The state of community medicine training in family practice residency programs

This paper describes the state and nature of community medicine training in family practice residency programs. A random sample of 224 family practice residency programs was surveyed about the perceived value of community medicine in their residency, the teaching modalities they use, the extent to which their training provides competency in four defined dimensions of community medicine, and which program characteristics and curricula were predictive of higher perceived competency. The participation rate of our survey was 72%. Respondents ranked professional interest, institutional support, and departmental support highly. Less than half the programs provide instruction in community-oriented primary care (COPC), and less than half rate their department's involvement in the community highly. Most programs report that their training provides at least a moderate level of competency in four defined dimensions of community medicine. Curricular methods that are predictive of perceived competency include health department clinical experiences, home visits, cultural sensitivity training, participation in a longitudinal project, meetings with community leaders, and instruction in COPC. Community medicine is valued in residency curricula, but there is limited uniformity in curricular content and methods. Active and structured education modalities might be more likely to result in competency in community medicine.