Family Medicine最新文献

Background and objectives: The Council of Academic Family Medicine Educational Research Alliance (CERA) is a unique collaboration of academic family medicine organizations (Society of Teachers of Family Medicine [STFM], Association of Family Medicine Residency Directors, North American Primary Care Research Group, Association of Departments of Family Medicine) that facilitates and improves educational research in family medicine. CERA conducts approximately five surveys per year, including residency program directors, clerkship directors, department chairs, and general membership. Members of these organizations propose modules of 10 questions for these surveys. Proposals are peer-reviewed, and the top proposals are incorporated, along with standardized demographic questions, into an omnibus survey. We sought to determine the impact of self-reported gender of the primary submitter on survey module acceptance rates.

Methods: We conducted a bibliometric analysis to explore author characteristics and quantify dissemination efforts. We conducted ꭓ2 analyses to determine gender differences in proposal acceptance. We used the exact binomial test to compare proportions of women authors to the benchmark proportion of women in STFM.

Results: Overall, women submitted 66% (460/699) of CERA survey module proposals and authored 65% of accepted CERA modules (157/241) with the highest proportion concentrated among Clerkship Surveys (73%, 40/55). The acceptance rate did not differ significantly by gender (χ2=0.07, df=1, P=.80). A total of 73.4% (177/241) of module authors went on to present or publish their findings; we found no significant differences in scholarly output by gender (χ2=0.70, df=1, P=.41).

Conclusions: These findings indicate that the CERA module submission process has been successful in achieving comparable acceptance rates for men and women submitters. Other specialties should consider a similar model as a means to support early career educational researchers, including women.

Background and objectives: In the context of an evidence-based medicine theme, medical students in their first year at McGill University formulate a PICO (population, intervention, comparator, and outcome) question arising from a patient encounter in family medicine. We sought to analyze clinical questions addressed within PICO projects submitted by first-year medical students shadowing a family physician.

Methods: A total of 180 student projects were split equally between two reviewers. Questions were then classified according to a three-component classification system: (a) type of question (screening, diagnosis, prognosis, treatment [including preventive treatment], etiology, and harm); (b) Ely's taxonomy; and (c) question topics based on the 105 priority topics of the College of Family Physicians of Canada.

Results: The most frequent question type among the students was treatment/prevention (152, 84.0%), followed by etiology (7, 3.9%), screening (6, 3.3%), prognosis (6, 3.3%), harm (5, 2.8%), and diagnosis (4, 2.2%). Based on Ely's taxonomy, the most frequent question was "How should I treat condition x (not limited to drug treatment)?" (105, 58.3%). Of the 105 priority topics from the College of Family Physicians of Canada, in children (18, 10%), pain (16, 8.9%), pregnancy (12, 6.7%), depression (11, 6.1%), and behavioral problems (10, 5.6%) were most frequently represented.

Conclusions: Clinical questions addressed by first-year medical students, of which the vast majority are about treatment and prevention, can be classified. Students did not commonly address questions related to diagnosis, indicating that additional teaching may be required to use the PICO format to address this question type.

The 2023 Accreditation Council for Graduate Medical Education guidelines highlight learning collaboratives as the "optimal way to facilitate [family medicine residency] programs' ability to attain their educational and community aims." As a result, many residency programs are seeking to develop, expand, or sustain learning collaboratives. This study aims to provide practical advice, examples, and encouragement for residency programs interested in creating or participating in a learning collaborative, based on lessons learned from the representatives' collective experiences. A purposive sampling of five learning collaboratives at various stages of development and growth was conducted to capture a representative range of models. Data were collected through participatory engagement and refined through iterative rounds of member checking. Despite differences in form and structure, learning collaboratives share commonalities in the support they provide their participants. They encounter common barriers and rely on similar strategies for success.

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.

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: 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: 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.