Prevalence of Clinic First Curricula: A Survey of AFMRD Members

Clinic First residency curricular approaches hold promise as models to successfully prepare primary care residents for future practice. The objective of our study was to estimate the prevalence of the Clinic First model in current family medicine residency training environments, and assess beliefs surrounding curricular structure and postgraduate practice.

An eight-question survey was conducted among Association of Family Medicine Residency Directors (AFMRD) members in 2017. Data were grouped and analyzed for statistical significance and correlation using analysis of variance, Kendall's τ, χ2, and Fisher exact test.

Two hundred-eleven AFMRD members responded to the survey; 27% described their current curriculum as Clinic First; 68% stated that their ideal curriculum is Clinic First. Residents in Clinic First programs spend more half-days in continuity clinic per week compared with traditional programs during PGY1 (1.79, 1.39, P=0.001) and PGY2 (3.18, 2.90, P=0.024). In group analyses, 63% of Clinic First respondents prioritized clinic in developing resident schedules, compared with 8% of traditional respondents (P<0.001). Seventy-four percent of Clinic First respondents described their philosophy as full spectrum, compared with 93% of traditional respondents (P<0.001). Seventy-five percent of respondents listed their graduates' most common practice type as outpatient practice, and there were no differences between groups (P=0.361). Sixty-one percent of traditional respondents stated that their ideal curriculum is Clinic First (P<0.001).

There is a high level of interest in the Clinic First model as a tool to prepare residents for future practice, but barriers to implementation need to be explored and addressed.