Mercy Family Medicine St. Louis

Sarah Cole, DO, FAAFP, Program Director

Kara Mayes, MD, On-site Evaluator/Project Lead

Problem Statement:

  • Primary care physicians historically receive more training in evaluation and management of conditions associated with obesity than they do in evaluation and management of obesity itself.
  • Obesity is an increasingly common disease in the United States, with a prevalence of 41.9% among US adults & 19.7% among United States (US) children and adolescents.
  • The number of current diplomates or candidates to the ABOM are insufficient to address the management of patients with obesity and its associated conditions and their geographic distribution may be skewed toward tertiary care or academic research centers.
  • Some insurers may limit access to specialty care for obesity management.

Proposed Solution

Extension of Residency for Mercy Family Medicine St. Louis Residents

A Mercy Family Medicine St. Louis resident who is anticipated to meet ACGME FM-RRC requirements for graduation within the 36-month length of the program may opt to extend their residency to 48 months. This extension involves completing an additional 12 months of residency training with an area of concentration (AOC) in community-based primary-care obesity management.

Obesity Medicine Fellowship Council Core Training Requirements

These 12 months will meet the recommendations set by the Obesity Medicine Fellowship Council to provide core training in adult and pediatric medical obesity therapy. The training will include lifestyle-based and surgical obesity training, as well as didactics on the science and clinical aspects of obesity.

Curriculum Structure for the Area of Concentration (AOC) in Obesity Medicine

The AOC’s 12-month curriculum will consist of 70% Obesity Medicine experiences and 30% continuity clinic within the Family Medicine Practice (FMP).

Hypotheses

Baseline

  • Family medicine physician trainees desire additional residency training in management of obesity.

Intermediate range

  • Participants who complete an AIRE PGY-4 with AOC in obesity management will achieve diplomate status with the ABOM.
  • Participants will rate their satisfaction with the program and readiness for post-graduate practice in obesity management highly.

Long term

  • Participants will continue patient care and advocacy and/or research in community-based obesity management in post-graduate practice.
  • Participants will track rates of obesity and associated conditions in their communities, with special attention to vulnerable populations, in post-graduate practice.

Our Key Measures

A primary outcome of the innovation is certification with the ABOM.

Secondary outcomes include residency continuity clinic practice patterns and AIRE participant post-graduate practice patterns that effectively

  1. Reduce community rates of obesity & associated conditions,
  2. Reduce community health disparities in obesity management,
  3. Advocate for health policy that reduces obesity or barriers to obesity management, and
  4. Contribute to research (including process improvement) in community based, primary care-led obesity management.

Expected

Impediments

  • Alternate pathway to ABOM certification that does not require extension of residency training may inhibit recruitment & enrollment
  • Development of CBME tools by key faculty/residents
  • Integration of CBME tools by all faculty/residents

Expected

Enablers

  • Robust patient population for OM clinic
  • Community partners requesting assistance with vulnerable populations
  • Inaugural resident champion

Competency Based Medical Education

  • Use of OMEC Milestone-based assessment in addition to ACGME-FM Milestone-based assessment during CCC reviews
  • Work-based assessment of both Primary Care and OM clinic such as chart review, ARCH model of feedback, daily shift cards or Assessment of Reasoning Tool or Measuring Motivational Interviewing Skills
  • Quarterly quality metrics of primary care patient panel in alignment with institutional quality metrics AND biannual calculation of percent change BMI for OM Clinic panel
  • Monthly patient satisfaction survey data for both Primary Care & OM clinics
  • Structured self-reflection and problem-based learning activities

Issues Needing Assistance

  • Post-graduate survey development
  • Adaptation to new ACGME-ABFM core outcomes
  • Faculty development
  • Recruitment & retention
  • Resident co-design

Our Inspiration

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