President's Report
by Scott A. Fields, MD
It has been an honor to serve as your president over the past year. STFM has been my academic home for the past 25 years. This was a tremendous opportunity to build on the organization’s history of success and to help shape a direction that will serve all of you and our discipline well in the future. I especially want to acknowledge the staff of STFM, without whom nothing of import would likely be accomplished. It is a wonderful team, and we are extremely fortunate to have Stacy Brungardt, CAE, our executive director, completing her first complete year in the role, providing ongoing leadership to the organization.
STFM is composed of a dedicated network of family medicine educators with a diverse background. I have learned much from my colleagues within the organization and will continue to do so in the future. Each of you has the opportunity to take advantage of this group to advance the issues within family medicine education for which you have a passion. By leveraging the expertise that exists within STFM, we each have the opportunity to do more and to do it better than we would on our own.
Visioning Process
One of the most important issues we have been working on for the past 3 years is renewing our mission statement. I believe that it is of great importance because, if done correctly, it should provide a path for our organization for the next 5–10 years. This work happens under the guidance of the Strategic Planning Committee led by the immediate past-president. This process began under the leadership of Bill Mygdal, EdD, in 2006–2007 and continued with Caryl Heaton, DO, in 2007–2008 and John Rogers, MD, MPH, MEd, in 2008–2009. We have followed the visioning process outlined by Jim Collins in Built to Last, which starts with discovering the organization’s core values and purpose.
The committee, with approval of the Board, identified the core values and purpose of STFM.
Core Value
• Integrity
• Relationship centered
• Openness
• Nurturing
• Excellence
• Learning
Core Purpose
• Advancing Family Medicine to Improve Health Through a Community of Teachers and Scholars
In defining our core values and core purpose, we will use them to guide our decisions to assure alignment with our programs and activities.
We defined the overarching goal (BHAG):
To become the indispensable academic home for every family medicine educator
We have identified seven key indicators of our future success as an organization:
1. STFM is seen as the go-to resource and authority for family medicine education across the curriculum thereby attracting and necessitating membership by all family medicine educators.
2. Relationships developed through STFM are essential to the members’ professional well-being, vitality, and growth.
3. STFM is financially independent, has ample resources to meet its goals, and teaches its members how to help their local organizations become financially independent.
4. STFM has successfully demonstrated that excellence in family medicine education is only achieved if our clinicians/learners provide excellent care within progressive practices
5. STFM is an integrated collaborative member of the medical community that government bodies, foundations, and others look to for expertise in practice improvement and the education of the person physicians.
6. The academic family medicine groups are consolidated into one organization.
7. The consolidated academic organization is the authority in community-participatory medical research and medical education.
Finally, we are defining the measures and tactics that will be used to define our successful steps in reaching our goal in the future.
Financial Stability
One of the key attributes of a healthy organization is to have financial stability. I am extremely happy to report that we have finished 2008 with an operating margin of about $60,000. This is critical in a time when our reserves, like most of our institutions, are taking a hit in the market. This success is due to the work and attentiveness of our entire staff and Board, but especially the watchful eye of Chief Financial Officer Dana Greco, CAE, and Accounting Assistant Cindy Burns.
Core Services
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STFM strives to provide value to each of our members. Our goal as noted above is to be the indispensable academic home for every family medicine educator. Membership Services Coordinator Mary Ruhl works daily to help this occur. Our core membership services are our conferences, publications, digital resources library, Web site, advocacy efforts, and opportunities to network and work together with colleagues with similar interests in our groups. None of this would be possible without a superior administrative team. This team includes Executive Assistant Kay Frank, Membership Services Assistant Jean Schuler, Member Services Assistant Jason Jones, and Administrative Assistant Diana Azbill.
The Practice Improvement Conference, Predoctoral Education Conference, Behavioral Science Forum, and Annual Spring Conference continue to provide members with venues for learning, sharing, and interacting with peers. These meetings continue to be successful due to the innovative approaches taken by the Program Committee and the guidance by Meetings and Program Director Ray Rosetta, CMP, and Senior Meeting Planner Priscilla Noland.
Family Medicine and the Annals of Family Medicine are highly regarded peer-reviewed journals that provide members with access to cutting-edge innovation and research, scholarly interchange, and publication opportunities. The STFM Messenger provides timely online updates about STFM activities and other items of interest to members. The publications are facilitated by Publications Assistant Jan Cartwright.
The STFM Web site, which was totally redesigned this year to better serve our members, provides information about the Society and its conferences, publications, and other resources, including a membership directory and list of group members for networking. The redesign would not have been possible without the leadership of STFM staff: Deputy Executive Director Angela Broderick, CAE; Communications Director Traci Nolte, CAE; IT Director Larry Peery; and Web Developer Bruce Phillips.
The Family Medicine Digital Resources Library (www.fmdrl.org) provides online access to more than 1,000 teaching resources prepared by STFM members and available free for use in educational efforts. The Communications Committee has hired a consulting firm to assess the FMDRL user interface and offer recommendations for usability enhancements.
At no time has the advocacy been a more critical issue for our organization. With the new administration, there are opportunities to influence the future of Title VII, AHRQ funding, and the importance of the patient-centered medical home. In addition to your participation as concerned members, we have Government Relations Director Hope Wittenberg, MA, and Government Relations Assistant Eric Gascho, advocating on our behalf on a daily basis.
A major initiative this year was the STFM Foundation Group Grant Program where groups could apply for up to $10,000 for a 2-year project. The STFM Executive Committee, with the assistance of Chief Development Officer Joan Morrill, reviewed the submitted proposals and selected two for funding:
• Online Training in Dietary Supplements for Family Medicine Physician—Group on Integrative Medicine
• Medical School Admission Policies—Group on Rural Health
These and other activities are initiated and reviewed by your Board and Committee chairs. You have been served well by this hardworking group who generously share their passion and expertise: President Elect Terrence Steyer, MD; Past President John Rogers, MD, MPH, MEd; Secretary-Treasurer Alison Dobbie, MD; CAS Representatives Mark Johnson, MD, MPH, and Susan Skochelak, MD, MPH; Members-At-Large Deborah Witt, MD, Ellen Whiting, MEd, and Deborah Taylor, PhD; Executive Director Stacy Brungardt, CAE; Communications Committee Chair Elizabeth Naumburg, MD; Education Committee Chair Jeffrey Stearns, MD; Legislative Affairs Committee Chair Jerry Kruse, MD, MSPH; Membership Committee Chair Sim Galazka, MD; Program Committee Chair James Tysinger, PhD; Research Committee Chair James Gill, MD, MPH; Resident Representative Daisuke Yamashita, MD; and Student Representative Erin Corriveau.
Goals for 2008-2009
When I had the opportunity to share my goals for my year as president, I identified four items of programmatic focus for the year. I would like to bring you up to date on each of these.
1.Development of a budgetary construct for STFM that provides the resources, in an ongoing manner, to invest in projects that move a national educational agenda forward, across the learning continuum.
STFM has made good progress in this regard. First, I want to acknowledge the work of the STFM Foundation with whom we have been able to work collaboratively and move some very important agenda forward. The Foundation provided support for our Family Medicine Clerkship Core Content Curriculum project (C4) and also the grant projects for activities by our Groups On. Additionally, the Board has used the STFM Opportunity Fund to support a scholarly evaluation of our clerkship sites’ adoption of the patient-centered medical home.
2. Creation of a scholarly agenda to transform the educational experiences for our learners, to advance family medicine, and improve the health of our patients within the personal medical home.
Much of the scholarly agenda has revolved around the patient-centered medical home initiative. Below is an outline of many of the initiatives that STFM has led or participated in over the past year:
1) Clerkship Medical Home Initiative: STFM funded a 2-year observational study of the development of medical home teaching clinical experiences for family medicine clerkship students. The goal of the project is to understand efforts to spread the patient-centered medical home model to clerkship teaching practices. Family medicine needs to know the current status of clerkship PCMH clinical experiences and learn how predoctoral programs are attempting to remodel their clerkship clinical practice sites to expose students to the principles of the PCMH model. Jim Gill, MD, MPH, chair of the STFM Research Committee, will present data from the study at our January Board meeting. This study was conducted under the supervision of the STFM Research Committee by investigators at Oregon Health and Sciences University who are also conducting the P4 evaluation. OHSU has evaluated 13 medical schools and their preceptors for this project.
2) STFM/SGIM/APA Project: STFM is collaborating on a project that will plan and implement a national conference on the PCMH. Specifically, the conference will focus on the evidence regarding the PCMH, what we currently know, what we need to know, and how to advance and disseminate this knowledge base. The Society of General Internal Medicine is the lead organization on this project. STFM and the Academic Pediatrics Association are the co-leads.
Scope of Project
The project scope includes three main conferences/meetings:
1. The main conference, which will be an invited conference including approximately 100 participants. This is tentatively planned for the middle of 2009.
2. A planning meeting for this main conference. This planning meeting included the steering committee and took place on October 7, 2008, in Washington, DC. At the planning meeting, the committee identified themes and will commission four to five white papers on the top themes. These papers will serve as discussion points for the main conference.
3. A demonstration project conference was held December 2, 2008. This was an invited conference, where researchers who have done demonstration project evaluations presented their findings. This information will help inform decisions on which themes to select for the white papers.
Participants
Steering committee members will participate in the main conference, along with others that will be invited by the committee to attend. These include representatives from the three primary care specialties as well as research, government, and private industry. A list of steering committee members is attached. Note that there are several individuals representing family medicine, including Jim Gill, MD, MPH (co-PI for STFM); Bob Phillips, MD, MSPH (representing AAFP); Kevin Grumbach, MD; Mike Parchman, MD; Warren Newton, MD, MPH; as well as two TransforMed physicians (Kim Leatham, MD, and Bill Harrington, MD). There are additional family physicians who are representing other organizations (Allen Dobson, MD, and Larry Cassalino, MD).
3) Workshop on Residency Training for the PCMH: On October 25, STFM and the University of South Carolina cosponsored a faculty development workshop in Columbia, SC, called “Training for the PCMH: Integrating Practice Redesign Into the Residency Curriculum.” Elizabeth Baxley, MD, put together a strong team that led the workshop for the 48 participants. This workshop focused on helping residency faculty build their knowledge and skills on the subject of preparing learners for practicing in PCMHs. The presenting faculty own the material presented at the workshop, and STFM is discussing with them other opportunities for sharing this material.
4) STFM/AAFP Conference on Practice Improvement: STFM and the AAFP cosponsored a successful Conference on Practice Improvement, December 4–7, 2008, in Savannah, Ga. Sessions focused on various aspects of the PCMH, and we heard many comments about the quality of sessions at the meeting. Attendance was 341, nearly 100 more than the prior year. We also partnered with TransforMed to offer a preconference session at the conference. Attendees from the preconference workshop were invited to join the TransforMed learning collaborative to have ongoing conversations with others to learn more about how to implement the PCMH.
5) STFM Podcast on the PCMH: STFM launched into the world of podcasts with John Rogers, MD, MPH, MEd, providing an overview of the PCMH and how it relates to training. This was posted October 21, 2008, at http://www.stfm.org/audio/podcast.html.
6) Other PCMH Activities: The PCMH has been or will be the conference theme for our major conferences, including the 2009 annual meeting with the theme “Transforming Education to Meet the Needs of the Personal Medical Home.” We have published several articles on this topic in Family Medicine (including seven president’s columns by Dr Rogers) and the STFM Messenger. There are several documents on the Family Medicine Digital Resources Library that relate to the PCMH. STFM also has an STFM Group on the Patient-centered Medical Home, chaired by John Rogers, MD, MPH, MEd, and Caryl Heaton, DO. This group will serve as a key resource within STFM for furthering the work to establish the PCMH within teaching sites.
3. Facilitate the development of a consensus family medicine clerkship curriculum that can serve as a foundation for predoctoral programs nationally.
Core Curriculum for Third-year FM Clerkships
Our discipline decided that it needed to gain consensus on what should be taught in the third-year family medicine clerkship. After hearing the need from predoctoral directors and others in the discipline, STFM created a task force to develop a national family medicine curriculum for predoctoral education. The Family Medicine Clerkship Core Content Curriculum Task Force (C4) held its first meeting on November 1, 2008, in San Antonio. The task force includes broad representation of critical stakeholders. Members are C4 Task Force Chair Heidi Chumley, MD, Kansas University; fmCASES Representative Alec Chessman, MD, Medical University of South Carolina; ADFM Representative Joseph Hobbs, MD, Medical College of Georgia; AAFP Representative Deb Clements, MD, University of Kansas; AFMRD Representative Tim Munzing, MD, Kaiser Permanente Orange County; and STFM Education Committee Representative Gary Shokar, MD, University of Texas Medical Branch; Group on Predoctoral Directors representatives Katie Margo, MD, University of Pennsylvania; Susan Cochella, MD, University of Utah; and Rob Hatch, MD, University of Florida. The group held a special session at the 2009 Predoctoral Education Conference in Savannah to receive input from interested participants on their preliminary content list. The STFM Foundation has provided $25,000 to support this project.
A draft of the Family Medicine Clerkship Core Content Curriculum document was presented to approximately 60 predoctoral directors and faculty at the Predoctoral Education Conference. The C4 Task Force has already begun incorporating feedback received and will hold another feedback session at the STFM annual meeting. An early draft of the curriculum and an explanation of the process used to create it is available for comment at the STFM Web site, www.stfm.org. Once the input from the predoctoral community has been incorporated into the document, this material will be shared with the family for additional vetting.
Online Cases–fmCASES
The development of a set of online cases to address core curricular content is an important related project of STFM. STFM has partnered with iIntime, a nonprofit institute out of the Dartmouth Medical School, to develop a computer-assisted learning curriculum in family medicine, consisting of virtual patient cases. The project, called fmCASES, is being designed to teach the family medicine core clerkship curriculum in a manner that permits the program to be completed by an average medical student during an average clerkship in family medicine. iIntime has successfully designed online clinical cases for pediatrics, called CLIPPS, and is also working with internal medicine to develop online cases for internal medicine. A Project Development Group has outlined the content and learning objectives of the individual cases and will began training individual case writers at the 2009 STFM Predoctoral Education Conference. The Project Development Group includes Project Leader Shou Ling Leong, MD, Penn State University; Alec Chessman, MD, Medical University of South Carolina; John Waits, MD, University of Alabama, Tuscaloosa; Jason Chao, MD, Case Western Reserve University; and Stephen Scott, MD, Baylor College of Medicine.
NBME Task Force
A third component of the predoctoral education initiative relates to improving the quality of the NBME family medicine examination. STFM, in collaboration with CAFM, has been developing a broader relationship with the NBME. The NBME is developing a task force to facilitate the revision of the examination. Additionally, there was a special session at the Predoctoral Education Conference to identify and begin training of interested test item writers.
The three components of the C4 project, fmCASES, and NBME task force all are part of an overall initiative to improve the standardization of content and improve the quality of the curriculum presented to our learners across the country.
4. Expand the involvement and number of members actively involved in groups, task forces, and projects, internally and externally, on behalf of STFM.
There are a number of ways that we have worked to expand the engagement of our members in activities of import to the discipline and family medicine education. I would like to refer you to the President’s Column in the February issue of Family Medicine: http://www.stfm.org/fmhub/fm2009/February/Scott86.pdf
In that I outline the importance of leadership in trying times such as these and highlight a number of leadership opportunities that have been addressed during the past year. I am also heartened by the commitment of our members to develop new Groups to address issues of common interest. The most recent is the Group on Student-run Health Clinics that developed for 2 years worth of work at the Predoctoral Education Conference. There are now 47 Groups in STFM, each with a special interest and role in the future of family medicine education.
Behavioral Health
One of the more important areas that we have had to engage our members is in the area of behavioral health. There has always been an awareness of the importance of the provision of care in the context of the family and also the critical nature of behavioral health to the care of our patients. For that reason, the need to support our members who are teaching this content has been unwavering. The Board has reaffirmed the importance of behavioral health and care of the family to family medicine education, and we successfully worked with the Group on Family and the Group on Behavioral Medicine to try to identify strategies to meet the needs of our members. Several additions were made to the 2009 Annual Spring Conference to address the needs of this constituency.
The second difficult decision that the Board faced was to whether or not to renew our support of the Behavioral Science Forum. The cost of this conference to STFM is such that we cannot continue to provide the support in the same way that we have in the past. The Board has entered into an ongoing discussion with the leaders of the Forum on how a future relationship might be structured in a way that is beneficial to both groups. STFM has been asked for a formal representative to the Forum program committee. The Board has named Deborah Taylor, PhD, as our representative.
With these two major decisions, we are aware that our STFM members may feel that two important opportunities to meet to discuss issues of family and behavioral health have been lost. For this reason, the Board has been working closely with the Group on the Family and the Group on Behavioral Medicine to better meet their needs. Several positive outcomes form this include:
• A survey has been sent to all group members and other STFM members who have attended the Family Conference and the Forum. This survey was designed by the group leadership with input from the Research Committee in hopes of obtaining information that will provide guidance to the Board.
• The Group on Behavioral Medicine developed Core Principles of Behavioral Medicine, which has been adopted by the Board.
• The Board has been meeting with Collaborative Family Healthcare Association (CFHA), trying to define how we might collaborate. We believe that through collaboration we may be able to better support our members. Finally, we are discussing with our partners in the Council of Academic Family Medicine (CAFM) how we may be able to advocate for the importance of behavioral health in the PCMH.
• Finally, we are discussing with our partners in the Council of Academic Family Medicine how we may be able to advocate for the importance of behavioral health in the PCMH.
CAFM
CAFM is composed of the presidents and executive directors of all of the family medicine academic organizations: Association of Departments of Family Medicine (ADFM), Association of Family Medicine Residency Directors (AFMRD), North American Primary Care Research Group (NAPCRG), and STFM.
Purpose of the Coalition
1. provide a unified and unifying voice for issues of concern to academic family medicine and its constituent organizations.
2. perform an environmental scan, prioritize across issues, speak with a unified voice reactively, and move proactively to confront the issues facing the discipline.
3. address major issues confronting the discipline and will take independent action and/or delegate to individual organizations as appropriate.
4. emphasize action, accountability, and follow through, balancing the need for rapid action with due deliberation according to the needs of the issue.
CAFM meets every 6 months and holds monthly conference calls. At its meeting in January 2009, it finished an environmental scan SWOT analysis and selected priority joint projects for action. The final SWOT analysis provides a context for choosing the joint projects. Four key issues that were identified included:
• Patient-centered medical home: Reexamine focus–what is unique to academic family medicine? How can CAFM relate to PCPCC?
• RRC and Revisiting the Program Requirements in the next year
• Advocacy: Obama Administration–Policy
• Research Advocacy—identify funders, career development awards
In summary
Family medicine is now at a crossroads. Never has your work meant so much to our society. There is an increasing awareness of that fact outside of our discipline and our profession, and a multitude of new opportunities will be coming our way. But with opportunity comes responsibility. We must learn from our mistakes of the past. We must advance family medicine for what it can do for others, not what it can do for us. Our patients will look to us for the compassionate, comprehensive, coordinated care that we represent. Our learners will look to us for guidance as to how to be effective in this new world of team-based care, grounded in science but provided with sensitivity to our patients’ needs. And our colleagues will look to us for inspiration and support. You have given me the rare opportunity to help our discipline and our organization move forward. I am deeply grateful. I believe that we are well positioned with your energy and commitment. I hope to continue to be a voice for our future and a partner in the process.
With gratitude,
Scott A. Fields, MD
President