Family Medicine最新文献

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.

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.