Focus On Research November 2012

Focus on Research:

P4 and Beyond: The Birth of an Educational Network

Elaine Waller
Elaine Waller,
Research Assistant

By Elaine Waller, Research Assistant

In February 2007, 14 family medicine residency programs from across the country were selected to participate in a 6-year comparative case study called P4 (Preparing the Personal Physician for Practice). They proposed a variety of innovative approaches to residency training ranging from moving the continuity clinic into the community, to expanding the length of training, to providing opportunities for individualized training, and more. 

Prompted by the 2004 Future of Family Medicine Report and sponsored by the American Board of Family Medicine, the Association of Family Medicine Residency Directors and TransforMED, the P4 initiative was designed to inspire and examine innovation in residency training and represents the first serious reconsideration of the structure, length and content of family medicine residencies since primary care residencies were defined in the late 1960s and early 1970s. The aim of P4 was to spur innovation in all family medicine residencies. 

The P4 evaluation team led by co-investigators, Patty Carney, PhD and Patrice Eiff, MD, along with research staff, Elaine Waller and Bill Hatt, has used a rigorous scientific approach to study and measure these innovations in search of the most effective ways to educate the country’s future family physicians. A robust relational database containing more than 5 years worth of residency program, resident, continuity clinic and graduate data drives the many analyses currently underway. 

Numerous manuscripts and presentations were produced throughout the project, but the evaluation team is now in a position to answer some larger questions related to the initiative. Manuscripts in development examine the impact of working in teams and in redesigned continuity clinics toward a PCMH, scope of practice, the financial and regulatory challenges of innovation, and the impact of innovation on residents’ knowledge. 

Some highlights from the study: 

  • 38/44 (86%) innovations undertaken by the 14 programs were partially or fully implemented. Six of 14 programs (42.9%) fully implemented all of their planned innovations.
  • 143 national presentations and 26 manuscripts have resulted from P4 work: 122 presentations and 19 site-specific manuscripts by the innovators and 21 presentations and 7 manuscripts by the P4 management and evaluation team. Several manuscripts are in review or planned for submission by the evaluation team and more manuscripts are anticipated from the P4 programs.
  • Program, Continuity Clinic & Resident Core Measures were collected with near 100% data capture every year of the project with a resultant 830 unique residents represented.
  • Graduate Survey response rates exceeded 70% overall for all years so far (2006 thru 2010 grads).

What’s next? Recognizing that 5 years was not enough time to capture outcomes from all the P4 graduates, the evaluation team sought funding from the ABFM Foundation for two more years of graduate survey collection. This extension, through 2014, will yield complete data sets (through residency and into practice) for 3 resident cohorts with full exposure to their program’s innovations. The ability to follow these cohorts longitudinally into practice, and to study the connections between training and scope of practice, practice location, etc., makes this study and the resulting data set unique in the field of medical education. 

MedEdNet, the country’s first medical education PBRN, is the result of this groundbreaking work and builds on the framework and data set established by the P4 project. MedEdNet is in the early stages of development and is currently focused on creating a membership fee structure that is both affordable for members and sustainable for the future of the network. The network’s core instruments have been developed and a public website ( has been launched. Next up is to develop an online membership application process and create a members-only space with access to a sophisticated data viewing and request portal.