Family Medicine最新文献

Background and objectives: New family medicine residency program and graduate board certification requirements necessitate a transition within programs to competency-based medical education (CBME) to ensure that the discipline is training physicians to meet America's health care needs. A task force formed by the Society of Teachers of Family Medicine (STFM) created recommendations for implementation of CBME.

Methods: The STFM CBME Task Force reviewed papers written by CBME experts and, through group discussions and consensus, drafted recommendations. Feedback on drafts of the recommendations was provided by leaders of the American Academy of Family Physicians, American Board of Family Medicine, American College of Osteopathic Family Physicians, Association of Departments of Family Medicine, Association of Family Medicine Residency Directors, North American Primary Care Research Group, and STFM.

Results: The STFM CBME Task Force created 12 recommendations to guide programs and one recommendation for the specialty of family medicine for implementation of CBME.

Conclusions: The transformation of the educational framework in family medicine to competency-based is a significant change for programs, learners, faculty, and staff. Residencies and family medicine organizations can reference these national recommendations as they incorporate CBME principles to advance residency education.

Background and objectives: Family medicine has experienced wide variation in the proportion of allopathic medical students it attracts, ranging from a high of 16.8% to a low of 6.8%. We sought to measure the changes in specialty choice between the start of medical school and graduation.

Methods: We compared the specialty choice reported on the American Association of Medical Colleges annual allopathic Matriculating Student Questionnaire (MSQ) from 2014 to 2017 with the Graduation Questionnaire (GQ) from 2018 to 2021.

Results: Among 55,635 students who completed both the MSQ and the GQ, more than 70% changed their specialty choice between matriculation and graduation. Just 45% of students who reported family medicine at matriculation chose family medicine at graduation. However, 70% of students entering family medicine at graduation had selected some other specialty at the start of medical school. This increase of more than 3,000 students who made their family medicine specialty choice during medical school represents a net gain of nearly 1,000 students entering family medicine over the 4 years.

Conclusions: Most allopathic medical students change their specialty choice during medical school. The historic concern about students being talked out of family medicine during medical school is still partially valid, yet the data reported here show that the majority of students entering family medicine at graduation had reported a different specialty when they entered medical school. While increasing family medicine recruitment into medical school is crucial, these data also show the critical importance of family medicine departments helping recruit and support medical students' family medicine choice during medical school.

Background and objectives: Primary care is shifting to value-based care (VBC) payment models, which measure and prioritize quality outcomes and cost efficiency. These models include functions such as interdisciplinary teamwork, proactive panel management, and measurement of total cost of care, with the specific aim of improving quality and reducing health care costs. Graduating residents will require training in the key principles of VBC to succeed in many primary care settings. This research study explored current training practices in VBC within family medicine residency programs.

Methods: A Council of Academic Family Medicine Educational Research Alliance study of family medicine program directors assessed the current state of VBC education. The survey questions assessed whether programs had a formal VBC curriculum, what elements of VBC are taught and how, and the present barriers and facilitators to VBC education.

Results: The overall response rate for the survey was 45.39% (320/705). Most respondents (92.2%) agreed that teaching VBC within their residency curriculum was important, but only 26.9% of programs have established a formal VBC curriculum. The most frequently taught element is the "evaluation and management of quality outcomes" (80.9%), and VBC is mostly taught through didactics (79.7%). The most frequently reported barrier to teaching VBC was the lack of time within the curriculum and/or competing priorities (37.5%).

Conclusions: Residency programs in primary care specialties would benefit from a formal VBC curriculum appropriate for graduate medical education. This curriculum should include assessment tools for residents that include objective measures for VBC skills and training.

Background and objectives: Residencies train residents in procedures and assess their competency, but existing assessment tools have demonstrated poor reliability and have not been validated.

Methods: This mixed-methods study validated a shave biopsy checklist with family medicine and dermatology faculty at two academic centers. In each phase of the study, teaching faculty scored a video-recorded simulated procedure using the checklist, and investigators assessed content validity, interrater reliability, and accuracy.

Results: In focus groups of nine family medicine and dermatology faculty, 16 of 18 checklist items met or surpassed 80% interrater reliability. Overall checklist reliability was 74%. Focus group surveys initially revealed insufficient content validity. Lowest performing items were removed, and then the follow-up content validity index (0.76) surpassed the required threshold (0.62). Twenty-one of 70 family medicine faculty completed a final survey, which showed a content validity index of 0.63, surpassing the required threshold of 0.42. Twelve of 70 family medicine faculty viewed and scored a simulated video-recorded procedure. Overall interrater reliability was 91% (Cohen's d=1.36). Fourteen of 16 checklist items demonstrated greater than or equal to 90% interrater reliability. Accuracy analysis revealed 67.9% correct responses in focus groups and 84.9% in final testing (simple t test, P<.001, Cohen's d=1.4).

Conclusions: This rigorously validated checklist demonstrates appropriate content validity, interrater reliability, and accuracy. Findings support use of this shave biopsy checklist as an objective mastery standard for medical education and as a tool for formative assessment of procedural competency.

Background and objectives: Physician scheduling affects job satisfaction and retention. This study explores how family medicine residency inpatient staffing relates to core faculty retention and program director (PD) perception of faculty satisfaction with work-life integration.

Methods: A total of 280 family medicine residency PDs responded to the 2023 Council of Academic Family Medicine Education Research Alliance survey. We used the ꭓ2 test to explore associations among program demographics, inpatient staffing characteristics, faculty retention, and PD-reported faculty satisfaction with work-life integration. We measured associations among pairs of ordinal variables with Spearman's correlation.

Results: In two-thirds (66%) of programs, faculty cover the inpatient service at least every 8 weeks, with 40% of programs reporting averages of 70 or more hours per inpatient week; nevertheless, most programs' faculty were perceived to be satisfied with less than 10% turnover. The number of hours per week was inversely associated with PD-reported faculty satisfaction (r=-0.21, P=.001). Faculty turnover was directly associated with community size (r=0.17, P=.01). Faculty turnover was more likely to be greater than 10% if the number of hours per inpatient week was more than 89 (odds ratio 12.4, P=.02). Faculty turnover, PD-reported faculty dissatisfaction, and plans to change inpatient staffing were all correlated (r>0.28, P<.0001).

Conclusions: Most family medicine residencies have core faculty cover the inpatient service at least once every 8 weeks, during which they work at least 60 hours per week. Longer hours are associated with lower perceived faculty satisfaction of work-life integration, with a threshold effect on faculty turnover. Family medicine residency programs must carefully balance the needs of residents, the community served, and faculty themselves.