PRiMER (Leawood, Kan.)最新文献

Introduction: Utilizing medications to treat opioid use disorder (MOUD) is both highly effective and unfortunately underutilized in the US health care system. Stigma surrounding substance use disorders, insufficient provider knowledge about substance use disorders and MOUD, and historical lack of physicians with X-waivers to prescribe buprenorphine contribute to this underutilization. Our study aimed to elucidate barriers to accessing MOUD in Milwaukee, Wisconsin.

Methods: We conducted semistructured interviews with patients receiving MOUD at a family medicine residency program in Milwaukee, Wisconsin. Interviews were audio-recorded, transcribed verbatim, and analyzed using the qualitative analysis Framework Method. Researchers in our team reviewed transcripts, coding for specific topics of discussion. Coded transcript data were then sorted into a matrix to identify common themes.

Results: Interviews with 30 participants showed that motivations to seek treatment appeared self-driven and/or for loved ones. Eighteen patients noted concerns with treatment including treatment denial and efficacy of treatment. Housing instability, experiences with incarceration, insurance, and transportation were common structural barriers to treatment.

Conclusions: Primary drivers to seek treatment were patients themselves and/or loved ones. Barriers to care include lack of effective transportation, previous experience with the carceral system, and relative scarcity of clinicians offering MOUD. Future studies may further explore effects of structural inadequacies and biases on MOUD access and quality.

Medical educators are expected to disseminate peer-reviewed scholarly work for academic promotion and tenure. However, developing submissions for presentations at national meetings can be confusing and sometimes overwhelming. Awareness and use of some best practices can demystify the process and maximize opportunities for acceptance for a variety of potential submission categories. This article outlines logistical steps and best practices for each stage of the conference submission process that faculty should consider when preparing submissions. These include topic choice, team composition, consideration of different submission types, and strategies for effectively engaging participants.

Introduction: Existing literature about student-run clinics (SRCs) often focuses on student rather than patient experiences. To begin to gather data on norms and practices at SRCs nationally, this pilot study surveyed faculty leaders from SRCs around the country about metrics such as clinic organization, patient demographics, and care services.

Methods: A 38-question survey was distributed via email to members of the Student Run Free Clinic Faculty Association (SRFCFA) in October 2021. All responses were collected electronically via Qualtrics survey software.

Results: Most SRCs are held at least once weekly in variable physical locations. All SRCs surveyed use an electronic medical record. Student leadership typically rotates annually. Preceptors skew towards generalists rather than specialists. Clinics have variable patient volumes but see majority uninsured and non-English-speaking patient populations. Responses about consistency of result communication, follow-up visits, referrals to specialty care, and management of high-risk patients were mixed. The majority of respondents did not feel that learner experience was prioritized over patient care.

Conclusion: The design and operations of SRCs nationwide is variable and not standardized. There remains a limited understanding of patient experiences and patient-centered outcomes at SRCs, and thus it is difficult to guide best practices. Future efforts to collect patient perspectives and outcomes should be emphasized given the vulnerable populations these clinics serve.

Introduction: Increasing student participation within the classroom can improve student engagement, the classroom environment, and student learning, and can provide for more diverse perspectives on the content. Think-pair-share (TPS) is an instructional strategy that can be used to promote and support student participation and enhance learning. Our study aimed to investigate the use of this strategy in early medical education.

Methods: Using content analysis of video recordings, equity mapping software, and student surveys, we examined the implementation of TPS in three different small groups of first-year medical students. We looked for increased student participation, equity in the distribution of student participation, and quality of discussion as evidence of TPS's effectiveness in promoting student learning.

Results: TPS increased student participation and improved the quality of discussion. Additionally, students indicated TPS positively affected their learning, with the "thinking" and "pairing" time being especially important.

Conclusions: In utilizing TPS as an instructional strategy, medical educators can provide a structure that promotes a more equitable distribution of student participation, increased student interaction, and in-depth collaborative dialogue that enhance the overall learning experience.

Introduction: Medical educators have often perpetuated misunderstandings about race-based medicine and at times failed to create safe educational environments for diverse learners who frequently experience mistreatment. It is imperative that family medicine faculty be equipped to recognize and mitigate bias and inequities in our teaching, research, and clinical care.

Methods: Our residency formed a diversity, equity, inclusion, and antiracism (DEIA) faculty work group to address the need for faculty training. We developed and administered a 32-item needs assessment survey in 2020 to determine gaps in antiracist knowledge and skills among our faculty members. Over the following year, faculty members designed and implemented a series of faculty training sessions including a half-day faculty retreat to address the highest need areas. We reassessed faculty confidence and skills using a follow-up survey in 2021.

Results: Faculty respondents demonstrated increased confidence in their knowledge of various DEIA topics and ability to intervene when observing biased or culturally insensitive behaviors from colleagues. Participants also reported increased confidence in their ability to mitigate bias in their teaching and clinical work.

Conclusions: Our longitudinal DEIA faculty training series, embedded into the existing structure of the residency, resulted in improvements in DEIA-related confidence and skills among faculty members. This training model could be adapted to a variety of residency settings as one step toward dismantling racism in medical education and clinical practice.

Background: Virtual recruitment for all residency programs was endorsed by the Accreditation Council for Graduate Medical Education (ACGME) for the 2021 and 2022 recruitment seasons. This study assesses the impact of virtual recruitment on cost and outcome in a family medicine residency program.

Methods: We assessed program recruitment costs and interview-day time with applicants in one program for the 2019 to 2022 recruitment seasons, and we sent an anonymous survey to interviewed applicants (n=98) for the 2022 match year. In-person interviews were conducted in 2019 and 2020. Virtual interviews were conducted in 2021 and 2022.

Results: Program recruitment costs decreased from over $70,000 annually for in-person interview seasons to between $10,000 and $20,000 annually for the virtual interview years. Applicant time with the program on interview days decreased from 515 minutes when held in-person, to 345 minutes when virtual. Applicants expressed that they were generally satisfied with the virtual interview format though their preference for the virtual format was only slightly greater than for in-person interviews (38.6% and 35.1%, respectively); 26.3% of the responding applicants had no preference for either format. During virtual interview years, applicants interviewed at an average of 16.6 programs with 80% indicating that virtual interviews allowed for consideration of more programs.

Conclusion: The virtual interview format was associated with decreased interview-day costs for programs and interviewees, and decreased time on interview days for both groups. It allowed applicants to consider more programs.

Introduction: Point-of-care ultrasound (POCUS) is becoming more common as a diagnostic and clinical tool. Some medical schools have incorporated POCUS training in their curriculum. A family medicine clerkship during the third year of undergraduate medical education is appropriate for incorporating musculoskeletal (MSK) education. Musculoskeletal ultrasound (MSKUS) is a potential tool for augmenting this teaching.

Methods: Third-year undergraduate family medicine clerkship students were given prework related to ultrasound physics, terminology, and sonographic appearance of MSK structures. This was followed by a 2-hour session in the first week of their clerkship covering the shoulder and knee MSK exams, and incorporated hands-on scanning. Students practiced MSK exams during their 8-week clerkship and POCUS was available in clinic. They were administered a postsession survey to rate the MSKUS curriculum. Objective, structured clinical exam (OSCE) testing, including performance evaluation of the knee examination during the final clerkship week, was compared to prior-year OSCE scores.

Results: Third-year medical students felt the use of MSKUS was helpful and enhanced overall understanding of MSK exams. We did not see an improvement in OSCE scores. Students reported a desire for more POCUS training.

Conclusion: POCUS is a powerful tool within the clinical and academic setting. We were able to develop a curriculum using MSKUS to augment teaching the shoulder and knee exams to third-year family medicine clerkship students. While we did not see an improvement in OSCE scores evaluating the performance of a knee exam, students reported greater understanding of the exams with the MSKUS instruction added. Students desire more POCUS training in the undergraduate medical curriculum.