January 26, 2017

Residency Program Selected for “Clinic First” Honor

A site visit from the nation's leaders in the "clinic first" education initiative will help the residency program accomplish this transition. 


Family Medicine residents gathered around a table.
University of Michigan Family Medicine Residents

The Ypsilanti site of the Family Medicine residency program was selected as a recipient of a site visit by the Transforming Teaching Practices group. This visit will be focused on the “clinic first” initiative that the residency program has started implementing.

The program was one of 20 primary care residency programs selected around the country.

Margaret Lekander Dobson, M.D.
Margaret L. Dobson, M.D.

“This opportunity allows us to further our efforts in training the next generation of Family Physicians, in a model with proven best practices to highlight and value residents in their teaching clinics,” said Margaret L. Dobson, M.D., assistant professor and residency program director.

The site visit will be conducted by a team from the University of California, San Francisco’s Center for Excellence in Primary Care and their Transforming Teaching Practices team.  The team will visit the Ypsilanti Health Center this spring.

“Clinic first” is a new thought process in the education of primary care residents. It stemmed from the systematic issues that were observed in primary care residency programs including dysfunctional clinic operations, lack of continuity of care, frustrated patients and frazzled residents. The leaders behind “clinic first” promote a reversal of the traditional residency paradigm of “hospital first and clinic second” to “clinic first and hospital second” or prioritizing ambulatory care and continuity of care.

Leaders in this movement have highlighted five building blocks to move towards a “clinic first” program including:

  1. Engaged leadership
  2. Resident Scheduling
  3. Resident Engagement
  4. Team-based care
  5. Continuity of care 

Our residency program has been working towards this goal since June 2016. Some of the trial transformations our residency team has made are centered around team based care, resident engagement and continuity of care.  This has included time for residents in one site to manage their own gaps in preventive care, for example focusing on asthma action plans or pap smears, and time to fit these patients into their clinic.

At the other site residents have been included in discussions of complex patients, with our complex care navigator, and are encouraged to bring their own complex patients for this multidisciplinary discussion.  Once these pilots are completed we intend to use them to develop best practices and to inform roll out across both sites.  Future targets might include resident scheduling, and resident engagement.

Read more about “Clinic First” in “The Road to Excellence for Primary Care Resident Teaching Clinics” found in Academic Medicine.

Look for more exciting news on this program following the visit from the Transforming Teaching Practices group.