Family Medicine最新文献

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: Faculty members who are underrepresented in medicine (URM) may benefit from mentorship that is designed specifically to meet their unique needs and is focused on improving their career pathways in academic medicine. The Underrepresented in Medicine Mentorship Program (URM-MP) is an academic society-based mentorship program that pairs early career URM faculty with mid- to late-career faculty specifically trained to address URM issues.

Methods: During the first 3 years of the program, mentors received web-based training on addressing oppression and marginalization of URM faculty in academic medicine. Mentor and mentee pairs met monthly for 1 year and received support from program leaders through web-based check-in meetings twice per year. Pre- and postassessment data were collected from mentees to help identify their needs and evaluate their experiences. Check-in meetings provided feedback about the program.

Results: Fifty-seven URM faculty participated in years 1, 2, and 3. Results of pre- and postsurveys showed that mentees significantly improved their self-perceived effectiveness to enhance their careers, to find resources to perform their jobs, and to navigate the challenges of advancing in academic medicine. Qualitative analyses revealed themes of appreciation for mentors supporting their unique experiences as URM faculty. Check-in feedback further reinforced the relationship aspects of the mentorship as a significant benefit of this program.

Conclusions: Society-based mentorship that involves specific training for mentors and fosters trusting mentor-mentee relationships can improve URM faculty's confidence regarding their ability to succeed in academic medicine.

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.

Background and objectives: Institutional racism causes worse health outcomes for patients of racial/ethnic minority groups via limited access to health care, disparities in quality of care delivered, and lack of physician diversity. Increased attention to racism in 2020 led many medical institutions to examine their diversity, equity, and inclusion (DEI) efforts. In the context of increased national attention to health equity, this study sought to investigate the current status of DEI infrastructure by evaluating leadership and support related to DEI in family medicine departments in 2020 and 2021.

Methods: We analyzed department and chair characteristics as well as departmental DEI infrastructure (ie, leadership and actions) from Association of Departments of Family Medicine survey data in 2020 (data collected from June to September 2020) and 2021 (data collected from September to December 2021). We performed multiple regression analyses to evaluate whether department characteristics or specific DEI activities were associated with increased DEI infrastructure in 2021 compared to 2020.

Results: Of the 165 department chairs sent the survey in both 2020 and 2021, 56 (33.9%) responded both years. Departments with a designated DEI leader increased from 42.9% in 2020 to 60.7% in 2021, but about 40% of departments lacked key supports for this position (ie, funding, staff support, and a pathway for advancement). Regression analysis did not demonstrate associations between independent variables and three measures of departmental DEI activities.

Conclusions: This study demonstrates that designated leadership for DEI work increased in family medicine departments between 2020 and 2021.

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: 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.