PRiMER (Leawood, Kan.)最新文献

Introduction: When faced with an acute illness, patients routinely make the decision of whether to present to their primary care physician (PCP) or the emergency department (ED). While the ED is known to be a high-cost component of the health care system, many ED visits include nonurgent ailments that could easily be treated within the medical home/primary care office. Particularly for patients who have an established PCP, the factors driving a preference for ED use remain poorly understood. The purpose of this study was to better understand patient motivation for visiting the ED rather than the PCP office.

Methods: This observational study aimed to take a qualitative look at the patient population using a health system ED in the city of Wilkes Barre, PA, from December 2021 to March 2022. We conducted 30 interviews of patients who recently visited the ED and analyzed the responses for recurring themes.

Results: Major themes included the benefit of the PCP-patient relationship, patients' preference for multiple sources of medical guidance, patients' subjectively justifying their symptoms as emergent, seeking emergent care despite perception of higher cost, and factoring in time spent at a health care facility waiting for answers.

Conclusions: This study contributes to further understanding of the values that drive ED use by using patient voice as a powerful tool to understand communities and local trends, which will allow health care systems to adapt and personalize protocols to their specific population.

Introduction: As the number of medical students who identify as underrepresented in medicine (URiM) increases, the disparities related to gender and URiM status persist. This study examines the current initiatives within family medicine clerkships to reduce bias in evaluations.

Methods: Our 10-item survey was included as a module in the 2022 Council of Academic Family Medicine Educational Research Alliance national survey of family medicine clerkship directors. Our survey questions asked about whether programs had strategies to reduce bias in student evaluations, antiracism initiatives, perceptions on effectiveness of the initiatives, and type and cadence of faculty development on evaluations for preceptors.

Results: The overall response rate for the survey was 59.12% (94/159); all respondents completed our module. Seventy percent said they had implemented strategies to reduce bias in evaluations, 60% felt these were effective, and 80% felt that reducing bias in evaluations was a priority. The majority, 89/91(95%), indicated that their medical schools had a current social justice, diversity, or antiracism initiative. We identified a positive association between specific antibias medical school initiatives and clerkship directors undertaking practices to reduce bias in evaluations (P=.005).

Conclusions: Most programs had implemented strategies to reduce bias and felt that doing so was a priority. Community-based preceptors were less likely to have faculty development around reducing bias compared to those in academics. Further improvements may need to prioritize including community preceptors in educational efforts to reduce bias.

Peer review is primarily thought of as the process used to determine whether manuscripts are published in medical or other academic journals. While a publication may be one outcome of peer review, this article shares a model of 4 Ps to remind faculty of some important additional applications of peer review. The 4 Ps are publication, presentation, promotion, and practice. The medical literature offers few reasons why faculty should get involved in peer review. In this article, we define peer review, illustrate the role of peer review in four important processes, describe how the volume of material to review has changed over time, and share how participation in these processes promotes career advancement. Understanding the peer review process and its benefits can encourage professionals to participate in peer review in any of the four Ps as they recognize the benefits to their discipline and their career.

Introduction: Competency in diversity, equity, and inclusion skills is critical for graduate medical education program coordinators. Coordinators contribute to high-level personnel and program management while also providing informal social support to residents. However, little has been reported about program coordinator learning needs, interest, and self-reported skills and attitudes regarding diversity, equity, and inclusion initiatives in graduate medical education. This study sought to describe the characteristics, job tasks, attitudes, and learning needs of program coordinators attending a professional development session about diversity, equity, and inclusion.

Methods: Participants registered for a September 2022 program coordinator professional development workshop on diversity, equity, inclusion, and bias were invited to complete an electronic needs assessment prior to the workshop. Items were based on expert opinion and literature review. We performed descriptive and comparative analysis.

Results: The response rate was 54% (106/198); 90% (94/104) of respondents identified as female; 42% (44/104) identified as an underrepresented minority. Fifty-seven percent (63/104) received mandatory training on bias while 13% (14/104) were previously trained on bias at a conference specific to the role of a coordinator. Eighty-nine percent (86/104) of coordinators reported having contact with applicants during recruiting; 67% (63/104) offer informal resident evaluations. Most participants agreed it is the coordinator's professional responsibility to confront colleagues who display signs of discrimination toward women (66%; 62/104) or based on cultural/ethnic identity (65%; 61/104).

Conclusions: Program coordinators report visible and impactful roles in the residency leadership and management team. Few coordinators have received diversity, equity, and inclusion training related to their complex work in graduate medical education. Future graduate medical education diversity, equity, inclusion, and bias competency programs should specifically include program coordinators.

Introduction: Point-of-care ultrasound (POCUS) is increasingly being employed in family medicine. Residency tracks can be an effective way to increase mastery in a specific subdiscipline for interested residents, but no studies exist on the implementation of a POCUS track in family medicine. We address this gap in the literature by assessing POCUS use by POCUS track residents compared to non-POCUS track residents and faculty in an academic family medicine department.

Methods: We performed a retrospective review of all POCUS scans completed in the first year after implementation of a family medicine residency POCUS track. Scans were analyzed by two reviewers. We compared scan volume and type between POCUS track residents, non-POCUS track residents, and faculty. A blinded quality analysis was performed on each group of scans.

Results: A total of 572 scans were completed on 536 patients over 1 year. POCUS track residents scanned significantly more than non-POCUS track residents (mean difference of 72.2, CI 59.1 to 85.4; P<.0001). The most common scan types across groups were musculoskeletal and soft tissue. POCUS track residents showed statistically improved scan quality in all scan types, while non-POCUS track residents showed statistical improvement only in soft tissue, shoulder, and abdominal aortic aneurysm scans.

Conclusions: This is the first longitudinal study of a novel academic family medicine residency POCUS track. Participation in a POCUS track can increase the number, variety, and quality of scans performed. Our curriculum can be a model for family medicine residency programs that wish to provide robust POCUS training.

Background and objectives: Mentorship is critical for the career development of health care professionals and educators. Facilitating successful mentorship is valuable in supporting future leaders and educators in family medicine. Since 1988, the Society of Teachers of Family Medicine's New Faculty Scholars (NFS) program has provided 1-year mentorship opportunities for new faculty. This qualitative study used group concept mapping to identify the characteristics of successful mentorship relationships within the NFS program.

Methods: Eight New Faculty Scholars (five mentors, three mentees) from 2015 to 2021 participated in a virtual 90-minute group concept-mapping and pattern-matching session. Participants generated statements in response to a prompt about successful features of mentorship relationships. Participants categorized responses by similarity and rated each statement on a numerical scale from 1 to 5 (1 indicating lowest, 5 indicating highest) according to importance, current presence within the program, and feasibility.

Results: Statements generated by participants were grouped into seven common themes. Categories rated most important included interpersonal skills, mentor soft skills, and mentor preparation. Structured processes and goal setting, mentor soft skills, and mentor preparation were rated most feasible in terms of future improvement.

Conclusions: Interpersonal skills, mentor soft skills, and mentor preparation were the most highly rated by participants, but also displayed the largest disparity when compared to ratings on current presence. Future efforts to improve interpersonal communication and mentor training can potentially lead to greater satisfaction with the NFS program. The most highly rated categories indicated the primary benefit of the relational components of mentorship.

Introduction: US child firearm fatality rates have risen since 2013. Child Access Prevention (CAP) laws aimed at reducing minors' access to firearms have existed since the 1980s. However, specific requirements for safe storage of firearms, standards of negligence, and penalties for offenders vary significantly by state, yielding a heterogeneous body of CAP legislation. A few studies have investigated the relative impacts of these laws on child firearm injury rates, with sometimes conflicting results. Here, we present a rapid review of the existing literature on CAP laws and their apparent impact on firearm-related injuries among US children, to assess whether CAP laws are an effective tool for reducing child firearm injuries.

Methods: We conducted a rapid review of published reports that evaluated the impact of CAP laws on pediatric firearm injuries and/or deaths in the United States. We extracted target population data and outcomes of each study. The data are presented narratively.

Results: A total of 14 articles met criteria for evaluation. Taken together, these studies showed that implementation of CAP legislation was associated with reduced pediatric firearm injuries and fatalities. Moreover, longitudinal or time-series studies that examined changes in pediatric firearm injuries pre/post-CAP legislation yielded the most consistent and robust findings.

Conclusion: CAP laws were found to be associated with reduced pediatric firearm injuries and deaths, with the magnitude of effect being proportional to CAP law stringency.

Background and objectives: Motivational interviewing (MI) is a patient-centered approach to behavior change counseling that is used among health professionals across multiple disciplines. However, MI training has yet to be broadly offered to health professional (HP) students. This study aimed to evaluate student interest in MI and the efficacy of an MI workshop to assess whether MI training should be incorporated into HP curricula.

Methods: We conducted a needs assessment to evaluate HP student interest in learning MI. We then hosted a 6.5-hour MI workshop, followed by optional standardized patient encounters (SPEs). SPE performance was evaluated with a scored competency assessment.

Results: Needs assessment respondents (N=93) were predominantly medical students (53%), of which 49% were interested in primary care-related fields. Most (58%) reported receiving 0 to 2 hours of MI training in their required curricula, yet 87% intended to use MI and were interested in receiving training. Nineteen students attended the MI workshop. Postworkshop knowledge assessment (N=11) improved by an average of 34% (premean [±SD], 41% [±12]; postmean [±SD], 75% [±10]; P<.001). The SPE mean competency score (5.09) surpassed the threshold for competence of 5.

Conclusions: HP students reported receiving minimal MI training in their curricula despite being highly interested in MI. Interested students responded to our interdisciplinary MI workshop and SPEs with high satisfaction, suggesting that HP schools may benefit from incorporating MI into their curricula. Nevertheless, response rates were low, and selection bias may have skewed responses toward more favorable perceptions of MI.

Background and objectives: In health care, empathy is a clinician's ability to understand a patient's emotional state and convey that understanding in their care; and being culturally sensitive is communicating and respecting cultural differences. Providing health care on digital platforms introduces a new challenge of conveying empathy and cultural sensitivity. This study aimed to evaluate whether patients who were seen in-person had different perceptions of clinicians' empathy and cultural sensitivity compared to those who were seen via telemedicine.

Methods: In this cross-sectional pilot study, we recruited primary care clinicians (N=8) and their telemedicine (N=14) and in-person patients (N=20) from two clinics at Emory University in Atlanta, Georgia. We evaluated clinicians' empathy and cultural sensitivity by self-report and from patients' standpoints.

Results: Patient perception of clinician empathy scores were similar (P value=.31) for in-person appointments (mean=33.8) and telemedicine appointments (mean=31.3). Patient perception of culturally sensitive communication varied in the sensitivity domain and was consistently low for the domain of discrimination (suggesting low discrimination among the clinicians) regardless of the modality of the visit.

Conclusions: This novel pilot study demonstrated comparable empathy and culturally sensitive communication scores in telemedicine and in-person visits, highlighting the potential for continued use of telemedicine in outpatient primary care. Delivery of care via telemedicine can enable an expansion of high-quality care to underserved communities. Future studies are needed to confirm our findings to enhance the experience of telemedicine visits for patients and clinicians.

Introduction: Clinical teaching cases are a cornerstone of health professions education programs, but cases historically have lacked diversity and have the potential to reinforce essentialism. In this article, we describe the creation, implementation, and feasibility assessment of a professional development workshop aimed at integrating an existing bias reduction tool into discussion and revision of teaching cases.

Methods: Six 60-minute workshops were held introducing "The Race and Culture Guide for Editors of Teaching Cases" to different health profession education programs wherein all participants worked in small groups to critique and edit two sample teaching cases. To assess initial feasibility, facilitators completed a facilitator evaluation survey to capture experiences after the first three workshops. Due to positive feedback, workshops were continued, and participants completed a participant evaluation survey to understand learner impact.

Results: Facilitators (n=6) identified the workshop as addressing an important need, highlighted the value in small-group format, and noted their ability to facilitate future sessions. Participants (n=18) rated the workshop as useful, effective at challenging biases, and would recommend the workshop to others.

Conclusion: The purpose of this study was to understand the feasibility of implementing a discussion-based workshop integrating a bias reduction tool. Initial feasibility and acceptability assessments demonstrate that this workshop.