Family Medicine最新文献

Background and objectives: Leaders in academic family medicine founded the Family Physicians Inquiries Network (FPIN) 27 years ago to facilitate scholarship and research in family medicine residency programs. This study evaluates the perceived value of FPIN membership (defined as what members feel FPIN membership adds to their program) by analyzing responses to open-ended questions in the annual membership survey from 2018 to 2023.

Methods: The survey asked questions such as, "Would you recommend FPIN to a friend? Why or why not?" and "Do you believe that the care you are providing patients in your community is better as a result of your involvement with FPIN?" Researchers applied thematic analysis to code and categorize responses into themes that capture a meta-summary of ideas.

Results: Over the 5-year study period, individuals in 109 of the 169 programs (66% of programs) responded to the survey, including 289 responses to open-ended questions. We were unable to calculate an accurate response rate, but our best estimate is about 2%, making the quantitative portion less useful. Qualitative analysis revealed themes of strengths, impact, and areas for improvement. Strengths subthemes included publishing clinically useful summaries, assisting novice writers, welcoming supportive environment, and publishing guidance and feasibility. Impact subthemes included journal impact and objective, and broader visibility. Areas for improvement subthemes included FPIN financial constraints, help desk answers publishing frustrations, and website difficulties.

Conclusions: FPIN members responded positively and valued participating in FPIN.

Background and objectives: Associations between training length and scope of practice in family medicine are unknown. We compared scope of practice among family medicine graduates from 3YR and 4YR training programs.

Methods: We compared survey responses 1 year after graduates started their first job as an independently practicing physician according to their length of training. Comparisons were made across three groups: (1) 3-year program graduates with 36 months of training (3YR-36); (2) all 4-year program graduates with either 36 or 48 months of training (4YR-36/48); (3) 4-year program graduates with only 48 months of training (4YR-48).

Results: Our sample included 1,136 graduates. Of these 423 (37.2%) were in 3YR programs, 447 (39.4%) were in 4YR-36/48, and 266 (23.4%) were in 4YR-48 months. Participant demographics and practice characteristics were similar across groups. Graduates with 4 years of training were more likely to provide pediatric inpatient care than 3YR program graduates (4YR-48 [43.6%] vs 3YR [35.1%], P=.032); and more 4YR program graduates provide adult inpatient care (3YR [39.8%] vs 4YR-48 [52.5%], P=.002). Graduates of 4YR programs (both groups) were statistically more likely to include 13 of 24 procedures in practice compared to those from 3YR programs, including point-of-care ultrasound, vaginal delivery, joint injection/aspiration, circumcision, and vasectomy. Graduates of all participating programs reported performance that exceeded national means for 20 of 32 (62.5%) clinical practice areas and procedures.

Conclusions: Graduates of 4YR programs reported obtaining a unique set of skills and undertaking a broader scope of practice postgraduation compared to graduates of 3YR programs.

Background and objectives: International medical graduates (IMGs) are a quarter of US practicing physicians and residents, with higher numbers in family medicine. Our objective was to determine whether the progression of milestone ratings varies between IMGs and US medical graduates based on a residency's historical percentage of IMGs.

Methods: Data, which were all from the American Board of Family Medicine, included milestone ratings of each family medicine graduate from 2018 to 2020. We calculated the mean milestone rating for each core competency at each assessment. The main exposure was the 10-year percentage of residency graduates who were IMGs: very low (<10%), low (10%-33%), medium (34%-66%), and high (67%-100%). We used repeated measures multilevel regression to test for adjusted associations of resident and residency characteristics with milestone performance. Interactions between IMG status and historical percentage of IMGs tested for differential milestone growth.

Results: Our sample included 12,302 residents from 538 residencies. Of the family medicine residencies, 41.8% had less than 10% IMGs. Across milestones, mean growth between rating periods ranged from 0.46 to 0.54. In adjusted regression analysis, both being an IMG (β=-0.003 to -0.07) and training in a higher historical IMG residency (β=-0.01 to -0.08) were associated with lower milestone ratings. IMGs in high IMG programs had higher ratings for medical knowledge and professionalism (β=0.07).

Conclusions:  We found comparable milestone ratings between IMGs and US medical graduates, with IMGs getting a small boost if they were trained in a program with a higher percentage of IMGs. Our results demonstrate that the performance of IMGs may be enhanced in residencies with a history of acculturating them.