 model.
The AFMRD Clinic First Collaborative has been informative through in person meetings, webinars and email networking. We have been able to gain insight into best practices of “Clinic First” concepts. Our team will continue to move forward with these concepts despite some of the challenges we have encountered, as we see tremendous value in a Clinic First model for Family Medicine education.