Areas of Concentration (AOCs) are an identified educational method of customizing and enhancing resident education and encouraging the natural development of resident interest and expertise in a focused area, while maintaining a strong commitment to comprehensive generalism in family medicine.
Building off of the 2007 AFMRD Guidelines for Individual Areas of Concentration, our model emphasizes an institutionally coordinated approach to the step-by-step process of choosing, developing curricula for, and ensuring the maintenance of AOCs which are of uniformly high educational value.
“Intentional diversification” through a specific enhanced curriculum has been attractive to medical students and residency programs (Nash 2008). This has been implemented in a variety of ways with various terminologies – tracks, areas of concentration, areas of focus, majors, etc. In 2007, the Association of Family Medicine Residency Directors (AFMRD) developed a guideline for what should define and be the essential elements of an area of concentration (AFMRD 2007). This work was largely based on work done by the P4 Project, where many programs included areas of concentration in their innovations. The challenge for many programs is how to take these guidelines and implement locally appropriate areas of concentration that have equivalency of educational value across what can be very diverse topic areas. From our experience, we have defined important steps when developing areas of concentration including:
Institutional criteria for choosing which AOC’s to develop.
Defining the degree of flexibility to be offered with regards to individualization of AOC’s.
Developing uniformity of curricula across AOC’s to ensure equivalency of educational value.
Developing curricula aligned with ACGME competencies and with measurable outcomes.
The incorporation of research, QI, community medicine, and scholarly activity into Area of Concentration curricula.
The logistics of scheduling block time and longitudinal time for the AOC curricula.
The establishment of timelines and deadlines for the various AOC curricular components.
The inclusion of opportunities for “resident-as-teacher”, information mastery, and EHR enhancement as an expectation of AOC curricula.
A coordinated institutional approach to tracking resident progress and portfolio maintenance.
Areas of Concentration (AOC’s) allow family medicine residents to diversify their educational experience beyond traditional elective time. The transition to four year residency training offers residents an even more in-depth exposure to, and a more expanded breadth of training in, their chosen AOC.
Some Background Reading on Areas of Concentration:
Pugno PA “One Giant Leap for Family Medicine: Preparing the 21st-Century Physician to Practice Patient-Centered, High-Performance Family Medicine” JABFM March–April 2010 Vol. 23 Supplement. S23-27. Click here
Crownover B, Crawford PF. “Areas of Concentration Increase Scholarly Activity” Family Medicine 2008; 40(2):87-90. Click here
Nash LR and Robinson MD. “Areas of Concentration in Family Medicine Residencies”. Family Medicine 2008. 40(9):614-615. Click here
AFMRD Guidelines for Individualized Areas of Concentration (2007). Click here
National Presentations by LFMR Faculty on Areas of Concentration:
Luby R, Barr W, Gravel J. “A Practical Guide to Developing Areas of Concentration- Experience at a Community-Based Residency” 2015 STFM Annual Spring Conference, April 2015, Orlando, FL Click here
Gravel J, Barr W “Areas of Concentration” 2016 AAFP Program Directors Workshop, March 2016, Kansas City, MO (submitted proposal)
At Lawrence FMR we recognize that high quality healthcare is only one component of a healthy community.
Health leaders, particularly those committed to addressing health disparities and promoting health in vulnerable communities, must understand and be prepared to intervene upon the social and environmental determinants of health. As the first residency administered by a Federally Qualified Health Center and a leader in the teaching health center movement, we see our residents as leaders in a future where collaboration across sectors to improve community health will be the norm.
The curriculum emphasizes experiential learning. Beginning during orientation and continuing throughout their training, residents leave the clinical setting to interact with public and private community health stakeholders in Lawrence. While recognizing the challenges facing Lawrence as a low-income, urban, immigrant community, we emphasize an asset-based approach to community health change. In Lawrence we are fortunate that a culture of collaboration for community health change has been built over many years, and LFMR and the Greater Lawrence Family Health Center have been key stakeholders over the past 3 decades. Each new class of residents builds on that foundation when the pursue community health work outside of the clinic.
We at LFMR consciously recognize the tremendous resources in terms of knowledge, skills, and passion that our residents bring as members of the Lawrence community. Our goal with the community medicine experience is to grow those resources by creating opportunities for residents to pursue and develop their non-clinical health related interests. We hope that by protecting time during all four years for residents to engage in community health work, we are able to nurture a spirit of solidarity with the community we serve and graduate family physicians who will spend a lifetime pursuing health justice in underserved communities.
The Community Medicine curriculum has 5 major components:
Outpatient Clinical Experiences. Hands-on clinical and public health oriented experiences outside of our health center.
Class Conferences. Interactive and didactic learning experiences in social medicine, clinical care for vulnerable populations, and population approaches to health.
Community-Based Placements. Residents are paired with community based organizations or with a community project within the health center based on their interests and experiences. A longitudinal relationship allows for resident learning and collaboration in community health promotion.
Community Medicine Components of Areas of Concentration. Residents integrate community oriented education activities and patient-oriented health advocacy into their overall AOC experience. Our goal is to normalize these health-promoting activities of a community physician as resident progress through residency and transition to practice.
Area Health Education Center (AHEC) Youth Mentoring.
Community Medicine C
Outpatient Clinical Experiences
Integrated Experiences: Clinical experiences include those integrated into other outpatient blocks, including Tuberculosis clinic with the Department of Public Health and working at our health center’s school-based clinic during the Adolescent Health block. Residents participate in early intervention evaluations and Head Start assessments during Pediatric Development block. During the Addiction block, residents work with LFMR faculty at a local methadone clinic, and participate with group therapy for patients transitioning from the county correctional system.
Community Medicine Longitudinal Experiences: A separate Community Medicine block includes core experiences in community health. Residents spend time with clinical social workers both in their own clinic, and doing street outreach to the most vulnerable in our city. Residents participate in local municipal public health functions such as food and housing inspections, as well as nutrition education at our local WIC (Women, Infant, and Children) offices. Residents attend meetings of the Lawrence Mayor’s Health Task Force (Massachusetts Dept of Public Health Community Health Network Area 11), where they have an opportunity to network with vibrant community of public health stakeholders.
Elective Outpatient Experiences: A menu of optional experiences is also available during outpatient community medicine time. Residents may get a taste for other public health oriented work by experiences such as accompanying our public health nurse on DOT rounds with active TB cases, or spending a session in our hospital’s occupational health clinic. Other residents have chosen to spend elective clinical time pursuing more intensive experiences focusing on vulnerable populations such as with our own 13 site Healthcare for the Homeless program, training in refugee healthcare and assessments, and special training in transgender care.
Community Medicine Class Conferences
Conferences are targeted at the learning needs of residents as they progress through the four year curriculum. Initially, the focus is on patient care for vulnerable populations, and taking advantage of community resources in working with individual patients. Community medicine is also integrated with more traditional teaching in afternoon symposia that address such issues as intrapersonal violence, education, and asthma. As residents progress through the four years, the focus broadens to look more at population-based approaches within the clinic and in the community. Residents learn how to access, collect, and use population health information.
Residents are paired with one of a number of partner organizations and initiatives that are related to community health and active in the Lawrence community. Residents become experts in their area of community partnership, and develop connections and outside of the clinic. During outpatient blocks throughout each of their 4 years, residents are given half day sessions to spend with their community partners. The resident is expected to learn about the health promoting assets that exist in Lawrence in their area of community placement, and share that knowledge with other residents and clinicians. Quality improvement, research projects, grant proposals, new programs, and even new municipal legislation have evolved from community partnerships.
Below are examples of partner organizations and areas of focus:
Healthy food and green space/environmental health
Greater Lawrence Community Action Council:
Head Start health committee, WIC nutrition, lead program
Addiction Services, methadone
Lawrence Youth Team:
Youth violence prevention
Lawrence Public Schools:
Science education, school health, teen pregnancy prevention
Merrimack Valley YMCA:
Community-based promotion of physical activity. Support for LGTB youth
YWCA of Greater Lawrence:
Women’s health disparities, support of victims of domestic and sexual violence
Lawrence Community Works
Economic development, housing, promotion of social networks
Sexual and reproductive health
GLFHC Prevention and Education Department
Engaging homeless and substance using populations in care, harm reduction
GLFHC Doula Project
Training and creating pilot program that provides doula support for laboring GLFHC patients
City of Lawrence Board of Health
Participate in Board of Health meetings, contribute background research, draft new public health ordinances
Community Medicine Components of Areas of Concentration (AOC)
Each resident’s Area of Concentration includes a community medicine component, with required elements of community health advocacy and community based education.
Building on their own knowledge and the networks of the faculty, residents engage in advocacy activity that will promote the health of our community. This can take the form of writing a letter to the editor, calling members of congress, or taking a leadership role in national advocacy organizations. We think advocacy is an integral skill for working with the underserved, and most residents come to Lawrence having been involved in health advocacy. By carving out time and creating a structure to engage in advocacy during residency, we support residents in continuing this vital work in their careers.
The community education experience within the AOCs also gives residents mentored experience in culturally appropriate and effective communication. Through this experience, residents practice their communication skills, while improving the collective health knowledge of the community we serve. The experience also allows our residency to enrich the programmatic offerings of our partner organizations by making more available the expertise of our resident physicians and faculty. We hope the end results are better prepared family physicians and a more informed and empowered population.
Area Health Education Center (AHEC) Mentoring
At LFMR we believe that one key to eliminating health disparities is to engage the youth of Lawrence and mentor them in their professional development. The Greater Lawrence Family Health Center is fortunate to be home to the regional AHEC program. Each year, area youth who are part of the high school internship program at GLFHC spend an afternoon a month during the school year with members of the first-year residency class. Residents provide formal education based on the youths interest, and engage in formal and informal career mentoring.
The Lawrence Family Medicine Residency is committed to preparing residents to serve underserved people, wherever they are, in both high and low resource environments.
We believe global health experiences are an important part of our residents’ preparation for this mission, a mission which transcends national boundaries. Lawrence, Massachusetts proudly calls itself “The City of Immigrants” and is a gateway to the US for many of our patients; gaining insight outside the US healthcare context is therefore valuable. In addition to our Spanish curriculum, we believe cultural competency is an important trait of an optimally trained family physician. There is also no better way to experience a bit of what our patients feel as new immigrants by spending time in a non-English-speaking country, with a different culture.
These rotations are distinct from our Spanish immersion curriculum, which take place at language schools in Central and South America and Mexico, as well as our first year resident class trip to the Dominican Republic.
Although we do offer an Area of Concentration in Global Health, virtually all Lawrence residents participate in our global health curriculum during their residency. Our global health experiences are characterized by several important qualities:
Global health experiences are led by core Lawrence Family Medicine Residency faculty, who work with our residents (1-3 at a time) in an ongoing medical clinic or hospital. The depth of the medical and cultural experience for residents is therefore much deeper than a “medical tourism” approach to global health.
Our faculty members all have a very long-standing relationship with these communities that go back many years; in some cases the faculty member held a previous full-time job there prior to coming to Lawrence.
We offer a wide variety of types of medical experiences, all with a particular “flavor” of curricular emphasis besides the different countries and cultural immersions. For example, our Guatemala rotation emphasizes hospital and maternity care, our Nicaragua and Nepal rotations both feature remote rural experience, our Zambia rotation an HIV/ID emphasis, and our Ghana experience has a surgical emphasis.
“Resident as Teacher” is a major component of all our global health rotations- we want our time there to transcend our presence. Project sustainability and empowerment of those we serve are our overriding goals.
Residents may, of course, set up independent rotations in other countries depending on their interests or career goals.
Global Health Elective Rotations with Lawrence Family Medicine faculty:
(in alphabetical order)
Ghana Global Health Elective
LeadFaculty Member: Vince Waite, MD MPH TM, (15 years of previous full-time practice at the designated clinical site)
Location: Nalerigu via Gambaga, Northern Region, Ghana, West Africa
In country affiliate – Baptist Medical Centre – Established nearly 60 years ago, The Baptist Medical Centre in Nalerigu is a respected mission hospital located in the Northern Region of Ghana. It was founded through the joint efforts and vision of the Ghanaian Baptist Convention (Gold Coast Baptist Conference) and the International Mission Board (Foreign Mission Board at that time) in 1958. In 2014, the IMB handed the hospital over to the Ghana Baptist Convention who now manage and maintain it. Currently the BMC is a 123 bed hospital whose reputation brings people from as far south as Accra, as far east as Togo and Nigeria, and as far north as Burkina Faso and Mali. Most recent yearly statistics are as follows: 60,000 outpatient visits, 10,000 inpatients, 1,200 major operations, and 2,500-3,000 minor procedures. www.baptistmedicalcenter.org
What we bring: As volunteer physicians, we provide basic support in covering inpatient and outpatient services. We also help contribute to the overall educational mission of the hospital by sharing in regular teaching sessions and skills development workshops with local healthcare workers.
Why we go: Residents experience the practice of medicine and surgery in a radically different, resource limited practice situation. They improve clinical diagnostic and treatment skills, without the usual diagnostic support of modern medicine. Residents also improve surgical diagnosis and procedural skills, and gain experience in Clinical Tropical Medicine and Surgery.
What do residents do? : The elective provides a 3 week cross-cultural experience in Tropical Medicine and Surgery in a very rural African District Health Hospital in Ghana. The Resident will rotate through all the services of the hospital including general medicine, pediatrics, obstetrics, and general surgery. An emphasis will be placed on general surgical principles. The Resident will participate in the evaluation and treatment of patients in both the outpatient and inpatient settings.
Other parts of the experience: When not working, residents also have opportunities to explore the surrounding community and observe Traditional Healers.
Guatemala Global Health Elective
Lead Faculty Member: Andy Smith MD MPH- lived and worked in this community for 2 years besides recurring service trips
Location: Santiago Atitlan – the largest indigenous community in Latin America, set on the banks of Lake Atitlan in the western highlands of Guatemala
In country affiliate – Hospitalito Atitlan – a non-profit private hospital serving the local Tzutujil community of 50,000-60,000 as well as a larger catchment area. H.A. provides 24 hour emergency, inpatient and maternity care and is the only facility that can provide inpatient obstetric and hospital care within 2 hours.
What we bring: As volunteer physicians, we provide basic support in covering inpatient and outpatient services. We also help contribute to the overall educational mission of the hospital by sharing in regular teaching sessions and skills development workshops with local healthcare workers.
Why we go: We hope to foster in residents an appreciation for the challenges and joys associated with global health work while working alongside the local healthcare providers in their remarkable mission of bringing healthcare to a vibrant but often oppressed people.
What do residents do?: During the 3 week elective, residents work in all the hospital settings. Typically a resident would take call every 4th or 5th night and be in clinic 2 or 3 other days. Additionally residents help by doing outreach clinics to more remote villages, being on call for transfers and deliveries and helping with any visiting surgical teams.
Other parts of the experience: When not working, residents can explore the rich culture of the town, climb nearby volcanoes or work with a Spanish tutor to sharpen language skills.
Nepal Global Health Elective
Lead Faculty Member: Rob McKersie MD
Location: Dhading Region, Nepal. The Dhading Region is north of Kathmandu and stretches to the Tibetan border. 340,000 people live in its 50+ remote villages that are only accessible by foot. We will be trekking to three of these villages (Tipling, Shertung, and Lapa) over a two-week period in the spring and fall of each year. The trek will encompass trekking in the Himalayan Mountains over two high passes (14,000 ft).
In country affiliate: Himalayan HealthCare, Inc. HHC is a non-profit, non-denominational NGO founded in 1992. HHC provides primary health care, education, and income generation assistance to people living in remote and impoverished regions of Nepal, not reached by government and non-government organizations. HHC encourages local participation and involvement in all of its programs to ensure sustainability. Above all, HHC strives to help people help themselves.
What we bring: Our positive spirits, strong backs, collaborative can-do attitude, and willingness to trek into one of the most remote and beautiful mountainous regions in the world.
Why we go: There is a need: Nepal is ranked 157 (out of 187 countries) on the WHO’s Human Development Index and has some of the world’s poorest healthcare indices (IMR, MMR, under-five mortality rate). In addition, giving residents an opportunity to experience healthcare delivery in a challenging international environment is rewarding for both the residents and the recipients of their care.
What do residents do? During this 3-week elective, residents will practice evidence-based and competent medicine at three medical camps. The Residents will be part of a medical team, comprised of 10 other medical clinicians and 60 support staff, who will see patients in a primary care setting at rural clinics. We will work alongside; teach, in both informal and formal settings, (and learn from) HHC’s Nepalese healthcare providers that work in the village health clinics year round.
Residents will have an opportunity to meet traditional healers as well as work with local providers who have knowledge of medicinal remedies.
Other parts of the experience: Residents will have two days before and after the trek to enjoy Kathmandu and the rich cultural experience it has to offer. All participants, prior to the trek, will have a full-day tour of Kathmandu’s many wonderful cultural sites. Participants can also extend their stay in the region and experience a multitude of outdoor activities the country’s tourism industry offers: bungee-jumping, white-water rafting, tours of national wildlife parks, etc. Traveling to India has also been a destination of past participants.
For Personal Account of HHC’s Earthquake Relief Efforts by LFMR faculty Dr Rob McKersie click here
Nicaragua Global Health Elective
Lead Faculty Member: Tony Valdini, MD
Location: For over 10 years, we have been returning to Mongallo, Nicaragua, a pueblo outside Siuna (airstrip) in the Northeast Autonomous Region [RAAN] in a health post, “puesto de salud.” The catchment area of this subsistence-farming community located on the edge of the rainforest, is approximately 16,000 persons who live on less than a dollar a day. Public health infrastructure does not yet include “running water,” electrical power is rare, and only some homes have latrines.
In country affiliate – Our partners are many in the Siuna area: “Bridges to Community” an NGO from North America with an office in Siuna, “Hermanos por la Salud,” started by one of our former residents and based in Mongallo, and most importantly, the MINSA – Nicaraguan Ministry of Health. The latter is our referral source; they staff a hospital in Siuna, providing emergency care, general surgery, obstetrics, GYN and orthopedic services. Disease-specific clinics in TB, Malaria and Leischmaniasis are also held in Siuna.
What we bring: As volunteer physicians, we provide basic outpatient services in an area that does not receive physician visits. We are involved in case-finding (diabetes, hypertension, seizure disorders and pediatric anemia) and organizing referrals. Additionally, we help with supply chain and outreach medical care, transporting the health post nurse (for immunizations, prenatal care and contraception) and ourselves to field clinics in remote areas rarely or never served by physicians.
Why we go: We also hope to foster in residents an appreciation for the challenges and joys associated with global health work and an appreciation for what can be done by committed indivicuals whose laboratory faciaities are powered only by batteries. The mission of bringing healthcare to people who otherwise would not be able to access it makes the trip worthwhile. Since medications are “free,” if you can get to the health post, Alexandrina the health post nurse can get meds for patients “for life” once their diagnoses are discovered and recorded.
What do residents do?: During the 2 week elective, residents work in the health post and various field clinics in “more remote” settings. Typically, residents work 10 clinic days in the 14 day trip. There is no overnight call and no inpatient experience.
Other parts of the experience: We live with a family on a farm in the community and work with Nicaraguan “translators” from Bridges who serve as cultural brokers. After two weeks of clinic sessions residents spend a day and a half at a Pacific Ocean beach in San Juan del Sur, before getting on the plane to return home. Of course, all interactions with patients are in Spanish.
“Top Down Nica” Powerpoint (.pptx) on education system: Top Down Nica.
Zambia Global Health Elective
Lead Faculty Member: Chris Bositis MD MPH
Location: Lusaka, Zambia (the Zambian capital, population 1.7 million)
In country affiliate – University Teaching Hospital – a large tertiary care center that is the main referral hospital for the entire country. In addition to working with the UTH staff physicians, we partner with in-country faculty from the University of Maryland School of Medicine, who provide UTH with technical support with running their postgraduate HIV and ID training programs, as well as with their advanced HIV treatment center.
What we bring: Enthusiasm and humility, as we work alongside our experienced colleagues providing inpatient and outpatient care primarily for HIV-infected adults and adolescents. We also provide teaching sessions for the Zambian physicians in training.
Why we go: To experience the challenges and joys of working in a resource-constrained health system with a significant disease burden; to provide support for, and foster collaborative learning relationships with, our Zambian colleagues; to inform our understanding of what healthy, cross-cultural collaboration in the global health context should look like (NOT “medical tourism”).
What residents do?: During this 2 week elective, residents typically spend one week in the outpatient HIV clinic (including time in the “3rd-line treatment” clinic for patients who have failed multiple HIV treatment regimens), and one week in the inpatient setting working with the ID consult team. Residents have also spent time working in the ER, the neurology referral clinic, and other outpatient clinics.
Other parts of the experience: Residents have used their free time, or extended their time in country, to explore the incredible natural resources in Zambia including the Victoria Falls and a large number of national wildlife parks. We also try to cultivate relationships with our colleagues in country by sharing meals and experiencing traditional Zambian hospitality whenever possible.
Residency programs must prepare residents to practice in a transforming healthcare system, providing curricular experiences that traditionally have not been part of residency education but need to be.
Our residency is committed to preparing residents not just for the next 3-4 years but for the more distant future as well. We are committed to preparing residents to be leaders and patient advocates, not only able to adjust to changing practice environments and a changing healthcare system but to lead it on various levels to a better place.
We believe that family medicine is the specialty most aligned with achieving the “Quadruple Aim” – improving the health of populations, improving the patient experience of healthcare, reducing the cost of health care, and maintaining joy in our practice. Higher quality and lower cost can only be achieved by understanding not only care for the individual patient but also understanding (and improving) the current healthcare delivery system. Understanding that context in which family physicians practice and patients receive care, and in fact acquiring leadership and management skills in this context, is the best chance to achieve a truly value-based, patient-centered healthcare system.
The Health Systems Management curriculum has 5 major components:
Residents are based in an NCQA Level 3 Patient-Centered Medical Home (PCMH) practice in a team based setting. Teams are composed of family medicine faculty attendings (residents are paired with their advisor), residents, NPs, RNs, MAs, Patient Service Representatives (front desk personnel), pharmacists, outreach coordinators, and mammography personnel. Teams meet regularly to work toward improving population based health care and patient experience of care in the clinic.
Thursday afternoon class conferences (with associated readings) on HSM topics (see category list below).
Class-based scheduled experiential Health Systems Management individual activities (with associated readings), 10 per year for 4 years.
Weekly HSM journal club
6 week Clinical Chief block rotation for all 4th year residents.
In addition, residents with special interest in Health Systems Management, often intending to serve HSM-related leadership roles in the future, may participate in the Health Systems Leadership Area of Concentration.
Our residency’s PCMH is organized into 4 teams, named Amarillo (Yellow), Azul (Blue), Rojo (Red) and Verde (Green). Teams are located in one of 4 “pods” at our Haverhill Street residency practice location. There are two residents per class on each team, as well as three to four attendings. Clinical support personnel (NPs, RNs, MAs, PSRs, pharmacy, mammography) are assigned to teams as well so that residents get to know team members very well. Teams are further subdivided into teamlets, so as to provide a smaller working group. Patient registries and the team’s clinical performance measures for each team are regularly reviewed and PDSA cycles implemented to improve operational efficiency and clinical quality.
The PCMH model promotes partnerships between patients and their family physicians. The PCMH creates a medical team who will provide for all of a patient’s health care needs and will coordinate treatments across the health care system. Patient Centered Medical Homes demonstrate the benchmarks of patient-centered care by implementing open scheduling, extended clinical hours, and an effective use of current and expanded health information systems. To receive recognition, GLFHC demonstrated the ability to meet the program’s key elements. They include appropriate use of charting tools to track patients and organize clinical information, responsive care management techniques, as well as advanced use of information technology for prescriptions and care management. The standards are aligned with the joint principles of the Patient-Centered Medical Home established with the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, and the American Osteopathic Association.
Thursday afternoon conferences (TACOs) – HSM
Interactive residency class-specific HSM conferences are held on Thursday afternoons interspersed with other medical topics. First year conferences provide foundational HSM knowledge and skills, advancing to higher degrees of complexity through the fourth year. Residents also attend the MassAFP’s Family Medicine Day at the State House in Boston to learn and practice advocacy skills important to advocate for system change for patients’ benefit.
Experiential Health Systems Management individual scheduled activities
Expertise in Quality Improvement is an increasingly important skill set for those leading practice-based learning and improvement efforts. Besides the professionalism and medical ethics aspect of providing the highest quality care in the safest way possible for patients, the US healthcare system is currently undergoing transformational payment reform that will better value those physicians practicing in such a way so as to achieve the Quadruple Aim. Particular emphasis is therefore placed on training residents to be able to be leaders in QI in their future practices.
Specific curricular areas include performance measurement and improvement, quality and safety, community health center operations and governance, payment systems and finance, regulatory and medical-legal aspects, organizational culture and behavior, management skills and communication, leadership, care redesign and population health management, project management, health systems and policy, advocacy, data driven decision making, and personal and career management. Residents are scheduled for 10 different half-day sessions in each of the 4 years of residency.
HSM Journal Club
Residents participate in a weekly journal club on a chosen health management topic. The club is facilitated by the medical director or a senior resident.
Clinical Chief block rotation (6 weeks) in 4th year
The LFMR Clinical Chief block is scheduled during the fourth year of residency to integrate previous Health Systems Management learning into a “capstone” management and leadership experience. The Clinical Chief works closely with the residency practice site’s Medical Site Director and Site Operations Manager on all facets of running a CHC practice, from strategic planning to “nuts and bolts” daily operations.
Health Systems Leadership (HSL) Area of Concentration (optional)
The mission of the LFMR is to provide all residents with the skills to provide medical care and medical leadership in the emerging new healthcare system, particularly in underserved communities. The Health Systems Leadership AOC is designed to provide additional knowledge, practical skills, and leadership competencies for those residents who wish to extend the reach of what they can do to affect more people through leading Community Health Centers or other healthcare organizations. The current transformation of the US healthcare system provides an unparalleled opportunity for family medicine to assume a leadership role; the goal of the HSL AOC is to prepare residents to lead in this effort. Residents completing the HSL AOC curriculum will be especially well prepared to play an important role designing and implementing future healthcare delivery models in underserved communities, and advocating for system change and healthcare reform to achieve the “quadruple aim” for all. Residents doing the HSL AOC will attend external practice improvement and health system related conferences, do a HSL- related scholarly activity project, read and discuss additional materials in the medical and business literature, work closely with GLFHC practice administration and medical leadership for real-world experiences and skills implementation.
The Lawrence Family Medicine Residency, the nation’s first Teaching Health Center in 1994, is committed to providing residents not only strong clinical experience but also an academic environment for residents that encourages the creation and dissemination of new knowledge.
Our culture of innovation and our strong connections and integration with the community actually offer superior opportunities to produce community and primary care-oriented research. We do not see “Scholarly Activity” as an ACGME-requirement to check-off but rather an obligation to our community and our residents to strive for excellence. For family medicine, a Teaching Health Center organizational structure provides a great foundation for scholarly activity. With EHRs, research is increasingly becoming more easily “doable” in community health centers like ours (with 55,000 patients, 270,000 visits annually) rather than exclusively academic health center environments that often do not mirror a family medicine-served patient population.
The residency is currently actively engaged in our specialty’s Length of Training national demonstration study, and so our residency itself is being studied by the study’s evaluation team from OHSU in Portland, OR. Surveys our residents are completing about their experience will be published in the family medicine literature. Our two affiliated medical schools (UMass and Tufts) offer additional academic resources besides the Research Division we have built over the years here in Lawrence. Our residency remains one of the country’s most active participants in academic presentations at national family medicine education meetings; both residents and faculty are strongly encouraged to regularly present their work outside of Lawrence, at national, regional, and statewide family medicine meetings.
For Lawrence FMR Research Projects Overview: click here
For Lawrence FMR Academic Meeting Presentations (2010-2015): click here
For Lawrence FMR Publications (2010-2015): click here
Goal and Objectives:
The mission of the Lawrence Family Medicine Residency is to train family medicine physicians to provide patient-centered care for underserved populations. Our own patient population is predominantly Spanish speaking; our goal therefore is for each resident to complete residency proficient to provide medical care in Spanish without the need for an interpreter. Our focus is on verbal Spanish language skills.
Overview of the Curriculum:
It is neither expected nor required that residency applicants speak Spanish- just a desire to learn. LFMR has a nationally-known Spanish acquisition track record- residents here invariably develop strong Spanish communication skills by the end of their first year of residency and continue to build throughout their residency training.
10-day intensive language program at Dartmouth College (using the Rassias Method®) during orientation in June/July prior to seeing any patients. (http://rassias.dartmouth.edu/)
On site Spanish teacher/translator. A now retired high school Spanish teacher (Pat Donahue) provides scheduled one- on-one lessons for residents and shadows residents in their continuity clinics throughout their first year (and beyond if desired) for real -world instruction.
Each resident is paired with a bilingual medical assistant who provides language and cultural interpretation throughout residency.
The best way to learn a language is daily immersion (with support) – majority of patient interactions are in Spanish (with MA interpreter present in exam room in clinic).
First year residency class trip to the Dominican Republic which functions as an opportunity to see and experience the country of origin of half our patient population- as well as to have a break in the middle of winter in a tropical setting! Residents use 1 week of vacation time to attend, with most expenses covered by the residency (many choose to use their CME to cover the balance).
First year residents are encouraged to participate in a 2 week language elective to obtain both cultural and linguistic training in a Spanish-speaking country. The program provides funding to support the elective.
Components of the Curriculum: R1 Rassias® Spanish training (1.5 weeks) – Dartmouth College, Hanover, NH
Entering first year class attends this 10 day course together at Dartmouth; tuition, room & board covered by residency.
Rassias Method® is a unique approach that speeds language learning, increases language retention and has you speaking and understanding in “Ten days that make a difference”.
Originally developed for Peace Corps training, it has been adapted by language teachers in North America, Europe, Africa and Asia.
Instruction is individualized to meet each resident’s needs, from those with no Spanish language at program entry to those with advanced Spanish proficiency.
In addition to the 10 day intensive Spanish Rassias course at Dartmouth College during Orientation, and individualized instruction in Lawrence throughout the year, the residency provides a supported Spanish language school experience during the R1 year to acquire important cultural as well as linguistic experience.
Residents select the language school from a list of recommended overseas schools in the Caribbean, Mexico, and Central America.
On site Spanish teacher/translator. A (now retired) high school Spanish teacher provides individualized lessons for residents and shadows residents in their continuity clinics for real -world instruction.
Resident is paired with a bilingual medical assistant who provides language and cultural interpretation throughout residency.
The best way to learn a language is immersion (with support) – majority of daily patient interactions are in Spanish, so residents can get lots of practice!
R1 Spanish Class Trip to Dominican Republic (1 week)
First year residency class trip to the Dominican Republic is an opportunity to see and experience the country of origin of half our patient population- as well as to have a break in the middle of winter in a Carribbean tropical setting! Residents use 1 week of vacation time to attend, with most expenses covered by the residency (many choose to use their CME to cover the balance). Significant others welcome!
GLFHC's patient population is predominantly Spanish speaking. Our goal is for each resident to provide medical care in Spanish without the need for an interpreter. As a Lawrence Family Medicine resident, you will learn to be proficient in verbal Spanish language, building a deeper, more connected relationship with patients.
High quality healthcare is only one component of a healthy community. Health leaders, particularly those committed to addressing health disparities and promoting health in vulnerable communities, must understand and be prepared to intervene upon the social and environmental determinants of health. Lawrence Family Medicine residents are leaders in a future where collaboration across sectors to improve community health will be the norm.