Family Medicine最新文献

Background and objectives: Family physicians contribute significantly to the pediatric workforce, but little is known about their pediatric training during residency, specifically in the inpatient setting. Our objective was to gather data on the inpatient pediatric training of family medicine residents from the perspective of pediatric faculty.

Methods: We created a survey about inpatient pediatric training of family medicine residents, including pediatric rotation characteristics, ward team structure, educational resources, and faculty involvement. The Association of Pediatric Program Directors (APPD) accepted the survey for distribution to pediatric residency associate program directors. Demographic data about respondents were provided by APPD. Data were collected between January and February 2024. We performed descriptive analysis of survey responses.

Results: We received 74 responses from 190 institutions, for a response rate of 39%. Of the respondents, 81% provided training to family medicine residents. We found wide variability in the structure of this training. Only 7% of sites reported having curricula specific to training family medicine residents in inpatient pediatric care. Inpatient pediatricians (76%) are often tasked with creating rotation structure and curricula for training family medicine residents.

Conclusions: In the view provided by our limited survey population, we found variability in the training structure and content of pediatric inpatient experiences; few family medicine-specific curricular tools are being used for this training, with little to no family medicine faculty involvement in this training. An opportunity may be available for collaboration between pediatric and family medicine faculty to establish a foundation for future curricula.

Background and objectives: Evidence on the relationship between formative assessment engagement and summative assessment outcomes in practicing physicians is sparse. We evaluated the relationship between engagement in the American Board of Family Medicine (ABFM) formative Continuous Knowledge Self-Assessment (CKSA) and performance on high-stakes summative assessments.

Methods: This retrospective cohort study included 24,926 ABFM diplomates who completed CKSA modules and summative assessments between 2017 and 2023. We analyzed CKSA engagement metrics-such as the number of quarters completed, time of completion, and self-reported confidence-against performance on summative assessments, measured by z scores. Multivariable regression models controlled for demographic factors and prior assessment performance.

Results: The overall cohort summative assessment pass rate during the study period was 90.3%. Greater CKSA engagement was strongly associated with higher summative assessment performance. Diplomates who completed all four CKSA quarters had significantly higher summative assessment z scores than those completing fewer quarters (P<.001). Early CKSA completion and spending more time on low-confidence questions were also positively correlated with both CKSA and summative assessment scores (P<.001). These effects were observed across different levels of prior exam performance.

Conclusions: Engagement in formative assessments like CKSA, particularly early and consistent participation and reviewing incorrect or low-confidence questions, is linked to better outcomes on high-stakes assessments. Future research should explore the mechanisms underlying these associations and consider developing an index of engagement to identify physicians at risk of poor performance. Incorporating structured, longitudinal self-assessments like CKSA into certification requirements could enhance continuous learning and improve summative exam readiness.

Background and objectives: Family physicians are central to the national emergency department workforce, especially in rural communities. However, the number of family physicians working in emergency departments is decreasing, perhaps due to lack of training.

Methods: We assessed emergency medicine and trauma stabilization curricula in US family medicine residencies to identify barriers to training in these areas. Council on Academic Family Medicine Educational Research Alliance (CERA) program directors' surveys were administered between September 26, 2023 and October 30, 2023. We stratified data according to community size (<30,000; 30,000-74,999; 75,000-149,999; 150,000-499,999; 500,000-1,000,000; and >1,000,000) to explore whether training differed based on training program rurality.

Results: Of the 715 program directors, 271 responded (37.9%). Of the program directors who responded, nearly 76% reported that residents spend 100 to 299 hours training in emergency rooms, and more than 86% reported that residents lead 0 to 5 trauma stabilizations by the time their training is complete, which did not differ according to rurality. Only 3.0% reported that all their graduates were prepared to work independently in emergency rooms, and 3.4% reported that all their graduates were prepared to lead trauma stabilizations, which also did not differ according to rurality. Barriers to training included Accreditation Council for Graduate Medical Education (ACGME) emphasis on other practice requirements (58.3%) and a lack of emphasis on trauma stabilization (69.7%).

Conclusions: Most program directors reported that few of their residents were prepared to independently work in emergency departments. If ACGME wishes to increase family medicine graduates' entry into the emergency medicine workforce, system changes may be required to increase emphasis on emergency training and its core component of trauma stabilization.

Background and objectives: Barriers to performing family medicine research include funding, infrastructure, and mentorship shortages. The Council of Academic Family Medicine Educational Research Alliance (CERA) was created in 2011 to address these issues. This study explores the scope and impact of CERA-related publications in family medicine.

Methods: We performed a descriptive bibliometric study of CERA-related publications from 2011 to 2023. Articles were sourced from Medline (PubMed), SCOPUS, and the CERA website. Data analysis focused on publication type, authors, CERA survey type, and citation rates.

Results: From a total of 231 articles retrieved via initial searches and 166 from the CERA website, 174 were included in the analysis. Most studies (95.4%) were original research, with the journal Family Medicine publishing the majority (69.4%). General membership surveys had the highest citations per publication (6.3), while publications prior to 2017 had more citations on average (6.3) compared to those after 2017 (2.4). CERA-related publications featured 515 unique authors across 153 affiliations, with top contributors being Kelly Everard and Arch Mainous III.

Conclusions: CERA provides essential infrastructure for family medicine research, fostering diversity in authorship and affiliations. While impactful in family medicine journals, opportunities exist to extend CERA's reach. Continued support and enhancements in data use are both needed.

Background and objectives: Effective feedback is recognized as essential to clinical training. Hattie and Timperley conducted a comprehensive review of feedback to develop their Model of Feedback to Enhance Learning (MFEL). The MFEL proposes that effective feedback can focus on any of four levels: task, process, self-regulation, and self. While Hattie and Timperley are frequently cited for their review, few studies in medical education have used the MFEL to explore feedback. We used the MFEL to examine the content of documented workplace-based feedback to explore how this model applies in a family medicine residency program.

Methods: We conducted this retrospective cross-sectional observational secondary data analysis (learning analytics) study in a Canadian university-based family medicine residency program. Our data source was de-identified field notes (a tool to document workplace-based feedback) for residents at two teaching sites. We coded the feedback using the levels from the MFEL. We used descriptive statistics to analyze the frequencies of each level and combinations of levels.

Results: Of the 2,250 field notes examined, 422 (18%) were excluded because they contained no feedback. The majority (1,105; 60%) included a single feedback level, while 705 (38%) contained two levels, and 17 (1%) included three levels. No field notes included all four levels. Of the field notes containing one feedback level, the most common levels were task (835; 76%) and process (248; 22%). The most common combination of levels was process and task (649; 92.1%).

Conclusions: Hattie and Timperley's MFEL offers a way to explore feedback documented in medical education programs and may help programs identify opportunities for faculty development to improve feedback effectiveness.