Innovating Within the ACGME Regulatory Environment Is Not an Oxymoron

BACKGROUND AND OBJECTIVES: The aim of this study was to describe the analysis of program citations and cycle length for reaccreditation in the 14 family medicine residencies participating in the P4 project. METHODS: An exploratory narrative analysis was conducted on all actions taken by the Review Committee for Family Medicine (RCFM) between 2003 and 2012. The analysis included cycle length and types of citations associated with accreditation actions. Several validation steps were undertaken to confirm findings reported. RESULTS: Mean cycle length for all P4 programs was 4.0 before P4 (2007) and did not change significantly during P4. The average number of citations per program before P4 was 6.2, and during P4 the average was 6.8. The P4 averages were similar to national norms during the project period. The citations that most commonly decreased during the P4 project were: Continuity of Patient Care/ Inpatient, FMC Patient Population/Patient Volume, Orthopedics or Sports Medicine Curriculum, Resident Final Evaluation, Resident Workload/Duty Hours, and Resident Attrition. The citations that most commonly increased during the P4 project were FMC Patient Population/Demographics, Certifying Exam Scores, and Management of Health Systems Curriculum. CONCLUSIONS: Innovation and redesign of residency training in the P4 programs appears not to have affected the average cycle length or number of citations per program. The current regulatory environment in family medicine residency education appears to allow for innovation and experimentation.