Family Medicine最新文献

Background and objectives: Many medical schools have implemented primary care tracks to increase the number of medical students pursuing primary care. The Primary Care Program (PCP) at the Keck School of Medicine of University of Southern California is a 4-year primary care pathway that trains medical students to work in urban, underserved communities and has shown high student match rates into primary care residencies. This study evaluates the PCP graduates in residency and after residency, and assesses their career outcomes, their career characteristics, and the impact their PCP experience had on their careers.

Methods: All PCP alumni who graduated between 2015 and 2022 were invited to complete a 21-item Qualtrics (Qualtrics, LLC) survey. Descriptive data analysis was conducted through Qualtrics, and open-ended data were coded for themes.

Results: Seventy percent of PCP alumni (86/122) responded to the survey, with 65% (56/86) in residency/fellowship and 35% (30/86) in practice. Among those who matched into primary care residencies (61/86, 71%), the percentage that practiced or intended to practice general primary care was 70% (43/61). Respondents in practice (30) described their practice characteristics, including locations and payor mix consistent with majority underserved communities. Open-ended responses captured the impact that the PCP had on alumni's careers, with themes including mentorship, friendship/community, educational/service experiences, future career, exposure to types/kinds of practice, and social determinants of health exposure.

Conclusions: PCP alumni credit this program with impacting their retention in primary care and their career trajectories. This program can serve as a model for other institutions to help increase the number of medical students who pursue primary care careers.

Background and objectives: Case reports are a popular publication type, especially for medical learners. They also are an excellent educational vehicle that can spark a long-term interest in scholarship for medical learners. To maximize publication potential, authors need a framework when writing a case report.

Methods: We did a manifest content analysis on case reports published in 12 peer-reviewed medical journals between 2010 and 2019. We classified the case reports as detection, extension, diffusion, or fascination. The objective of our study was to determine whether case reports can successfully be classified by their primary contribution to the medial literature as detection, extension, diffusion, or fascination case reports.

Results: Using a predefined search strategy, we identified 1,005 manuscripts identified as case reports published from 2010 to 2019 in 12 journals from a variety of medical specialties. Only 673 of the 1,005 (67.0%) met our criteria for a case report. Of these, 59.1% most closely fit the category of diffusion case reports. Fascination case reports were the least common (1.2%). The format of published case reports varied widely among journals.

Conclusions: Case reports can be categorized according to their main contribution to the medical literature. Nearly 60% of all published case reports in this study were not published for the purpose of introducing a novel clinical entity. Instead, they were used as a vehicle to educate clinicians about previously described phenomena. Authors seeking to publish case reports should understand how the framing of their report is likely to influence their chances of being published.

Background and objectives: Many past studies have focused on uncertainty in medical practice, yet it is still not well understood in the field of family medicine, especially among residents. The aim of this study was to examine situations in which residents experience uncertainty and the coping strategies they use to deal with it. The results may have implications for advanced training programs and the specialist training in family medicine.

Methods: We conducted semistandardized interviews with 15 residents and young family doctors from Hesse, Germany and asked them to describe cases in which they experienced uncertainty. In total, 40 cases were reported. Using established methods, we derived a coding system with different categories.

Results: Uncertainty occurred in a broad and heterogenous range of cases, and it often involved complex interaction of biomedical, interpersonal, and psychosocial factors. The participants described various strategies that were helpful in dealing with the three different types of uncertainty. To deal with biomedical uncertainty, the residents primarily found information-seeking and consulting more experienced colleagues to be useful. In dealing with interpersonal and psychosocial uncertainty, they applied reflective strategies. Participants suggested open communication and honest dialogue about uncertainty and the thematization of the topic at much earlier stages (eg, during medical studies).

Conclusions: Family medicine residents experience uncertainty as an important part of their daily work. They do not necessarily interpret it as a negative phenomenon. Instead, uncertain situations often accompany learning effectiveness and an increase of self-confidence.

Background and objectives: Having a limited number of trained faculty is a barrier to successful incorporation of ultrasound into undergraduate medical education. We evaluated the effectiveness of a resident-led extended focused assessment with sonography in trauma (eFAST) session administered to fourth-year medical students during their emergency medicine clerkship by measuring students' end-of-year eFAST performance and confidence.

Methods: This was a single-site cross-sectional study of all graduating medical students enrolled in fourth-year clerkships between May 1, 2022 and April 30, 2023. A 60-minute, team-based eFAST session (intervention), taught by emergency medicine residents, was added to students' fourth-year emergency medicine clerkship in September 2022. All students were assigned to review an eFAST video (control). End-of-year performance and self-reported confidence assessments used a 20-point objective structured clinical examination (OSCE) and a 5-point Likert scale, respectively. The mean OSCE and confidence scores for control and intervention groups were compared using two-sample t tests and repeated after removing students exposed to additional US experiences.

Results: Of 113 eligible students, 103 students participated: 48 in the control group, 55 in the intervention group. The intervention group scored higher on the OSCE than the control group (11.9 ±4.6 vs 9.9 ±5.1, P=.04) and reported similar confidence (3.2 ±1.0 vs 2.8 ±1.2; P=.09). After removing the 28 students with additional US experiences, the intervention group scored higher (10.8 ± 4.4 vs 8.2 ± 4.0; P=.01) and reported higher confidence (3.0 ±1.0 vs. 2.3 ±1.0, P=.01).

Conclusions: Resident-taught eFAST instruction during emergency medicine clerkships led to improved end-of-year fourth-year medical student eFAST performance and confidence.

Physicians within the family medicine workforce are the most diverse compared to other medical specialties in both primarily clinical and academic settings. Family physicians also provide care to the most diverse patients and communities across the United States. As such, research and scholarly work from family physicians on diversity, equity, inclusion, and antiracism (DEIA) can be incredibly impactful. Yet many practicing and teaching physicians are unaware of their colleagues' scholarly DEIA work, which aims to elucidate inequities and barriers to optimal care and, importantly, to educate on ways physicians and learners can recognize and address specific needs of patients and communities marginalized by health care policies and practices. In collaboration with editors from several family medicine journals, the authors move beyond the traditional editorial space to share recent practice-changing and innovative articles, adding voice and momentum to improve DEIA efforts in all spaces where the practice and teaching of family medicine exists.

Background and objectives: Musculoskeletal (MSK) complaints comprise more than 20% of all visits to health care providers each year. Despite required experiences in MSK care, family physicians report low confidence in diagnosing and treating MSK conditions. The purpose of this study was to analyze the effects of early and longitudinal exposure to MSK education on residents' confidence in and likelihood of performing MSK physical exams and injections in future practice.

Methods: From 2017 to 2019, residents completed an annual survey assessing confidence in, frequency of, and future intentions to perform exams and injections for MSK conditions. We compared responses between family medicine residents who completed a 176-hour longitudinal sports medicine (LSM) curriculum distributed over all 3 years of residency and a comparable cohort of family medicine residents who completed a 188-hour concentrated MSK curriculum primarily in the final year of residency. We made comparisons using the Fisher exact test for categorical variables and an independent samples t test for numeric variables.

Results: We analyzed the 98 total responses from 50 residents. The proportion of residents reporting high ratings of their residency MSK education (26% to 60%), performing >5 injections (38% to 73%), reporting confidence in performing injections (12% to 40%), and indicating likelihood to perform MSK injections in the future (52% to 65%) were all greater in the LSM versus concentrated MSK curriculum cohorts (P<.05 for all).

Conclusions: Early and longitudinal exposure to MSK care and sports medicine in family medicine residency led to both an increase in MSK injections during residency training and a greater desire to perform these injections in postresidency practice.