Family Medicine最新文献

Background and objectives: Feedback to clinical supervisors of residents (preceptors) is critical to ensure quality teaching. Most feedback tools are based on theoretical models or expert opinion. No research has asked residents their thoughts on teaching practices. Our objective was to identify desired precepting practices by analyzing written feedback provided to preceptors by residents.

Methods: This project was conducted in a family medicine residency training program, analyzing feedback to preceptors from residents collected over 5 years. We used the nonviolent communication format, which identifies a request to a preceptor to continue an existing teaching behavior or change to a new one. The request statements were qualitatively analyzed by coders, aligning them when possible to categories of the Mayo Outpatient Precepting Evaluation Tool. Using content analysis, we coalesced all codes into categories from which we derived behaviorally based desired practices for precepting.

Results: Most (66.49%) of the requests were to continue a teaching behavior. We identified 26 desired practices in the following categories: setting the learning climate (n=5); preprecepting (n=2); preceptor presence (n=1); conveying clinical knowledge (n=4); decision-making (n=5); time management (n=4); and feedback on performance (n=5).

Conclusions: We identified precepting practices that residents desire. Some of these desired behaviors are not reflected in existing preceptor evaluation tools.

Background and objectives: Research has shown that effective team functioning increases patient satisfaction and reduces medical errors and burnout. The Team Development Measure (TDM), a 31-item instrument, was validated to assess four areas of team development: cohesion, communication, roles and goals, and team priorities. Despite its high reliability and psychometric validity, the large number of items in the TDM may be a barrier to its use in busy health care settings.

Methods: Using the original dataset of 1,194 participants from 120 primary care teams, we conducted an exploratory factor analysis. We used principal component analysis with varimax rotation and Kaiser normalization to validate a 20-item shortened version (TDM-20). We also performed a scree test as a parallel analysis.

Results: Our exploratory factor analysis identified two domains in the TDM-20. The first was communication and engagement, which we defined as team members' ability to respectfully interact toward accomplishing goals. The second domain was shared values and cohesion, which we defined as core beliefs that guide the behaviors of a group from an empathetic and psychologically safe position. Each domain comprised 10 items. The eigenvalues for the two domains were 10.9 and 1.10, accounting for 54.5% and 5.5% of the variance, respectively. Both domains demonstrated high internal consistency (Cronbach's α were 0.92 and 0.93, respectively).

Conclusions: The TDM-20 demonstrated high validity and is suitable for measuring team development in primary care medical settings. Further research is needed to examine whether the pandemic affected the results of the instrument in various cultural backgrounds and current medical environments.

Background and objectives: The purpose of this study is to compare the career outcomes of medical students who completed the Underserved Pathway (UP) at the University of Washington School of Medicine (UWSOM) to a matched cohort of their peers who did not complete the UP. Were participants more likely to practice in rural communities and/or primary care specialties than their peers who did not complete the UP?

Methods: Starting with a list of 243 UP students enrolled between 2004 and 2012, we used propensity-score matching to build a matched cohort of non-UP graduates and then used multiple regression to compare the groups, with a focus on career outcomes.

Results: A total of 384 UWSOM graduates were included in the analysis: 191 UP graduates and 193 non-UP graduates. Overall, UP graduates had three times the odds of practicing family medicine in a rural community than their non-UP peers and three and a half times the odds of practicing rural primary care.

Conclusions: Longitudinal cocurricular programs that encourage students to explore and gain experience in underserved communities may help address physician workforce shortages in rural areas.

Background and objectives: Opioid use disorder (OUD) education is crucial early in medical education in response to the overwhelming number of drug overdose deaths and the stigma attached to addiction among health care professionals. Our study aimed to examine factors associated with teaching about OUD and to determine whether OUD education has increased over the past several years.

Methods: Data were collected through a cross-sectional survey of 173 US and Canadian family medicine clerkship directors in summer 2024. Survey items included clerkship directors' perceived importance, presence of current OUD education, and perceived barriers to OUD education.

Results: The response rate was 52.6% (91/173). Nine participants did not complete the addiction medicine questions and were excluded from analyses. Nearly three-fourths of clerkship directors thought teaching OUD was important, but 45% of clerkships did not include any OUD education. Approximately one-third of clerkship didactics covered screening, brief intervention, and referral to treatment (SBIRT; 40.2%); diagnosis of OUD (42.7%); pharmacological treatment of OUD (37.8%); and opioid overdose prevention education (31.7%). Lack of time in the curriculum was the most commonly perceived barrier to OUD education in clerkship.

Conclusions: Clerkships were more likely to include OUD education if clerkship directors perceived OUD education as important or had faculty with expertise to teach OUD. Our survey revealed an increase in the inclusion of OUD education in family medicine clerkships over the past several years. Designing the addiction medicine curricula specifically for medical student education may contribute to enhancing OUD education.

Background and objectives: The 2023 Accreditation Council for Graduate Medical Education (ACGME) program requirements for family medicine residencies state that family physicians must have the competence to address racial and ethnic health disparities experienced by their patients. Racial justice curricula (RJC) or antiracism curricula can provide residencies with the tools faculty and residents need. This study explores the differences in perceived barriers between family medicine program directors (PDs) and residents.

Methods: Survey questions on RJCs were included in the 2020 Council of Academic Family Medicine Educational Research (CERA) survey of PDs and 2021 CERA survey of residents. Participants' perceived top two barriers to implementing an RJC in their residency program were illustrated with Sankey diagrams. We used the χ2 test and logistic regression for analysis.

Results: Of the 578 participants included, 312 (54%) were PDs and 266 (46%) were residents. Compared to PDs, residents were more likely to identify as female, less likely White, and more likely from community-based, nonuniversity-affiliated residency programs. PDs ranked lack of faculty training as the most important barrier, while residents ranked lack of time as the top barrier. Residents also were significantly more likely to rank lack of faculty interest and resident interest as barriers.

Conclusions: Family medicine PDs and residents identified different barriers to implementing an RJC. Additional research is needed to investigate the impact of knowledge and culture on residency programs' receptiveness to addressing racial and ethnic health disparities.