title: Quality assessment and improvement of post graduate family medicine training in the USA.
abstract: BACKGROUND
  In 2013, the World Organisation of Family Doctors published training standards for post-graduate medical education (GME) in Family Medicine/General Practice (FP/GP). GME quality has not been well-defined, other than meeting accreditation standards. In 2009, the Association of Family Medicine Residency Directors (AFMRD) developed a tool that would aid in raising the quality of family medicine residency training in the USA.
  
  
  OBJECTIVE
  We describe the development of this quality improvement tool, which we called the residency performance index (RPI), and its first three years of use by US family medicine residency (FMR) programmes. The RPI uses metrics specific to family medicine training in the USA to help programmes identify strengths and areas for improvement in their educational activities. Our review of three years of experience with the RPI revealed difficulties with collecting data, and lack of information on graduates' scope of practice. It also showed the potential usefulness of the tool as a programme improvement mechanism.
  
  
  CONCLUSIONS
  The RPI is a nationwide, standardised, programme quality improvement tool for family medicine residency programmes in the USA, which was successfully launched as part of AFMRD's strategic plan. Although some initial challenges need to be addressed, it has the promise to aid family medicine residencies in their internal improvement efforts. This model could be adapted in other post-graduate training settings in FM/GP around the world.
authors.affiliation: a Family Medicine , Mercy Hospital Saint Louis , Creve Coeur , MO , USA.
authors.forename: Grant S
authors.initials: GS
authors.lastname: Hoekzema
authors.affiliation: b Department of Family Medicine , Christiana Care Health System Family Medicine Residency , Wilmington , DE , USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Maxwell
authors.affiliation: c Department of Family Medicine , Greater Lawrence Family Health Center , Lawrence , MA , USA.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Gravel
authors.affiliation: d Department of Family and Community Medicine , Natividad Family Medicine Residency , Salinas , CA , USA.|e Department of Family and Community Medicine, San Francisco School of Medicine , University of California , Salinas , CA , USA.
authors.forename: Walter W
authors.initials: WW
authors.lastname: Mills
authors.affiliation: f Grant Medical Center (Ohio Health) , Grant Family Medicine Residency , Columbus , OH , USA.
authors.forename: William
authors.initials: W
authors.lastname: Geiger
authors.affiliation: g Department of Family Medicine , Mike O'Callaghan Federal Medical Center, Nellis AFB Family Medicine Residency , Nellis , NV , USA.
authors.forename: J David
authors.initials: JD
authors.lastname: Honeycutt
mesh_terms: D004503:Education, Medical, Graduate / Q000458:organization & administration / Q000592:standards*; D005194:Family Practice / Q000193:education* / Q000592:standards; D058005:General Practitioners / Q000193:education* / Q000592:standards; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration / Q000592:standards*; D058996:Quality Improvement; D014481:United States
keywords: Post-graduate; assessment tools; quality improvement; residency training