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From the Association of Family Practice Residency Directors

TEACHING TOMORROW’S LEADERS TODAYThe Association of Family Practice Residency Direc-tors (AFPRD) is a proud sponsor of the Annals of FamilyMedicine. The AFPRD’s mission is to promote excel-lence in family practice graduate education in order tomeet the health care needs of America. The Annals ofFamily Medicine is a much needed and welcomed publi-cation that will provide the research and evidence weneed to fulfill our mission.

As this year’s AFPRD President, I have chosen thetheme, Teaching Tomorrow’s Leaders, Today. Our resi-dency programs have the important responsibility ofcreating the learning environment from which thefuture leaders of family medicine will emerge. Ideally,in this environment residents would learn because theywant to, not because they are forced to, and the wholeorganization is designed to facilitate the learningprocess. In this environment, learning should be ateam effort, including the faculty and staff as well asthe residents. In his book, The Fifth Discipline, PeterSenge calls this kind of environment a learning organi-zation. Senge defines a learning organization as “anorganization that is continually expanding its capacityto create its future.” He goes on to say that while sur-vival is necessary, it is not sufficient for a learningorganization. He sees learning as an inherently cre-ative process, making the hallmark of a learning organ-ization one “that enhances our capacity to create.”1

One of the most creative expressions of learningis research. However, engaging residents in researchis among the toughest challenges we face as direc-tors. It is becoming increasingly important that wemeet this challenge, because doing research is one ofthe best ways to teach the new Accreditation Councilfor Graduate Medical Education (ACGME) compe-tency of practice-based learning and improvement.The ACGME defines this competency as follows:“Residents must be able to investigate and evaluatetheir patient care practices, appraise and assimilatescientific evidence, and improve their patient carepractices.”2 The Annals of Family Medicine was createdto publish research that facilitates practice-basedlearning and is the best journal to help teach thiscompetency.

To stimulate residency programs to develop theirresearch curriculum and ultimately contribute to theAnnals, we hope to highlight residencies that havedeveloped successful research programs in future issues

of the Annals. In this way, we can all learn from eachother in our quest to develop and become learningorganizations.

Robin O. Winter, MD, MMM, CPE

President

Association of Family Practice Residency Directors

References1. Senge P. The Fifth Discipline. New York, NY: Currency Doubleday;

1990:14.

2. Accreditation Council for Graduate Medical Education. ACGME Out-come Project. Available at: http://www.acgme.org/outcome. AccessedJune 14, 2003.

From the American Academy of Family Physicians

IMPROVING CARE, ONE STUDY AT A TIME

The AAFP is front and center when it comes toresearch to improve patient care, thanks in part to theefforts of its National Network for Family Practice andPrimary Care Research.

The mission of the network is to discover betterways of caring for patients, and its research projectsactively seek answers to the problems that confront pri-mary care physicians. Currently, several studies are invarious stages of development in its research pipeline.

“Infrastructure funding from the Academy for theresearch network has been critical to the network’searly successes,” says John Hickner, MD, MS, networkdirector.

The AAFP Board of Directors approved the planfor the network 4 years ago. Since then, the networkhas published the results of 2 studies, the first onpatient safety and the other on the bioterrorism pre-paredness of family physicians. Several more manu-scripts are near completion.

Be it through the study of pneumococcal immu-nizations in older adults or the assessment of treatmentbarriers for hepatitis C, the Academy is actively seek-ing answers to the problems that confront physiciansin their practices. “Simply put, the AAFP recognizesthe importance of research in primary care settings,”says Hickner. He has overseen many of these projects,including the first 2 described below.

Here is an overview of current projects:Pneumococcal Immunizations Among Older

Adults. Data collection began in August 2002 for this2-pronged study. The first goal of the study is to com-pare the use of handheld computers with traditional

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paper methods for data collection by medical staffs in25 practices. The data will be analyzed to investigateefficiency, quality, timeliness of data collection, anduser satisfaction. The second goal of the study, fundedby the Agency for Healthcare Research and Quality, isto define what segments of the adult population olderthan 65 years have received pneumococcal immuniza-tion, a vaccine that is recommended for elderly per-sons. Coinvestigators Richard Zimmerman, MD, andGregory Doyle, MD, plan to develop an interventiontrial to increase immunization rates.

Hepatitis C Survey of Family Physicians. This survey was devised with the knowledge that manypatients have undiagnosed hepatitis C. The researchwill be used to study family physicians’ clinical prac-tices in screening for, diagnosing, and treating hepa-titis C. Data are being compiled and analyzed fromsurveys that were sent to about 1,000 members of theAAFP as well as 243 network members. Participantswho completed the 30-item instrument were askedquestions ranging from which blood tests they use forscreening to their opinion of the risk of hepatitis C tosociety. By determining barriers to treatment, theresearch might help improve care for patients at riskfor hepatitis C. Barbara Yawn, MD; Jonathan Temte,MD; and Elizabeth Clark, MD, are coinvestigators forthe 9-month study, funded by Schering, which beganin January 2003.

Streamlining the Internal Review Board Process.Protecting human research subjects is of critical impor-tance to network researchers, who strive to balancethat concern with the need to conduct meaningfulstudies. The time it takes to complete the internalreview board process varies from one institution to

another, and because physicians might be affiliatedwith their own separate, local internal review boards(IRBs), there are often duplicative reviews that takeanywhere from a few weeks to a few months. Thehope that the review process could be improved wasthe impetus for this project. The desired outcome is todevelop reciprocal agreements between the network’scentral IRB and network physicians’ local IRBs and todesign a more efficient method of obtaining approvalfor physicians not affiliated with the network’s IRB.James Galliher, PhD, is principal investigator for thisproject.

Other Projects. The research network has alsoundertaken studies on improving patient safety, whichwere covered more fully in the premiere issue of thisjournal. In addition, the network is planning the firstnational Ambulatory Primary Care Patient Safety Con-ference. It will be funded by AHRQ and will be heldcooperatively with the Primary Care OrganizationsConsortium in September 2003 in Chicago. The meet-ing will bring together patient safety leaders from pri-mary care organizations to examine ways to improvepatient safety across all of the primary care disciplines.

In addition to studies on patient safety and thebioterrorism preparedness of family physicians, othernetwork projects have been completed. To date, net-work researchers have studied diabetes outcomes, alco-hol screening, and cancer care. “As with most descrip-tive research studies, these initial studies have gener-ated more questions than they have answered,” saysHickner, “ensuring that we have many more projectsfor the future!”

Toni LappAAFP News Department

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