The Transcendental Meditation (TM) technique decreases the distress associated with the experience of acute experimental pain. Fifteen advanced mediators and 15 controls were administered the cold pressor test before and after a 20 minute period of meditation (TM group) or relaxation (control group). Verbal reports of the intensity of pain sensation and pain distress were obtained at intervals during the cold pressor trials. Skin resistance and heart rate were measured throughout. The mean distress level for the TM group was significantly lower than controls during both trials; the mean pain sensation level for the TM group did not differ significantly from controls during either trial. Heart rate and skin resistant changed for both groups in the expected manner, with no significant differences between groups. The validity, implications, and possible causes of these results are discussed.

Background Residency programs are increasingly being asked to defend their quality, and that of the residents they produce. Yet “residency quality” is a construct that has not been well defined, with no accepted standards other than meeting accreditation standards. In 2009, the Association of Family Medicine Residency Directors developed a strategic plan that included the goal of raising the quality of family medicine training. Objective We describe the development of this quality improvement tool, which we called the residency performance index (RPI), and its first year of use by family medicine residency programs. We describe the use of the tool as a “dashboard” to facilitate program self-improvement. Intervention Using program metrics specific to family medicine training, and benchmark criteria for these metrics, the RPI was launched in 2012 to help programs identify strengths and areas for improvement in their educational activities and resident clinical experiences that could be tracked and reviewed as part of the annual program evaluation. Results Approximately 100 program directors began using the tool and 70 finished the process, and were provided aggregate data. Initial review of this experience 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 program improvement mechanism. Conclusions The RPI is a new quality improvement tool for family medicine residency programs. Although some initial challenges need to be addressed, it has the promise to aid family medicine residency in its internal improvement efforts.

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.

Background and Objectives: A decade ago, the Association of Family Medicine Residency Directors developed the Residency Performance Index (RPI) as a novel dashboard of metrics to support residency programs’ quality improvement efforts. Although the RPI has since been discontinued, we sought to identify lessons learned from an analysis of 6 years of data collected while the RPI was in use to inform future quality and accreditation efforts implemented at the national level. Methods: The RPI collected data from 2012-2017 for nearly 250 distinct family medicine residency programs, identifying strengths and areas for improvement. Eighty-two programs provided data for 3 or more years of measures allowing analysis of improvement trends. Results: For participating programs, aggregate data over 6 years indicated the majority had stable leadership and accreditation. Total family medicine center (FMC) visits by graduates and resident visit demographics were robust. Graduate scope of practice was consistent with nationally publicized trends. Programs hit most aspirational targets more than 40% of the time. However, analysis for those programs with 3 or more years of data revealed that the tool did not result in significant changes for most metrics. Linear regression analysis showed improvements in total patient visits, visits under 10 years of age, and certain procedural competencies for those programs with 3 or more years of data. Conclusions: The RPI was the first and only nationally utilized family medicine graduate medical education quality improvement tool. Individual programs did not show substantial change in quantifiable metrics over time despite limited evidence of select programmatic improvements. Nationally, aggregated data provided insight into scope of practice and other areas of interest in residency training. Further efforts in provision of residency improvement tools are important to support programs given the increasing complexity and high stakes of family medicine residency education.