Family Medicine最新文献

Background and objectives: The proportion of family physicians caring for children is decreasing. At the same time, US family medicine residency training requirements have increased flexibility in how to train future family physicians in caring for this population. Our objective was to evaluate the correlation between residency program structures and curriculum with graduates caring for children.

Methods: We conducted a prospective cohort study of family medicine graduates using the 2018 Council of Academic Family Medicine Education Research Alliance program director study to measure program characteristics and pediatric curricular elements, and the 2021 family medicine National Graduate Survey (NGS) of residents who graduated in 2018 to measure outcomes. We used logistic regression to determine associations between residency elements and graduate practice of outpatient pediatrics, inpatients pediatrics, or newborn hospital care.

Results: After data from the two sources were merged, our final sample was 779 family medicine graduates (48% of the NGS sample), where 74.7% reported practicing outpatient pediatrics, 16.8% inpatient pediatrics, and 25.9% newborn care. In multivariate analyses, residency processes associated with the care of children in one or more settings included having more than 10% of continuity clinic patients under the age of 10 and having two or more family medicine faculty supervising inpatient pediatrics or newborn care.

Conclusions: In a large national cohort study, we found that residency processes-especially faculty role modeling care of children and the inclusion of children in continuity clinic-are positively associated with residency graduates providing care for children. With residency training requirements changing, these results offer evidence-based interventions for programs to produce graduates who will care for children.

Background and objectives: A recognized gap exists between primary care physicians' training in musculoskeletal (MSK) medicine and the burden of MSK complaints in primary care. Family medicine interns often lack adequate baseline MSK physical exam skills, which prompted a proposal to introduce a fourth-year preceptorship to reinforce MSK education. The aim of this study was to prioritize the most important elements to include in this new clinical rotation.

Methods: We employed a three-round, modified Delphi method to derive consensus. Eleven panelists with experience and expertise in MSK training, medical education, or both generated a list of 118 elements. Each panelist then ranked each element by level of importance, and we reviewed the results. The ranking process was repeated two more times with a goal of achieving consensus.

Results: Seventy-seven curricular elements (topics, skills, experiences) achieved consensus recommendation by being ranked either "fairly important" or "very important" for inclusion in the curriculum. Twenty-eight items were unanimously ranked "very important," 42 received a mix of "very important" and "fairly important" rankings, and seven received unanimous ranking of "fairly important." Three items were unanimously ranked "neither important nor unimportant."

Conclusions: Longitudinal repetition of physical exam skills, reinforcement of relevant anatomy, and incorporation of specific frameworks for approaching MSK care are important components. Physical examination of the shoulder, knee, back, and hip are especially meaningful clinically.

Background and objectives: Because deaths from opioid overdoses have increased in the United States, family physicians are needed who can provide integrated care for a patient with HIV, hepatitis C, and opioid use disorder. We sought to describe the individual and residency characteristics of graduating family medicine residents who intend to practice such integrated care.

Methods: We used 2017-2021 data from the American Board of Family Medicine Initial Certification Questionnaire. Our primary outcomes were individual and residency characteristics of resident graduates who intended to provide integrated care. We used logistic regression to assess independent associations with providing integrated care.

Results: The response rate was 100% with 18,479 total respondents. After exclusions, our final sample size was 10,660 (57.7%) respondents. Of those, 782 (7.3%) respondents intended to practice integrated care. Using regression analyses, we found that resident graduates who intended to provide integrated care were more likely to be male, non-Hispanic or Latinx. After residency, they were more likely to intend to practice at a federally qualified health center, Indian Health Service, or nonfederal government clinic.

Conclusions: Only 7% of residency graduates reported their intention to provide integrated care for people with opioid use disorder after residency. In response to a surging opioid crisis, policymakers, residency educators, and residency funders/sponsors should increase the workforce of family physicians who can provide this integrated care.

Background and objectives: Black/African American medical professionals and students engage in patient-centered communication in ways that are not yet described in medical education literature. The purpose of this paper is to explore the ways in which Black/African American attending physicians, residents, and medical students enact patient-centered communication while interacting with their Black/African American patients.

Methods: Forty-one Black/African American attending physicians, residents, and medical students were recruited through a snowball sample of the authors' personal and professional networks. Participants engaged in semistructured interviews about their experiences of being Black in a predominantly White profession. Data were transcribed and analyzed using thematic analysis.

Results:  Black/African American attending physicians, residents, and medical students used patient-centered communication when engaging with Black/African American patients. Rather than relying on physician-focused styles of communication, participants situated their communication within their shared cultural backgrounds and approached their patients as they would approach family members. Participants reported that by centering the patient, they could communicate in a way that reflects shared norms and understandings.

Conclusions:  This study suggests that Black/African American attending physicians, residents, and medical students approach communication from a personal and familial space in an effort to disrupt conventional modes of provider-patient communication that do not center the patient or consider the patient's cultural background.