Goals and Objectives

The Bristol Family Medicine Residency Program was established in 1976 with the primary mission to help meet the need for more primary care physicians in Upper East Tennessee and Southwest Virginia, medically underserved areas. The training of family physicians, primarily for rural and small town practices, continues to be the fundamental goal of the program.

According to the American Academy of Family Physicians' definition, "Family physicians possess unique attitudes, skills, and knowledge which qualify them to provide continuing and comprehensive medical care, health maintenance and preventive services to each member of the family regardless of sex, age or type of problem, be it biological, behavioral, or social. These specialists, because of their background and interaction with the family, are best qualified to serve as each patient's advocate in all health-related matters, including the appropriate use of consultants, health services, and community resources."

The training provided in this program is designed to help resident physicians acquire and/or develop the attitudes, skills, and knowledge necessary to become competent family physicians, including the following:

• Competence in the evaluation and management of undifferentiated as well as defined problems in ambulatory and institutional medical settings. The family physician must be skilled in the initial assessment of patients, the definitive management of most of the common problems encountered in practice, and the appropriate referral and care sharing for those problems which go beyond his or her level of expertise.
• Competence in assessing and managing psychosocial problems of patients in the primary care setting. This includes an understanding of and respect for the inter-relatedness of the biomedical and psychosocial aspects of health and disease, and the interrelationship between the individual, the family, and the community. The family physician must be capable of making referrals to appropriate community professionals and agencies, and of taking a leadership role in the multi-disciplinary team approach to complex biopsychological problems.
• Competence in conducting a medical interview and in effectively communicating with patients and their families.
• Competence in, and an attitude which fosters the provision of ongoing health maintenance and preventive health care services over the lifetime of the individual and the family.
• An understanding of and competence in functioning effectively in current and future health care systems. Essential to this is the ability to work effectively as a member of a health care team to provide quality primary care in a cost-effective manner.
• The attitude that, as a family physician, he or she has embarked on a lifelong program of education that is largely practice based and uses information technology effectively.
• The attitude that, as a family physician, he or she should take an active role in the affairs of the local and national medical community, as well as the community at large.
• An understanding of and respect for the importance of continuity in the care of the individual and the family.
• The attitude that the practice of medicine is first and foremost a profession. Physicians must demonstrate integrity, respect, and compassion in their care of patients, sensitivity, and responsiveness to patients' culture, age, gender, and disabilities, and a commitment to ethical principles.
• An understanding of and respect for the importance of the health and well-being of the physician and his or her own family. This includes personal and family health maintenance, as well as recognition of and appropriate response to early indications of physical and emotional health problems and/or impairment.

To this end, prior to successful completion of the residency program, each resident must demonstrate competence in all of the core domains identified by the ACGME, RRC, and ACOFP for Family Medicine:

• Patient Care
  
• Medical Knowledge
  
• Practice Based Learning and Improvement
  
• Interpersonal and Communication Skills
  
• Professionalism
  
• Systems-based Practice

Competence within each of these domains will be determined by the resident's demonstration of competence in the specific skills identified below:

Patient Care

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents must demonstrate the ability to:

• Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families
• Gather essential and accurate information about their patients
• Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment
• Develop and carry out patient management plans
• Counsel and educate patients and their families
• Use information technology to support patient care decisions and patient education
• Perform competently all medical and invasive procedures considered essential for the area of practice
• Provide health care services aimed at preventing health problems or maintaining health
• Work with health care professionals, including those from other disciplines, to provide patient-focused care

Medical Knowledge

Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Residents must:

• Demonstrate an investigatory and analytic thinking approach to clinical situations
• Know and apply the basic and clinically supportive sciences which are appropriate to family medicine

Practice-Based Learning And Improvement

Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Residents must demonstrate the ability to:

• Analyze practice experience and perform practice-based improvement activities using a systematic methodology
• Locate, appraise, and assimilate evidence from scientific studies related to their patient's health problems
• Obtain and use information about their own population of patients and the larger population from which their patients are drawn
• Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness
• Use information technology to manage information, access on-line medical information; and support their own education
• Facilitate the learning of students and other health care professionals

Interpersonal And Communication Skills

Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients' families, and professional associates. Residents must demonstrate the ability to:

• Create and sustain a therapeutic and ethically sound relationship with patients
• Use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills
• Work effectively with others as a member or leader of a health care team or other professional group

Professionalism

Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents must consistently demonstrate:

• Respect, compassion, and integrity including:
  • A responsiveness to the needs of patients and society that supersedes self-
    interest.
  • Accountability to patients, society, and the profession.
  •  A commitment to excellence and on-going professional development.
• A commitment to ethical principles pertaining to provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices.
• Sensitivity and responsiveness to patients' culture, age, gender, and disabilities

Systems-Based Practice

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Residents must:

• Understand how their patient care and other professional practices affect other health care professionals, the healthcare organization, and the larger society and how these elements of the system affect their own practice.
• Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources.
• Practice cost-effective health care and resource allocation that does not compromise quality of care.
• Advocate for quality patient care and assist patients in dealing with system complexities.
• Know how to partner with health care managers and health care providers to assess, coordinate, and improve health care and know how these activities can affect system performance

In addition to providing the atmosphere and educational opportunities necessary for residents to develop and nurture these characteristics, we are committed to helping the individual resident further develop his or her own particular areas of interest and/or need for future practice.