Family Medicine最新文献

Background and objectives: Case reports are a popular publication type, especially for medical learners. They also are an excellent educational vehicle that can spark a long-term interest in scholarship for medical learners. To maximize publication potential, authors need a framework when writing a case report.

Methods: We did a manifest content analysis on case reports published in 12 peer-reviewed medical journals between 2010 and 2019. We classified the case reports as detection, extension, diffusion, or fascination. The objective of our study was to determine whether case reports can successfully be classified by their primary contribution to the medial literature as detection, extension, diffusion, or fascination case reports.

Results: Using a predefined search strategy, we identified 1,005 manuscripts identified as case reports published from 2010 to 2019 in 12 journals from a variety of medical specialties. Only 673 of the 1,005 (67.0%) met our criteria for a case report. Of these, 59.1% most closely fit the category of diffusion case reports. Fascination case reports were the least common (1.2%). The format of published case reports varied widely among journals.

Conclusions: Case reports can be categorized according to their main contribution to the medical literature. Nearly 60% of all published case reports in this study were not published for the purpose of introducing a novel clinical entity. Instead, they were used as a vehicle to educate clinicians about previously described phenomena. Authors seeking to publish case reports should understand how the framing of their report is likely to influence their chances of being published.

Background and objectives: Many past studies have focused on uncertainty in medical practice, yet it is still not well understood in the field of family medicine, especially among residents. The aim of this study was to examine situations in which residents experience uncertainty and the coping strategies they use to deal with it. The results may have implications for advanced training programs and the specialist training in family medicine.

Methods: We conducted semistandardized interviews with 15 residents and young family doctors from Hesse, Germany and asked them to describe cases in which they experienced uncertainty. In total, 40 cases were reported. Using established methods, we derived a coding system with different categories.

Results: Uncertainty occurred in a broad and heterogenous range of cases, and it often involved complex interaction of biomedical, interpersonal, and psychosocial factors. The participants described various strategies that were helpful in dealing with the three different types of uncertainty. To deal with biomedical uncertainty, the residents primarily found information-seeking and consulting more experienced colleagues to be useful. In dealing with interpersonal and psychosocial uncertainty, they applied reflective strategies. Participants suggested open communication and honest dialogue about uncertainty and the thematization of the topic at much earlier stages (eg, during medical studies).

Conclusions: Family medicine residents experience uncertainty as an important part of their daily work. They do not necessarily interpret it as a negative phenomenon. Instead, uncertain situations often accompany learning effectiveness and an increase of self-confidence.

Background and objectives: Electronic health record (EHR) customization is proposed to mitigate EHR-related burnout. Gender disparities in EHR usage are established, though less is known regarding differences in customization and its impact on EHR time. This study examined gender differences in vendor-derived proficiency score (PS) and its relationship to EHR time.

Methods: This was a retrospective observational study of ambulatory EHR use for adult primary care and medical subspecialty physicians at an academic safety-net health care system. The EHR vendor provided a physician PS (0-10), derived from customization and efficiency tool utilization. Primary outcomes were PS, time in system per day, and time in system per appointment stratified by gender. We used multiple variable linear regression to determine whether gender differences persisted with the inclusion of other factors.

Results: A total of 228 physicians were included in the study; 122 were women, and 106 were men. Women had higher median PS (7.6 vs 6.6, P=.021) and EHR time per day (150.5 vs 119.9 minutes, P=.013), but no difference in time per appointment (24.7 vs 26.1 minutes, P=.665). After adjusting for potential confounders, gender remained a significant predictor of PS, but not time in EHR. Higher PS was significantly associated with greater time in the system per appointment, but not per day.

Conclusions: While women had higher PS than men, gender was not significantly associated with measures of EHR time after adjusting for potential confounders. Higher PS was associated with greater time in the EHR per appointment, suggesting factors that influence EHR time are complex and varied.

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: 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.