For the past 5 years, I have been intimately involved with the Family Medicine Accelerated Track, or FMAT, at Texas Tech University Health Sciences Center School of Medicine (TTUSOM), so I’m always interested when an item lands in my Twitter feed or inbox about 3-year medical school curricula. As a result, it’s been hard to ignore the irony of not one but two Perspective articles in the September 19 New England Journal of Medicine (by Abramson et al.) and (Goldfarb and Morrison) and at least one prominent blog post (by Pauline Chen), all prompted by NYU’s launch of a 3-year pathway to the MD—and just as I was preparing for the AAMC meeting in Philadelphia that had as its theme “The Change Imperative.”
At TTUSOM, we’re not simply talking about the imperative for change in medical education, we’re implementing it through our FMAT program. In fact, TTUSOM Dean Steven Berk, MD, and I had the privilege of delivering one of the keynote presentations at the 2013 STFM Conference on Medical Student Education in which we described the FMAT program as we see it: a “disruptive innovation” in medical education. As a business model, a disruptive innovation—like Twitter, the iPad, or even the retail clinic—is that new thing that creates a new market or network, disrupting or fundamentally changing the old. Such innovations are often greeted with skepticism and grumbling about inferior quality, but the innovations that truly have the imperative for lasting change eventually create new networks.
By way of background, TTUSOM’s FMAT program was approved by the LCME in February 2010 and recruited its first class in 2011—eight students who graduated from TTUSOM in 2013 and who are currently flourishing as first-year family medicine residents in TTUSOM programs in Lubbock and Amarillo. Three additional classes are currently in training and we are recruiting the next. FMAT students complete the same curriculum as do their peers in the traditional curriculum with the following exceptions: an 8-week systems-based intensive experience after the MS1 year, a longitudinal and enhanced family medicine clerkship in the MS2 year, an 8-week capstone course in the MS3 year concentrating on inpatient experiences, and no fourth year. Of the 24 students in our first three classes who began FMAT training, two transitioned back to the 4-year curriculum due to academic challenges. No students have left the program because they had a change of heart about family medicine (which they may do at any time and return to the 4-year curriculum), although we know we will face that loss eventually.
What should be most apparent, especially to readers of this blog, is the “FM” that begins the program’s acronym: FMAT is specifically targeted at reducing shortages in the primary care physician workforce—which can be guaranteed only through increases in family medicine. Like NYU’s 3-year program, ours provides a seamless transition between medical school and residency training, but unlike NYU’s program, FMAT was developed by and is focused on family medicine. The program is also eligible for the NRMP’s family medicine accelerated track exception to the new “All-In” residency rules. Abramson et al point to the need to reduce student debt. We contend that debt reduction is especially important to students interested in primary care; thus, FMAT reduces debt from tuition and fees by 50%, both by eliminating one year of training and from scholarship support provided by TTUSOM.
So, a few final observations about accelerated training from our Texas cowboy boots on the ground:
- We argue that the most logical deployment of 3-year curricula is to bend the curve toward primary care—the very thing that makes the innovation disruptive. That disruptive curve is possible by reducing student debt, developing mentoring relationships between students and family medicine faculty and residents, and—if we’re honest—eliminating a year of training that can often be corrosive to primary care.
- And speaking of the MS4 year, both Chen and Golfarb and Morrison look back fondly at the fourth year of medicine school as valuable for pursuing electives and interviewing at potential residency sites. However, for students who have chosen a specialty (family medicine) and a residency program (one affiliated with TTUSOM) where they have already received extensive mentoring from program faculty, the fourth year is less important and may even dilute their intensive third-year clinical experiences.
- Also of critical importance in the FMAT acronym is the “A” for accelerated—a measure of time. Fast-paced programs offer few opportunities for remediation; the decision to enter the program requires the maturity of an early decision but also a goal of entering the workforce earlier; and the ability to succeed requires motivation and excellent time-management skills. So an accelerated program is not for every student,or for every student interested in family medicine. Some students need all 4 years to develop competencies and determine career goals, and some—as we’ve all seen—need even more. On the other hand, because the challenging nature of an accelerated program requires high-achieving students who can manage multiple demands, the result is a new level of prestige that is clearly recognized within the confines of a medical school’s ecosystem.
At TTUSOM, we look forward to continuing to tell the FMAT story. Our first graduates took their in-training exam last week, so in a few weeks we’ll review those results. Until then, we can report that the addition of an accelerated family medicine training model within an established medical school creates an opening for educational innovation and new methodologies that are the very example of an Imperative for Change in medical education and for delivery of health care.
Are you considering an accelerated training model at your medical school? What are your reasons for or against this model? Let me know here or reach me on Twitter @betsygjones.