Family Medicine最新文献

Background: Remediation and early intervention for family medicine residents who experience performance problems represent a challenge for programs, faculty, and residents. Some evidence suggests that identifying those at risk for performance problems and providing support early may prevent more serious issues later in residency.

Objectives: We wanted to explore the perspectives of content experts to identify best practices for early intervention and remediation to address common challenges and create a framework for more effective and inclusive early intervention and remediation.

Methods: We used a Delphi approach to identify themes and best practices for early intervention and remediation, including qualitative interviews, identification of themes, clarification of essential practices, and confirmation of agreement with core medical faculty.

Results: Our qualitative interviews and Delphi methodology identified best practices in five main categories: (a) early assessment and identification, (b) feedback, (c) resident engagement, (d) intervention strategies and resources, and (e) documentation. From an initial pool of 38 recommendations, we identified a final group of 11 practices that generated broad agreement among behavioral science faculty and core medical faculty.

Conclusions: Key principles for early intervention and remediation include early skill assessment, data-driven feedback, collaborative processes, diverse resources, clear documentation, and faculty training for providing actionable feedback. While our Delphi study provided in-depth insights into various programs' practices, it may not capture unique practices across all programs. Future research on early intervention and remediation should explore current practices, aiming for specific, collaborative, and transparent processes, with insights from experienced faculty, to enhance equity and effectiveness.

Background and objectives: Family physicians manage the treatment of patients with chronic illnesses like type 2 diabetes mellitus (T2DM). During residency, trainees are assessed on their management of chronic disease under the Accreditation Council for Graduate Medical Education patient care (PC) milestone. Residency programs are expected to ensure that trainees are prepared to meet patients' needs; however, evidence is mixed as to whether milestone evaluations predict how well a physician will perform in early unsupervised practice. This study tested whether higher PC milestone evaluations predict greater adherence to T2DM guidelines for early-career family physicians.

Methods: Using national provider identification numbers, we linked family medicine trainees' penultimate PC milestones with commercial insurance claims for T2DM patients. We associated doctors with patients by identifying the doctors who performed the evaluation and maintenance exams and observing the extent to which those patients received HbA1c, retinal, and renal functioning exams. We followed doctors who graduated in June 2016 through the first 18 months of unsupervised practice.

Results: Milestones were not significantly associated with screening outcomes: HbA1c (OR=0.963, 95% CI [0.840, 1.104]), nephropathy (OR=0.983, 95% CI [0.901, 1.072]), or eye exam (OR=1.001, 95% CI [0.936, 1.070]). Rather, for every additional diabetes patient a family physician saw, administration of standard tests increased: HbA1c (OR=1.005, 95% CI [1.002, 1.009]) and nephropathy (OR=1.004, 95% CI [1.002, 1.006]).

Conclusions: Milestones for chronic disease management were not correlated with diabetes management for early career family physicians. The volume of diabetic patients under a doctor's care was positively correlated with levels of expected screenings.

Background and objectives: Medical trainees express difficulty with interpreting statistics in clinical literature. To elucidate educational gaps, we compared statistical methodologies in biomedical literature with biostatistical content in licensing exam study materials.

Methods: In this bibliographic content analysis, we compiled a stratified random sample of articles involving original data analysis published during 2023 in 72 issues of three major medical journals. We recorded all discrete statistical methods and concepts detailed in the methods section of the articles and in three commercial licensing exam study resources. We created a unified list of discrete methods or concepts to define overarching domains and mapped each method to a domain to determine that domain's presence in each resource or article.

Results: In a sample of 273 journal articles and three study resources, we identified 1,057 unique key words mapped onto 20 domains. Statistical error, significance, power analysis, and group comparisons of categorical data were high-frequency domains among the articles. Overall, 63% of articles included methods from domains not covered in any study resource.

Conclusions: Medical licensing exam preparation does not reflect the breadth of contemporary statistics in biomedical research. Future interventions should expand medical students' understanding of research protocols and complex data manipulation.

Background and objectives: Limited knowledge is present regarding how fellowship training correlates with graduate outcomes and whether current residents desire an additional year of residency training. The aim of this study is to examine trends in fellowship training and compare residency and practice outcomes between those interested and those not interested in fellowship training as well as the proportion of residents desiring an additional year of residency training.

Methods: We compared data from the American Board of Family Medicine Initial Certification Questionnaire (2017-2019) to the National Graduate Survey (NGS; 2020-2022). We used bivariate analysis and ꭓ2 tests to assess for changes over time and to determine whether an association exists between those likely to pursue a fellowship and those interested in an additional year of residency training.

Results: The final sample included 4,930 residency graduates with NGS data (response rate 46.8%). Overall, most (71.0%) respondents were not interested in any type of additional training. We found no differences in interest in a fellowship based on in-training examination (ITE), certification scores, or milestones attainment. Respondents without interest in a fellowship were more likely to provide continuity of care in practice, while respondents with interest in a fellowship were more likely to be faculty and less likely to have symptoms of burnout.

Conclusions: Intention for fellowship training is associated with future faculty members and lower rates of symptoms of burnout and continuity practice. A majority of responding family medicine residents (>70%) do not favor an additional year of residency training.

Background and objectives: Family medicine implemented program signals and geographic and setting preferences in the 2023-2024 residency application cycle. We performed a qualitative study with the following aims: (a) describe residency program experiences with implementation of signaling and preferences; and (b) identify opportunities for applicants, advisors, residency leadership, and policymakers to optimize these two programs.

Methods: This qualitative study used the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) to guide interviews of family medicine program faculty from the Midwest United States between January and April 2024. We analyzed data using a thematic analysis.

Results: We interviewed 21 faculty members. About half of respondents somewhat or strongly agreed that program signals (10, 48%) and geographic and setting preferences (11, 52%) added value to the current system. We identified four themes: (1) Faculty adopted signals and preferences strategically to complement their existing application review strategies; (2) Signals were perceived as reducing application volume and burden; (3) Signals did not impact diversity and equity, but geographic preferences may benefit community health; (4) Modifications to signals and preferences are recommended to optimize use in family medicine.

Conclusions: Program faculty implemented signals and preferences into holistic review to reduce application review burden. Signals and preferences should support the unique experiences of family medicine residencies and needs for primary care physician workforce development. Future research should focus on refining signals and preferences and their impact on match outcomes and Supplemental Offer and Acceptance Program participation rates.

Background and objectives: Health care leaders use interprofessional collaborative practice as a strategy to improve health outcomes, and they have stressed its importance in the education of primary care medical providers to apply public health concepts like the social determinants of health and community collaborations. Interprofessional education (IPE) prepares students from different professions for collaborative practice as they enter the health workforce by developing core competencies. Understanding the importance of IPE is vital toward improving person and client-centered care and population health outcomes. This study aims to evaluate IPE workshops' effects on participants' confidence in applying public health concepts to improve health outcomes and intention to collaborate with local resources.

Methods: Public health-focused workshops were provided to encourage collaboration between Master of Public Health (MPH) students and residents in a family medicine residency program. We analyzed change using McNemar's tests to determine significant differences between pre- and postworkshop responses.

Results: In total, 33 family medicine residents and 41 MPH students provided full data for the evaluation. We found statistically significant differences between self-efficacy levels and intention to partner with resources between pre- and postworkshop surveys.

Conclusions: Results point to the efficacy and value of IPE opportunities in the education of family medicine residents and MPH students. This study presents a viable and useful example of IPE integration between MPH students and family medicine residents. Understanding social determinants of health and the use of local resources to better the health of the community is vital for both groups.