Annual Report
2001-2002
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Education
THE FAMILY PRACTICE RESIDENCY NETWORK
INTRODUCTION
MISSION STATEMENT
NETWORK PROGRAMS, 2001-2002
NETWORK CHANGES
NETWORK ACTIVITIES
COMMITTEES
FACULTY DEVELOPMENT WORKSHOPS
GRANT FUNDED FACULTY DEVELOPMENT ACTIVITIES
NETWORK CLINICAL FELLOWSHIPS
STUDENT TEACHING
SITE VISITS AND INTERNAL REVIEWS
FINANCIAL INFORMATION
MALPRACTICE COVERAGE
TELECOMMUNICATIONS AND TECHNOLOGY
WWAMI NET/WORK
WYOMING AFFILIATION STATUS
The University of Washington Family Practice Residency Network is one of the largest and most successful residency networks in the United States. The high quality of individual programs is reflected in the number and caliber of applicants and residents, the excellence of faculty and staff, and the strong support of sponsoring hospitals.
This report describes Network activities during the year July 1, 2001 through June 30, 2002. This is the 30th year of the Network’s operation. The Network now comprises fifteen residency programs in Washington, Alaska, Montana, and Idaho. Washington programs are located in Bremerton (Naval program), Olympia, Renton, Seattle (Group Health Cooperative, Swedish First Hill, Swedish @ Providence, and University of Washington Academic Medical Center), Spokane, Tacoma, Vancouver, and Yakima. Two programs are sited in Idaho (Boise and Pocatello), one program in Billings, Montana, and one program in Anchorage, Alaska.
The decentralized governance structure is now well established. Executive Committee members, an ALSO (Advanced Life Support Obstetrics) Coordinator, an Informatics Chair, and a Behavioral Science Chair each received partial financial support for their Network roles. Network resources were expended to facilitate both in-person and electronic communication and collaboration among faculty and staff with similar roles across programs.
Network residencies continued to receive a high level of interest from medical students during 2001–2002. Civilian programs received, on average, 314 applications and conducted an average of 76 interviews. Excluding military programs, 103 R1 positions were filled, with a Network average of 42 applicants per position. One hundred twenty-six physicians graduated from Network programs during 2001–2002, bringing the total number of Network graduates to 1,702. Based on early 2000 data on civilian graduates, 56% practice in Washington State, while 15% practice in Alaska, Montana, and Idaho. Approximately 31% practice in communities with populations under 1,000. Almost all (94%) are board-certified in Family Practice, with nearly 80% in active practice.
The following mission statement, drafted by the directors in November 1992 and revised in June 1998, summarizes the identity and purpose of the Network:
Who we are: The University of Washington Family Practice Residency Network is a group of family practice residency programs, represented by their directors, related to each other by geography and university affiliation.
Why we exist: The Network strives to promote excellence in Family Practice residency education, to provide academic leadership, and to respond to societal needs for family physicians.
What we do: The Network promotes growth in Family Practice residency training and development of quality educational programs.
WASHINGTON
Central Washington Family Medicine, Yakima
Family Medicine Spokane
—RTTs: Colville, Goldendale
Family Medicine of Southwest WA, Vancouver
Group Health Cooperative, Seattle
Providence/St. Peter Hospital, Olympia
Swedish @ Providence Family Practice Residency, Seattle
—Seattle Indian Health Board
—Sea Mar Community Health Center
Swedish First Hill Family Medicine, Seattle
—45th Street Community Clinic
—Downtown Family Medicine
Tacoma Family Medicine
—Puyallup Valley Family Practice
UW Family Practice Residency, Seattle
—Harborview Medical Center
Valley Medical Center, Renton
WASHINGTON MILITARY
Puget Sound Family Medicine, Bremerton
ALASKA
Alaska Family Practice Residency, Anchorage
IDAHO
Family Practice Residency of Idaho, Boise
—Caldwell RTT
Idaho State University, Pocatello
MONTANA
Montana Family Practice Residency, Billings
—Glasgow RTT
—Missouri River RTT
The Network has expanded rapidly in recent years, both in number of programs and number of residents per program. The informal structure present since the Network’s founding in 1972 was replaced in 1995 with a new structure, to improve communication and facilitate decision-making. An Executive Committee includes five elected positions: President, Vice President, Finance Chair, Education Chair, and Member-at-Large, and the Network Director and Administrator (ex officio). Elected individuals serving terms on the Executive Committee during 2001–2002 were:
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Dr. Michael Maples (Yakima), President
Dr. Gary Newkirk (Spokane), Vice President
Dr. Lisa Johnson (Olympia), Education Chair
Dr. Jonathan Cree (Pocatello), Member-at-Large
Dr. Harold Johnston (Anchorage), Member-at-Large
Network restructuring also established a mechanism for residency programs outside the state of Washington and the military program to contribute financially to the support of Network infrastructure and programs. As a result, all affiliated programs share in decisions affecting resource allocation.
The Network maintained a number of core functions centrally in support of its mission of training family physicians in the WWAMI region.
Core Faculty and Staff
The Network Director/Fellowship Director, Department Administrator, Network Manager, two technology and telecommunications specialists, and four support staff have comprised the Network administrative team.
Directors Meetings
Residency Directors from affiliated programs met quarterly, three times in the Seattle area and once in Kansas City (in conjunction with the National Family Practice Program Directors annual meeting). This year the sharp increase in malpractice premiums, part of a liability crisis facing all physicians in the region, led to the University's proposing a cost sharing of premiums with program sponsors. This crisis dominated director business this year. Curricular, faculty development, information systems, financial, and administrative issues were addressed as well. Particular attention was paid to Network-wide communication, analysis of Benchmarking and graduate follow-up data, tracking resident procedures on hand-held computers, and developing a residency administration system. After a year of use, the MedNav residency administration system was replaced by New Innovations, which is more likely to meet Network and program needs.
Changes in local health systems continued to have major effects on residency program operations. An important function of Directors meetings has been to share strategies for maintaining high quality educational programs in highly competitive health care environments. Program Directors and Administrators further refined practice benchmarks and productivity standards to be used by all residency programs as alternatives to commonly used benchmarks that are inappropriate for residency training settings.
Faculty and Staff Meetings
Program Administrators: Network Program Administrators met in December 2001 at the University to discuss progress on the Network benchmarking tool. Dr. Judy Pauwels was hired to work specifically on this project, and she presented the preliminary analysis of the revised and simplified tool she had worked on with every program to complete. The meeting served to identify errors and discrepancies in the data, and each program committed to correcting and clarifying data. Dr. Pauwels then completed a new data analysis and presented the results at the Residency Assistance Program meeting in Kansas City in March 2002. Dr. Oliveira presented them at the National Program Directors meeting in Kansas City in June 2002. A manuscript describing the study was submitted to Family Medicine and has been accepted for publication.
Behavioral Sciences Faculty: Network funding continued to support behavioral sciences faculty and their physician colleagues through sponsorship of meetings and inclusion in Network activities. A conference presented in October 2001 on "Genetics in Primary Care" was attended by 38 faculty. The Behavioral Sciences Chair served on the Network's Education Committee and was instrumental in developing the Chief Resident Conference presented in June 2002.
Behavioral sciences faculty planned and successfully integrated ongoing continuing education into their bi-annual meetings. The group continues to actively share best practices and curricular materials, fostering an increase in collaborative teaching designs throughout the Network.
Program Coordinators: Network Program Coordinators met at the Valley Family Practice Residency, Renton, Washington in March 2001 to share experiences and solve problems of mutual concern. Topics included RAP Updates, Palm Pilot Project (tracking resident procedures with hand-held computers), and the Mednav residency administration system.
Program Nurse Managers: Network Nurse Managers met on October 29, 2001 at Family Medicine of Southwest Washington in Vancouver. Some of the topics covered were scheduling systems, numbers of clinic visits/patients seen, no-show rates, role of RNs in residency training, JCAHO reviews, and Network-wide communication.
Education Committee: The Education Committee, chaired by Dr. Lisa Johnson, supervised faculty development activities, including oversight of grant-funded programs such as the Faculty Development Fellowship and the Evidence Based Medicine project. The committee continued to survey program directors and faculty to identify topics of interest, and then worked to provide programs in these areas. The ALSO Coordinator for the Network was a member and presented plans and strategies to this group. The committee was actively involved in planning the annual two-day Chief Resident Conference and the Director Development sessions occurring the day before each Directors meeting. Directors Development sessions concerned topics of mutual concern to directors, such as funding of residency education, future of Family Medicine, insurance coverage / risk management, the Mednav residency administration system, and student recruitment. This committee provided recommendations to the Executive Committee and Directors on funding educational programs.
Executive Committee: As Network President, Dr. Maples served as Chair of the Executive Committee during 2001–2002. Among the agenda items were Network involvement in national legislative activity, marketing issues, agendas for Directors meetings, and affiliation and internal reviews, but malpractice insurance coverage dominated the year.
The annual Collaborative Care Conference attended by behavioral scientists and their physician colleagues was held in October 2001 and centered on “Genetics in Primary Care.” A 2002 Collaborative Care Conference focused on “Management of Diabetes” was planned for October 2002.
The Network again offered an opportunity for faculty to increase their skills in Evidence Based Practice. This year’s topic was answering clinical questions using evidence based sources to create publishable answers for the Clinical Inquiries feature in the Journal of Family Practice. Dr. Jim Stevemer and Susan Meadows, a medical librarian from the University of Missouri, Columbia were the invited speakers for the day-and-a-half session. This workshop was preparatory to the Network joining FPIN, the Family Practice Inquiries Network, and its objective was to provide expanded knowledge and skills in Evidence Based Practice. The EBP training included a half-day session on “Teaching Faculty to Do Family Practice Inquiries Network (FPIN) Reviews.” A full- day course giving an overview of FPIN (JFP Clinical Inquiries), DynaMed, Prime Answers, and Quest followed this.
In June of 2002, we held our third annual Chief Residents Conference. Residents from nearly all Network programs attended this workshop, and residents and directors continued to be very positive about the ability of the program to prepare Chiefs for the year ahead.
GRANT FUNDED FACULTY DEVELOPMENT ACTIVITIES
A new federally funded Faculty Development three-year continuation grant began in July 2001, enabling the Faculty Development Fellowship program to complete its 15th successful year during 2001–2002. Five weeks of on-site intensive training in Seattle were combined with a year-long project focused at each Fellow’s residency program. In addition to continuing the Fellowship program, we made proposals in this grant for strengthening faculty development at our geographically remote affiliated residency sites. These consist of courses conducted on site as well as using a televideo interface. Asking faculty to complete a needs assessment survey tool enhanced planning for the courses at each site. Another component of the grant is a train-the-trainer program for selected faculty leaders from various clerkship sites in our region. Training focuses on four key areas: 1) student advising and career choice; 2) evidence and population-based medicine; 3) patient-centered care; and 4) clinical teaching.
The Tacoma and Spokane programs offered fellowship training in Rural Family Medicine and Obstetrics, respectively. The Tacoma program graduated four Fellows in 2002, for a total of 57 graduates, at least 80% of whom are practicing in small rural communities (under 10,000 population) with full Obstetric privileges. The Spokane program graduated two Obstetrical Fellows during 2001–2002. The University of Washington's Sports Medicine Fellowship had one graduate, while the Sports Medicine Fellowship for Boise remained unfilled for 2001–02. Swedish First Hill, in the second year of their Geriatrics Fellowship, had two graduates in 2002.
Most residency sites participated in the clerkship required for University of Washington medical students, usually one student per six-week rotation. All residency programs have medical student training opportunities.
SITE VISITS AND INTERNAL REVIEWS
Internal reviews assist Network programs in program evaluation, curriculum development, and preparation for accreditation reviews. They also provide for an exchange of ideas that helps to strengthen Network programs.
Several RRC reviews were conducted during 2001–2002 including: Alaska Family Practice Residency, Anchorage; Montana Family Practice, Billings; Family Practice Residency of Idaho, Boise; Idaho State University Family Practice, Pocatello; Puget Sound Family Medicine, Bremerton; and Swedish First Hill Family Medicine, Seattle. All reviews were successful with full accreditation received. Internal reviews were completed for Group Health Cooperative Family Practice Residency, Seattle; and Swedish @ Providence Family Practice Residency, Seattle.
Allocation and oversight of Washington State Support funds (both SB2619 and Primary Care Training, formerly SB5304 funds) were provided by the Family Practice Education Advisory Board (FPEAB) appointed by Governor Gary Locke. In disbursing Primary Care Training funds, the FPEAB was advisory to the Vice President for Medical Affairs and Dean of the School of Medicine, Paul Ramsey, MD. The Network Regional Revenue account, funded by affiliation payments from the military and non-Washington civilian programs, funded travel and support of activities and services provided to the contributing programs.
The University of Washington continued to pay the premium for eligible Network programs to receive medical liability coverage under a commercial policy from Physicians Insurance. Due to a very large increase in premium, the University, represented by Associate Deans John Coombs MD, and Andy Ziskind, MD, began discussions with the Executive Committee and Directors about cost sharing of the premium with individual program sponsors. An agreement was reached to propose to all sponsors a stepwise increase in cost sharing to reach a maximum of a 50/50 premium split. This change will require an addendum to all affiliation agreements, and the process of accomplishing this remains for the 2002–2003 year.
TELECOMMUNICATIONS AND TECHNOLOGY
Network funding has made videoconferencing available to all Washington State programs. The televideo systems in the Network are well suited for remote training, didactics, precepting, presentations, and telemedicine. Some programs use this technology a lot, and others have not adopted it as fully.
The FirstClass email communication system continued to grow and improve. Multiple electronic conferences received daily use. Swedish Family Medicine relied increasingly on FirstClass in an effort to move to a paperless office. Other programs used FirstClass for email communication, collaboration, and sharing of files and didactics.
Palm OS handheld computers continued to be the standard for resident procedure documentation in 2001–2002. Pendragon software was used throughout the Network to make Palm systems easier to use and to produce reports more effectively. Dr. Chris Vincent continued working with the Pendragon/Palm system and deployed it to Network programs. Some sponsoring institutions made systems changes, requiring a restart of this system to keep it functional; continued compatibility and training issues will be an ongoing management challenge for the Network.
WWAMI NET/WORK, the Network’s newsletter advertising Family Practice opportunities throughout the WWAMI region, was published bimonthly during 2001–2002 . Readership consisted of current residents and graduates of affiliated residency programs, as well as a growing number of subscribers seeking practice locations in the WWAMI region. Circulation exceeded 2000 during this period. This year each issue contained a report of some aspect of the Graduate Followup Survey. WWAMI NET/WORK also continued to be published electronically on the Network’s website. Electronic publication made the updating of ads more timely and proved to be a cost-effective means of expanding the WWAMI NET/WORK’s audience.
Discussions continued with the two established Wyoming residency programs in Cheyenne and Casper regarding potential affiliation with the Network. Now that the University of Wyoming’s WWAMI program for medical students is well established, the University of Wyoming’s focus is on graduate medical education in Wyoming. As part of this review, the Network and the WWAMI program provided faculty to do site reviews at the Casper and Cheyenne residency programs for the University of Wyoming. Wyoming program directors were invited to Network Directors meetings, and the new Casper director, Karen Wildman, came to the March and June meetings.
Program highlights from each of the residency programs are available from the Network office at 206-685-1856.
Home URL: http://www.fammed.washington.edu/