Family Medicine最新文献

Background and objectives: The number of family medicine positions unfilled in the Main Match has increased from 2019 to 2023. In the 2023-2024 family medicine application season, the specialty adopted the changes in the Electronic Residency Application Service (ERAS or MyERAS), which included geographic preferences and offered applicants five program signals. We compared the number of unfilled positions from prior years to results of the 2024 family medicine Match after the adoption of these changes.

Methods: We analyzed publicly available data from the National Resident Matching Program to compare the number of positions filled in the Main Match from 2019 to 2024. We estimated the number of expected positions filled using multiple linear regression and application data from ERAS and the number of available positions in the Match.

Results: A total of 636 positions were unfilled in the 2024 family medicine Main Match. Our statistical analysis, based only on the number of applicants and the number of available positions, predicted 630.65 unfilled slots with a 95% confidence interval from 605.53 to 655.77. The 2024 family medicine position fill rate decreased slightly at 87.8% compared to 88.7% in the 2023 Match. The number of family medicine programs that did not fill in the Main Match increased in 2024 to 241 (30.3% of programs) compared to 217 (28.1%) in 2023.

Conclusions: MyERAS changes in the 2023-2024 family medicine application season, including geographic preferences and program signaling, were not associated with a change in the number of programs or positions filled in the family medicine Main Match.

Background and objectives: Medical schools and family medicine organizations have been working on advancing diversity, equity, inclusion, and antiracism (DEIA). Black, Indigenous, and People of Color (BIPOC) faculty members are disproportionately expected to lead DEIA initiatives, negatively affecting academic promotion and well-being. Our study aimed to describe the existing DEIA initiatives, strategies, and barriers to implementing support for DEIA work, as well as the implications of addressing the minority tax in US and Canadian family medicine departments.

Methods: We used data collected as a part of the 2023 Council of Academic Family Medicine Educational Research Alliance (CERA) study. The survey was delivered to 227 department chairs across the United States and Canada.

Results: The survey response rate was 50.2% (114/227). Sixty-two percent of the respondents strongly agreed that advancing DEIA was important, and 55.4% reported having a DEIA leader, with 75.4% of those positions reportedly held by BIPOC faculty. Lack of funding was identified as the most significant barrier (26.2%), followed by lack of faculty expertise (18.7%). Department chairs who strongly agreed that DEIA work was important were significantly more likely to report having a DEIA committee, mentorship for BIPOC faculty, and a holistic review for faculty recruitment than those who did not strongly agree.

Conclusions: Though most department chairs perceived advancing DEIA work as important, appropriate compensation and institutional support are often lacking. Further study is needed to explore ways in which departments can enhance their institutional support for DEIA initiatives.

Background and objectives: Residency programs are expected to meet many requirements in training their residents, including providing adequate numbers of pediatric visits and procedures opportunities. In the residency program studied here, these numbers were inadequate, despite the efforts of faculty members over the years. A self-designated faculty champion (with traits including vision, persuasiveness, proactivity, and tenacity) launched a series of clinical initiatives to combat these problems.

Methods: The number of pediatric visits in the Family Medical Center (FMC) were tracked and compared from 2012, prior to the intervention led by the faculty champion, through 2023. The number of procedures performed in the FMC were tracked and compared from 2015, when the procedures-only clinic was launched by the faculty champion, through 2023.

Results: The number of pediatric visits in the FMC in 2012-2013 was a total of 12. By 2022-2023, that number had grown to 1,454. The number of procedures in the FMC was four in 2015-2016, but by 2022-2023 had grown to 470. The improved numbers support competency-based medical education, with increased faculty observation, teaching, and evaluation. For procedures training, the improved numbers support faculty members in using the Procedural Competency Assessment Tools to evaluate resident performance.

Conclusions: A faculty champion who is interested, self-motivated, persistent, and focused on leading the project from beginning to end can bring about significant improvements in a residency program, despite the program's track record of difficulty in making such improvements.

Background: Limited faculty development is a barrier to advancing evidence-based medicine (EBM) education. This study sought to describe program director perception of EBM culture in family medicine residency training and to assess the association among structured faculty roles, EBM curricula, and specific resident outcomes including publications in EBM.

Methods: Members of the Society of Teachers of Family Medicine EBM collaborative drafted survey questions based on a literature review. The questions were electronically distributed in May 2023 to all US family medicine residency program directors who had not previously opted out by the Council of Academic Family Medicine Educational Research Alliance within its study of family medicine program directors. We analyzed results using descriptive and comparative statistics.

Results: The overall response rate was 44.7% (309/691). We found that 260/281 (92%) of program directors reported an EBM curriculum of some kind, and 253/281 (90%) of program directors agreed/strongly agreed that EBM was accepted by residents. Of the respondents, 72/281 (25.6%) reported that no specific faculty member was responsible for their EBM curriculum. Most program directors reported that less than 50% of residents will leave their programs with the ability to detect an error in original research (23.8%; 67/281), detect an important omission in an UpToDate article (16%; 45/281), or author a narrative review for American Family Physician (10%; 28/281).

Conclusions: Program directors reported strong acceptance of EBM among residents and a high prevalence of a formal curriculum. However, many lacked a specific faculty lead, and few reported that residents had strong EBM skills. This study identified gaps in residency training to support future EBM-skilled family physicians as well as concerns about pathways for the development of future EBM faculty.

Background and objectives: Student-run free clinics (SRFCs) have been proposed as one educational strategy to increase medical students' interest in primary care careers. We sought to overcome gaps in the literature by investigating the effect of opening an SRFC at different institutions on institution-level match rates into family medicine, the largest source of primary care physicians in the United States.

Methods: We connected a list of SRFCs from primary care clerkship directors and the Society of Student-Run Free Clinics with a database of institution-level match rates into family medicine from 2000 to 2018. Using regression discontinuity analysis, we assessed whether opening an SRFC would increase family medicine match rates.

Results: Across a sample of 58 medical schools in the United States, we found that SRFCs did not significantly change the number (P=.44) or percentage of medical graduates (P=.42) entering family medicine residency. We also found no significant effects of SRFCs on the number of students entering family medicine in different contexts, including public/private institutions (P=.47), geographic areas (P=.26), departmental administrative structures (P=.69), and institutions with higher historical rates of producing graduates entering family medicine (P=.22).

Conclusions: Though SRFCs may potentially support other aspects of undergraduate medical training, they should not be used as a singular strategy for addressing shortages in the primary care workforce in the United States. Further educational research should examine multipronged strategies to increase the supply of early-career primary care physicians in the United States.