Middlesex Health Family Medicine Residency

Kimberly Legere-Sharples, MD, MSMEd, FAAFP, Residency Program Director
Yadira Acevedo, MD, FAAFP, On-site Evaluator/Project Lead
Problem Statement:
The traditional, 3-year Family Medicine residency poses significant time constraints given the ever-growing complexity of medicine and individual learner interests
Proposed Solution

A fully integrated, 4-year program, allows for additional learning encounters, an enhanced core-curriculum, and learner flexibility to develop additional areas of interest
Our 4 year Curriculum
Nation’s first comprehensive, mandatory 4 year residency program
Implemented 2007
Enhanced core for all and “track time” for individualization
- 7 additional core rotations- peds, OB, sports medicine
- 28 weeks of tracks spread through PGY-3 & 4
- Emphasis on broad scope, continuity, and clinical volume
94 4-year graduates
Core Experiences
Additional Pediatrics and OB
- Helps residents develop the confidence necessary to continue this care in practice
- Counters national trends towards eroding scope of practice
Practice management and systems medicine
- Allows residents to be successful in practice
- Adds value to their employers
- Prepares graduates to become leaders
Tracks of Excellence
- Pregnancy and Newborn Care
- Integrative Medicine
- Academics
- Global and Community Health
- Behavioral Medicine
- Geriatrics and Palliative Medicine
- Sports Medicine
- Lifestyle Medicine
- Personalized
Our Key Measures
- Applicants per offered position
- Match rates
- USMLE Step 2 score of applicants and matched candidates
- ABFM In-Training and Certification performance
- Resident attrition rates during training
- Resident clinical experience volume
- Resident continuity of care
- Resident achievement of FM Milestones
- Resident satisfaction with training
- Residency community engagement
- Graduate satisfaction with practice
- Graduate scope of practice
- Graduate location of practice
- Graduate preparation for practice as perceived by both the graduates and their future employer
- Program financial performance
- Patient care delivery measures (referral rates, total cost of care, ambulatory sensitive ED visits/hospital admits, and patient experience)
So Far, our 4-year graduates. . .
- High levels of resident and graduate satisfaction
- Substantially more clinically confident
- Choose broader scope practice
- Use the skills acquired in their tracks in practice
- In strong demand in employment market
Additional Clinical Volume
- While competency is important, there is no substitute for substantial clinical experience
- Our graduates have substantially more than 3 year residents
- 2600 outpatient encounters
- 1600 adult inpatient encounters
- 140 newborn encounters
Expected Impediments
- Nationwide physician burnout
- Variation in resident engagement and clarity of goals
- Maintaining the right balance between core activities and track interests (cake vs. frosting)



Expected Enablers
- 17 years of experience being a 4-year program
- Strong institutional support
- Specialist commitment to teaching and providing opportunities

Competency Based Medical Education
- Assess the residents ability to achieve high-level milestones reflecting their progress towards clinical mastery
- Competency-based skills assessment for procedural training
- Direct observation and OSCE assessment
- Given the heterogenous nature of the activities in each resident’s area of concentration, individual learning plans and assessments will be required
Issues Needing Assistance
Developing competency-based evaluation tools
Our Inspiration
