Family Medicine最新文献

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.

Background and objectives: The delivery of population health education in medical school can be challenging. We developed a patient outreach activity for third-year students to teach them the role of population panel management in primary care.

Methods: The family medicine undergraduate medical education and population health teams collaborated to develop an educational patient outreach toolkit. After an orientation, family medicine clerkship students were assigned to call patients on their faculty adviser's patient panel to discuss care gaps and identify barriers and potential strategies to improve care. After the experience, students completed reflection questions, which we analyzed.

Results: From February to August 2022, 82 third-year medical students participated in the patient outreach activity during their 6-week clerkship. Of the 1,235 total attempted calls, 24% of the patients scheduled their appointments afterward. After analyzing the reflective student feedback, we identified six main takeaways, which focused on the importance of population health, the identification of barriers to care, positive and negative feelings that students experienced when making calls, student self-identified areas of growth, and the fragmentation/inefficiency of the health care system.

Conclusions: An opportunity exists to continue to teach students about how to communicate with patients about their health and how to address and improve social determinants of health. This curricular activity can be a step toward efforts to align population health and clinical practice and a way for medical students to add value by educating patients.

Background and objectives: Learning to provide long-acting reversible contraception (LARC) during family medicine residency is an important step in building capacity for the primary care workforce to meet the reproductive health care needs of communities. We aimed to measure the impact of adding a contraceptive visit type (CVT) allowing for rapid access to contraception (RAC) on family medicine resident LARC procedure numbers.

Methods: Our program created a CVT in which patients were seen only for contraceptive services. We added the CVT to third-year family medicine resident continuity clinic schedules and a block of CVTs (the RAC clinic) to the third-year gynecology rotation. Residents self-reported LARC procedure numbers performed throughout residency, and the totals were compared for graduating residents from 2023 (post-RAC cohort) to 2022 graduates and 2018-2022 graduates (pre-RAC cohort).

Results: Post-RAC cohort residents reported a statistically significant increase in intrauterine device (IUD; P=.015) and contraceptive implant (P=.010) removals compared to the 2022 pre-RAC cohort. Insertions of IUDs and contraceptive implants were unchanged when compared to the pre-RAC cohort. IUD removals (P=.004) and insertions (P=.034), and contraceptive implant removals (P=.028) were significantly increased for post-RAC compared to 2022 graduates, with no difference in contraceptive implant insertions (P=.211).

Conclusions: The addition of the CVT and RAC clinic contributed to an increase in LARC removals in both comparisons, and IUD insertions between 2022 and 2023. This clinic model offers an opportunity for other family medicine residency programs to improve access to contraceptive services and increase resident training in LARC management.

Background and objectives: Social determinants of health (SDoH) education has gained popularity in undergraduate medical education; however, emphasis varies, and the curricula or assessment methods are not uniform. This study sought to examine the current SDoH teaching and assessment methods within family medicine clerkships and to identify characteristics associated with SDoH curriculum with multicomponent (two or more) teaching strategies and higher Kirkpatrick levels of assessment (Level 3-behavior change and Level 4-results).

Methods: An online survey was conducted through the 2023 Council of Academic Family Medicine Educational Research Alliance (CERA) Clerkship Directors Survey.

Results: The survey response rate was 56.8% (96/169). The degree of SDoH emphasis in the medical school was positively associated with the number of teaching strategies (r=0.48; P<.001). We found a trend toward degree of SDoH emphasis being associated with higher Kirkpatrick levels of assessment (H[3]=7.83; P=.05). Having an SDoH faculty champion was associated with more teaching strategies (F[1,77]=8.73; P=.004), more types of assessments (F[1,78]=5.88; P=.018), and higher Kirkpatrick levels of assessment (H[1]=4.46; P=.035). Underrepresented in medicine clerkship director identity was not associated with the number of teaching strategies or higher Kirkpatrick levels of assessment.

Conclusions: Greater degrees of SDoH emphasis and having a faculty champion were associated, or trended toward association, with multicomponent teaching strategies and higher Kirkpatrick levels of assessment, which prepare students to provide SDoH responsive care that could lead to reduction in health inequities.

Background and objectives: Graduate medical education programs need leadership assessments and curricula to engage residents and advance their leadership skills. The Foundational Healthcare Leadership Self-assessment (FHLS) is a validated 21-item self-assessment of leadership skills residents need to be effective team leaders in health care settings. It generates a composite score along five foundational leadership domains: accountability, collaboration, communication, team management, and self-management. Our objective was to determine whether a leadership curriculum, using the FHLS as an educational tool to support self-assessment, self-directed learning, and reflective practice, promotes self-awareness and engagement in leadership development.

Methods: We conducted a qualitative pilot study in the University of Utah Family Medicine Residency Program, integrating the FHLS into our residency's longitudinal leadership curriculum using coaching, self-directed learning, and reflective practice. Family medicine residents completed the FHLS prior to their leadership rotation. Faculty met with each resident during their rotation using a coaching paradigm based on data from the FHLS to inform leadership self-awareness. Residents identified a leadership domain for self-improvement, selected resources for self-study, and submitted a written reflection. We conducted qualitative content analysis on the reflections for evidence of self-awareness and engagement in leadership development.

Results: Residents completed 27 leadership rotations between May 2019 and April 2020, generating 21 reflections. Qualitative content analysis of resident reflections grouped by FHLS leadership domains identified evidence of impact on the residents' leadership development.

Conclusions: This qualitative pilot study supports the usefulness of the FHLS within a residency leadership curriculum to promote self-awareness and engagement in leadership development.