President’s Column
William Yates
University of Oklahoma
Challenges and Opportunities in Combined Residency Training Programs

     I strongly support Kevin O'Connor's selection of combined residency training for a program theme for this year's AMP annual meeting. I have had the opportunity to be directly involved in three different combined residency training programs during my academic career. While starting my academic psychiatry career at the University of Iowa, I observed the development and growth of one of the first Internal Medicine-Psychiatry residency training programs directed by Roger Kathol. Later, at Iowa I had the opportunity to submit the proposal for the combined Family Medicine-Psychiatry residency program. When I moved to the Tulsa program of the University of Oklahoma in 1997, I joined a department with a Family Medicine-Psychiatry combined residency. These experiences have provided me an insight into the challenges and opportunities for the future of combined residency programs.

     Combined residency programs start off with a challenge inherent in their structure-getting two independent academic departments to work together toward a common goal. This may not sound like a big challenge but it is. Not only must this mutual commitment be present at the program's inception, but mutual commitment must continue in a sustained manner over time to be successful. Changes in leadership positions in either department can challenge the viability of a combined residency program. Individual department stability is threatened with a change in department chairs. Combined residency training programs are threatened when either department chair is replaced. This doubles the chance that a combined program will undergo a risk for instability at any time. Throw in the fact that each department also has a residency training program director for their individual programs. You can easily see how the challenge to keep the residency education leadership team intact can be a ongoing issue.

     Another challenge facing the combined programs is to provide applicants with a sense of the added value of combined residency training. What does a primary care resident receive in return for spending two extra years in training? Can combined residency graduates recoup the cost of additional years on retraining on their student loan debt and delay in beginning a physicians salary? This type of data is not available, but Caroline Carney has been leading an effort to better understand the "outcome" for the small but growing number of combined residency graduates. In this newsletter she summarizes some of the results from this survey This is an extremely important effort for the AMP to support. We must take advantage of the opportunity to encourage gathering of information to document the added value that many of us take for granted. Resident applicants to combined residencies are asking these questions and need answers to make their residency selection decisions.

     The AMP also has an opportunity to provide a forum for academic leaders who might be new to working in combined residency programs. Many new department chairs or residency training directors may have limited knowledge of some of the challenges of running combined residency programs. The AMP annual meeting should provide a forum for education and support of those taking on new roles in combined residency education. I encourage all members to attend this year's season. Certainly, this year's theme and focus will get AMP started on an important path for our organization.

     The AMP has embarked on a communications opportunity by recently activating it's listserv. Some interesting discussions have emerged. Rick Malis has provided technical assistance in getting the listserv up and running. Recent topics for discussion have included a question and answer interchange on combined residency training and job openings for those with combined training. If you would like to be added to the listserve, email me at william-yates@ouhsc.edu for directions. We are looking for this forum to allow us to continue and improve our communications throughout the year.

William R. Yates, M.D.

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