Family Medicine最新文献

Background and objectives: The COVID-19 pandemic dramatically altered the format of residency recruitment, leading to the widespread adoption of virtual interviews, followed by the adoption of preference signaling. This study examines how the structure of the 2023-2024 interview season influenced family medicine residency program directors' intentions for future interview formats and their preferences regarding the number of preference signals.

Methods: A Council of Academic Family Medicine Educational Research Alliance survey, including demographic questions, was distributed to all family medicine residency program directors in the United States in spring 2024. Data analysis included descriptive statistics, cross-tabulations, χ2 tests, and multivariable logistic regression.

Results: The overall response rate to the question set was 43.7% (308/705). The majority of programs used a fully virtual interview structure in 2023-2024; programs with 100% virtual interviewing were significantly more likely to plan to maintain this model for future interviewing (P=.000) and to favor the current allotment of five preference signals (P=.005). Program director gender, ethnicity, or program type did not significantly influence the intention to maintain a virtual interview format.

Conclusions: The structure of the 2023-2024 interview season was significantly consistent with program directors' plans for future recruitment practices.

Background and objectives: Associations between training length and clinical preparedness are unknown. We compared assessments of clinical preparedness for family medicine graduates from 3-year and 4-year training programs.

Methods: In this prospective case-control study, we compared responses from two surveys, which occurred 3 months after graduates started their first job. One survey was conducted by a supervising physician. The other was conducted by a clinic staff member who rated family medicine graduates from both 3-year and 4-year programs.

Results: Our study included 403 graduates of 3-year programs, 185 who trained in 4-year programs with 36 months of training (4YR-36) and 274 who trained in 4-year programs with 48 months of training (4YR-48). Physician assessor ratings were similar across study groups on 18 of 21 Entrustable Professional Activities. The 4YR-48 graduates were rated higher for "practicing independently" on providing a usual source of comprehensive, longitudinal medical care for people of all ages (86.5% vs 77.9%); managing prenatal (63.1% vs 41.2%); and labor, delivery, and postpartum care (41.4% vs 25.7%). For five care process areas, physician assessors were more likely to rate 4YR-48 graduates as having "no challenges" with speed/timing related health care visits (91.9%) compared to 3YR graduates (82.4%). We noted no differences according to study group for staff member assessors.

Conclusions: We found several differences in clinical preparedness according to length of training in this pilot study. Comprehensive longitudinal care, including prenatal and maternity care, were rated higher among graduates of 4YR-48 programs.

Background and objectives: This study sought to quantify the anecdotally reported experience of decredentialing in the profession of medicine, specifically as it applies to gender. Decredentialing is defined as the experience of being addressed by first name without permission or being mistaken as a nonphysician provider.

Methods: Eight questions regarding decredentialing microaggressions and resultant stress reactions were submitted as part of the 2023 Council of Academic Family Medicine Educational Research Alliance general membership survey.

Results: Women physicians reported significantly higher rates of unauthorized first name use by patients (15% vs 3% for men patients; 7% vs 3% for women patients). Women physicians also reported significantly higher rates of decredentialing by being mistaken as a nonphysician by patients (39.8% frequent vs 1.1%), clinical staff (13.0% frequent vs 0.7%), and other physicians (10.9% frequent vs 1.1%). Women respondents reported more substantial stress responses after unauthorized first-name use (36.9% more stressful vs 6.3%) and mistaken roles (47.7% more stressful vs 8.4%). Subgroup analysis of self-identified underrepresented in medicine (URiM) populations showed significantly higher rates of microaggressions among URiM women physicians compared to men physicians and in total URiM respondents versus non-URiM respondents.

Conclusions: Women physicians experience the gender microaggression of decredentialing via unauthorized first-name use by patients and being mistaken for a nonphysician more frequently than men physicians. Women physicians also more frequently experience a stress response from these microaggressions. Decredentialing, long acknowledged anecdotally by women physicians, is a valid gender microaggression disproportionately affecting women physicians.