Family Medicine最新文献

To provide quality patient care, health professionals must be able to effectively communicate interpersonally and in team environments. While a lack of communication and conflict negotiation skills certainly can create obstacles to patient care, the organizational structures in which health professionals do their work also can obstruct communication or make it more difficult. Structurational divergence theory helps identify and explain the negative communication cycles that result when individuals must fulfill obligations from multiple competing systems, each with its own social rules. The structure of health care delivery systems also can result in structurational divergence, as health care workers must often navigate the space between their clinician priorities of improved patient health and the corporate priorities of greater efficiency and profit. This divergence creates tension for the clinician that can lead to burnout and moral injury, especially when the clinician feels forced to act outside the patient's best interests. Individual efforts to address moral injury are less likely to be successful than collective group action. However, medical education can take steps to prepare students with the knowledge and tools necessary to navigate competing role demands, systemic obstacles, and ethical dilemmas to ensure quality patient care.

Background and objectives: Quiet quitting, or doing only the minimum work necessary for one's job, is a phenomenon in the work environment that has been discussed widely in popular media but only recently referenced in academic literature and not formally examined in the context of residency education. This study examined the concept of quiet quitting in residency education, gathering perspectives from leaders in family medicine residency programs.

Methods: Quiet quitting and similar concepts were presented at a workshop at the 2024 Residency Leadership Summit hosted by the American Academy of Family Physicians. Participant responses were collected during the workshop from approximately 250 attendees to gather perspectives on and experiences with these behaviors in their residency programs. Investigators independently coded responses using thematic analysis.

Results: Responses from 215 participants (approximate response rate=86%) identified disengagement, professionalism concerns, and strategic time usage as quiet quitting behaviors in residency. Contributing factors to quiet quitting reflected generational shift in work values, systemic issues, faculty modeling, and lack of training or work experience. Identified consequences were primarily negative and related to decreased physician competence and poorer quality of patient care. Proposed interventions included making systemic changes, establishing clear expectations and consequences, and bolstering well-being and resilience.

Conclusions: This study provides residency leadership perspectives on quiet quitting in family medicine residency programs. Given the potential for negative consequences of quiet quitting on physician competence and patient care, developing a shared understanding of this phenomenon within residency education is important.

Background and objectives: Grade inquiries and appeals are a common occurrence in family medicine clerkships, and they are a source of stress to clerkship directors (CDs). This survey sought to establish the rate of grade inquiries and appeals in family medicine clerkships, to determine whether CDs perceive these rates to be increasing, and to determine whether grade appeals or inquiries contribute to CD burnout or to changes in grading criteria.

Methods: Data were collected as part of the 2024 Council of Academic Family Medicine Educational Research Alliance (CERA) clerkship directors survey. Respondents answered questions about the rates of grade inquiries and appeals, whether CDs feel burned out, and whether they ascribe the cause of their burnout to be related to grade inquiries/appeals.

Results: The response rate was 53%. In a given academic year, 6% of family medicine students initiated grade inquiries, and 3% initiated grade appeals. Correlations showed that the percentage of students initiating grade appeals was associated with general burnout, grade appeal related burnout, and the desire to give up their CD role. CDs who felt less supported in their decisions about grade appeals were significantly more likely to report burnout or to want to resign from that role.

Conclusions: Grade inquiries and appeals contribute to CD burnout. CDs who experience more inquiries/appeals or who perceive the number of inquiries/appeals to be increasing may modify their grading criteria to avoid grade appeals. Supporting CDs in their decisions regarding grade inquiries and appeals is important.

Background and objectives: The clinical learning environment exerts a profound influence on trainees' educational outcomes and professional development. Despite its recognized importance, no validated instrument currently exists to systematically assess this environment within family medicine residency programs in the Chinese context. This study aimed to evaluate the educational environment of family medicine residents in Guangdong Province, China, and to examine the validity of the Chinese version of the Postgraduate Hospital Educational Environment Measure (PHEEM) for this population.

Methods: In this multicenter cross-sectional study, 240 residents from six hospitals were surveyed using the 40-item Chinese version of the PHEEM (scored on a 5-point Likert scale). Principal component analysis with Varimax rotation was used to identify factors (eigenvalue >1).

Results: Three domains were identified-role autonomy, teaching, and social support-explaining 63.07% of total variance. Cronbach's α was 0.966 overall; subscale α values were 0.858, 0.969, and 0.890, respectively.

Conclusions: The PHEEM shows strong internal consistency and structural validity for assessing the family medicine residency learning environment in China. Further research is recommended to confirm its broader applicability.

In this article, we describe and discuss the concept of critical andragogy and apply it to the process of faculty mentorship in academic medicine, or critical mentorship. We describe the systemic barriers that impact faculty from ethnic and racially minoritized backgrounds and provide recommendations to academic institutions for mentoring minoritized faculty. Additionally, we provide recommendations for the content and structure of the mentorship relationship when the mentor is from a majority background. Our goal is to provide those who mentor faculty, are in leadership, and design mentorship programming with information to support faculty career development in the context of structural barriers for faculty professional growth.