Family Medicine最新文献

Family medicine residency programs can implement pathway programs to grow a diverse primary care workforce capable of caring for all patients and communities. A pathway program aims to support students from selected level(s) of the educational continuum toward becoming qualified applicants to health professions programs. This guide provides an evidence-informed approach to developing, implementing, and evaluating effective pathway programs that residency programs can use to build the diverse health care workforce that is critical for health equity. First, we provide practical guidance for program development that uses a logic model and builds partnerships with schools and crucial stakeholders. Then, we discuss how to incorporate a needs assessment to align program goals with student needs. Next, we describe how to leverage social cognitive theory to maximize impact on learners and their ultimate achievement. Finally, we overview systematic evaluation to support long-term program success. Effective program planning leverages the processes through which learning occurs, influencing learners' self-efficacy and outcomes expectations through relatable role models and mastery experience. We provide concrete examples from the Family Medicine Bridging the Gap Pathway Program. Pathway program developers can accelerate students' trajectory toward health profession graduate schools by choosing interventions that serve their greatest needs, thus preparing competitive applicants able to progress to the next educational level.

Background and objectives: Physician demographics in North America do not yet reflect the diversity of the communities they serve, accounted to systemic barriers targeting underrepresented in medicine (URiM) groups. URiM medical graduates are more likely to pursue generalist specialties, including family medicine. Mini Med Schools (MMSs) are pathway programs intended to motivate URiM youth to pursue medicine. A gap in literature exists regarding the potential of MMSs to provide youth with useful information. We examined the extent to which youth reported a change in knowledge about medicine as a career before and after attending an MMS.

Methods: Asclepius Medical Camp for Youth is a weeklong MMS for high school students, held at one Canadian university. In 2022, 50 youth participants were invited to complete surveys and quizzes measuring their knowledge about pursuing a career in medicine.

Results: The mean self-reported knowledge differed significantly precamp (n=34, M=5.87/10, SD=1.9) versus postcamp (n=26, M=8.28/10, SD=1.4; t[35]=7.07, P<.05). Likewise, participants' scores demonstrated a significant difference in mean scores precamp (n=43, M=7.12, SD=2.39) versus postcamp (n=39, M=9.31, SD=1.13; t[42]=5.08, P<.05).

Conclusions: These findings highlight MMSs as a promising strategy to provide knowledge about medical careers beyond instilling motivation. By both inspiring and informing URiM youth, the long-term outcome of diversifying medicine may be achieved.

Background and objectives: Diversity, equity, and inclusion (DEI) efforts strive to create a physician workforce that represents the general population. Barriers remain, however, regarding the promotion of women and underrepresented in medicine (URiM) physicians. We sought to describe gender and race trends in academic family medicine leadership over the past decade.

Methods: We performed a secondary analysis of Council of Academic Family Medicine Educational Research Alliance clearinghouse data, examining demographic survey responses from available surveys of family medicine clerkship directors (CDs), program directors (PDs), and department chairs from 2011 to 2023.

Results: During the time studied, family medicine CDs female representation expanded to 60.2% of CDs, an increase of 23%. CDs increased Asian representation by 127% without significant change in other racial groups. Family medicine PDs female representation expanded to 54.5% of PDs, an increase of 97%. PD Black representation expanded by 51%, and Asian representation expanded by 100%. Family medicine department chairs female representation expanded to 37.5% of chairs, an increase of 61%. Similarly, Black representation expanded by 95%, and Hispanic representation expanded by 150%. In total, 19.1% of chairs identified as URiM in 2023.

Conclusions: Family medicine has improved advancements into academic leadership positions. Family medicine CDs and PDs have achieved representative status of females but lag in URiM representation. Family medicine department chairs have made progress in both female and URiM representation but still lag compared to the general and family medicine physician population. Additional mentorship and sponsorship are needed to access the resources available in family medicine to further advance DEI in the representativeness of its leadership.

Background and objectives: While workforce diversity helps mitigate health inequities, few initiatives support prospective abortion providers who are underrepresented in medicine (URiM). To address this issue, Reproductive Health Education in Family Medicine established the Resident Scholars Program for Workforce Diversity (RSPWD), a year-long program for URiM and other Black, Indigenous, People of Color (BIPOC) residents committed to sexual and reproductive health (SRH) provision. Program elements include: (a) mentorship by BIPOC family physicians; (b) virtual didactic sessions about SRH integration into primary care, advocacy, leadership, reproductive justice, and patient-centered care; (3) conference sponsorship; and (4) community-building among residents and mentors.

Methods: We conducted a qualitative study with the program's first cohort of residents and mentors to examine perspectives about program successes and needed improvements. We used a semistructured interview guide along with a direct contact analysis approach.

Results: We interviewed eight scholars and four mentors. From the interviews, we gleaned data on three main themes: (a) value of mentorship, (b) importance of community, and (c) program improvement suggestions. Scholars expressed appreciation for SRH mentorship from BIPOC mentors who had lived experiences similar to their own, noted the mentorship's importance for career-building, and spoke positively of their sense of safe community among all program participants. Respondents shared suggestions for improved scheduling and requested better guidance for navigating the mentee-mentor relationship.

Conclusions: The RSPWD success is reflected in the enthusiasm and gratitude for the program and the resulting mentorship and community that fostered supportive personal and professional relationships, including career opportunities. When considering the importance yet dearth of workforce diversification in family medicine, this program offers a promising model for supporting a more diverse and representative future SRH workforce that may apply to other family medicine clinical niches.

Background and objectives: Academic advancement requires scholarship productivity. Faculty underrepresented in medicine (URiM) face unique challenges that hinder their scholarship productivity. We introduce the term "scholarship delay" as a phenomenon that affects early career academic faculty and describe what is known in the literature about this phenomenon among URiM faculty.

Methods: For the narrative review, we searched PubMed between November 2023 and September 2024 for articles describing URiM publication productivity. Out of 2,351 initial results, we included articles published between 2000 and 2024 and produced in the United States. After excluding articles based on title and abstract content, we thoroughly examined 43 articles and selected 33 for this review. We included primary research articles including survey studies, literature reviews, and demographic data analyses.

Results: Factors that mediate scholarship delay exist prior to one becoming a faculty member; URiM faculty and trainees are disproportionately affected. Several mediating factors cause scholarship delay, including lack of strong research mentorship and sponsorship, lack of protected time toward scholarly pursuits, and competing clinical responsibilities. Additionally, URiM faculty can suffer from unsupportive institutional cultures that lack resources or infrastructure to help them thrive in the production of scholarly work.

Conclusions: Scholarship delay is a significant and underreported phenomenon that affects early career URiM academic faculty and trainees. Solutions that may help mitigate this issue include rectifying barriers at the individual and institutional level prior to and during one's journey as a faculty member.

Background and objectives: The US physician workforce is at a critical juncture, with a projected shortage and misdistribution of primary care physicians. Culturally and linguistically diverse states, such as California, are challenged to search for innovative approaches in medical education to address the physician needs of diverse underserved communities. The University of California recognizes this imperative and supports Programs in Medical Education (PRIME), including PRIME Leadership and Advocacy (PRIME-LA) at University of California Los Angeles (UCLA). This study examines medical education outcomes for PRIME-LA graduates versus a comparator group.

Methods: We conducted a secondary data analysis of the graduation questionnaire responses from UCLA graduates between 2018 and 2023. Our study included 97 PRIME-LA graduates and 811 comparator graduates. Primary outcomes included intentions to practice in underserved areas and intentions to care for underserved populations. Secondary outcomes included participation in experiences related to health disparities, health education, providing mentorship, and specialty of interest.

Results: A higher proportion of PRIME-LA graduates reported an intention to practice in underserved areas than the comparator group (89% vs 32%, P<.001). Intentions to care for underserved populations were higher among PRIME-LA graduates than those in the comparator group (93% vs 44%, P<.001). Family medicine is the most common specialty among PRIME-LA graduates in contrast to graduates of the comparator group (26.4% vs 6.3%, P<.001).

Conclusions: Mission-based medical education programs play a critical role in addressing the physician workforce gap in underserved communities. The PRIME-LA program may equip students with additional skills and training to address California's physician workforce needs.

Background and objectives: Primary care physician (PCP) shortages and uneven geographic distribution are well-documented. Black populations have less access to primary care and worse health outcomes, with a lack of provider-patient racial concordance playing a role. Addressing these disparities requires targeted approaches that produce more Black PCPs in high-need areas, including expanding community-based residency programs (CBRPs), which are more likely to produce physicians in high-need areas. This research explores the relationship between high-need Black counties and the location of CBRPs.

Methods: We used geographic information systems to identify high-need counties-defined as those in the bottom quartile for PCP capacity for every year from 2013 to 2020 and in the top quartile for percentages of Black populations (2017-2021). Next, we applied proximity analysis to identify high-need counties within 25 and 50 miles of CBRPs.

Results: More than 3 million people live in the 147 high-need counties, which are mostly in the Southern United States. Nearly 60% of the 867,000 Black people living in these counties can be found in Georgia, Mississippi, North Carolina, and Virginia. About one-half of high-need counties do not have any CBRPs located within 50 miles. More than one-third of these counties are in Georgia, Louisiana, and Virginia.

Conclusions: Increasing the number of PCPs in high-need areas requires targeted funding for expanding current and creating new CBRPs with the greatest potential of producing physicians in these areas. Future research will explore all family medicine residency programs relative to high-need areas and identify potential new program locations.