Preparing the personal physician for practice (p⁴): site-specific innovations, hypotheses, and measures at baseline

This study's purpose was to describe the innovations, hypotheses being tested, and measures used in residency training redesign in 14 family medicine residencies associated with the P⁴ project.

We conducted a content analysis of site visit reports to identify and categorize the curricular innovations that are part of the P⁴ Project. Similarly, we cataloged specific hypotheses to be tested and both site-specific measures and core measures collected by the evaluation team to assess hypotheses.

Selected P⁴ programs include three university-based programs; three community-based, university-administered programs, and eight community-based, university-affiliated programs. These 14 programs had 24 continuity clinics, and 334 residents were enrolled in the baseline cohort (2006--2007). Between two and five innovations were proposed by programs in the baseline period linked to 70 planned hypotheses, with a range of three to seven hypotheses (mean of 4.5). Seven programs (50%) focused on Patient-centered Medical Home practice redesign, and seven (50%) assessed different aspects of a 4-year curriculum as the two most common innovations. Team-based care and team training were tested in six programs, and five tested an individualized curriculum tailored to each resident. Eight programs submitted 11 grants, and six programs were successful in obtaining funding to support P⁴ activities. The sources of funding primarily included the Health Resources and Services Administration, US Department of Health and Human Services, and local foundations, and the mean number of dollars attained was $659,528 (range=$50,000--$2,500,000). Seven grants were received through local sources, totaling $3,219,884 with an average of $459,983 per program.

The P⁴ project had a successful launch and to date has retained all 14 programs that started in 2007. Though no direct funding was provided by P⁴ to individual sites, all have focused on important contemporary challenges for training excellent family physicians, all are engaged in important evaluations, and nearly half have successfully obtained project funding to support their specific P⁴ activities during the baseline period.