A Virtual Patient Encounter to Promote Integration in a Preclinical Case-Based Learning Session.

In medical education, virtual patients increase the realism of learning in a safe environment. We added an integrated learning event using a virtual patient to integrate patient history taking into a preclinical basic science course. Herein, we describe the process and our overall satisfaction with the virtual patient encounter.

Can Life Experiences Predict Readiness for Residency? A Family Medicine Residency's Analysis.

BACKGROUND: Program directors for Family Medicine residencies must navigate an increasingly complex recruitment landscape. With increasing United States allopathic and osteopathic graduates and continued high volumes of international graduates, the ability to identify application characteristics that predict quality residents both for filtering applications for interview offers and ranking is vital. Our study concentrates on the predictive value of reported life experiences including volunteerism, work experiences, prior career, research experience, and participation in medical student organizations including student leadership. METHODS: Through a retrospective cohort study, we extracted the described life experiences from resident application materials. We then obtained initial clinical performance data on the Family Medicine inpatient service during the first six months of residency to determine readiness for residency. This analysis occurred in 2020 and included all matriculants in the graduating classes of 2013 through 2020 for a single residency. Of 110 matriculating residents, data were available for 97(88%). RESULTS: Applicants with a history of a prior career demonstrated improved overall readiness for residency with competency domain-specific advantages in Interpersonal and Communication Skills and Systems-Based Practice. In contrast, applicants reporting participation in research performed below peers in all competency domains. Applicant reports on volunteerism, work experience, academic productivity and student involvement did not correlate with initial clinical performance. CONCLUSIONS: Residency directors should recognize applicants with prior careers as likely having strong communications and systems-based practice skills. All other examined experiences should be evaluated within the context of broader applicant assessments including research experience which overall has a potential negative correlation to clinical readiness.

One Institution's evaluation of family medicine residency applicant data for academic predictors of success.

BACKGROUND: Family Medicine residencies are navigating recruitment in a changing environment. The consolidation of accreditation for allopathic and osteopathic programs, the high volume of applicants, and the forthcoming transition of the United States Medical Licensing Exam (USMLE) Step 1 to pass/fail reporting all contribute. This retrospective cohort study evaluated which components of a student's academic history best predict readiness for residency. METHODS: In 2020, we analyzed applicant data and initial residency data for program graduates at a single residency program between 2013 and 2020. This included undergraduate education characteristics, medical school academic performance, medical school academic problems (including professionalism), STEP exams, location of medical school, and assessments during the first 6 months of residency. Of 110 matriculating residents, assessment data was available for 97 (88%). RESULTS: Pre-matriculation USMLE data had a positive correlation with initial American Board of Family Medicine (ABFM) in-training exams. Pre-matriculation exam data did not have a positive correlation with resident assessment across any of the six Accreditation Council for Graduate Medical Education (ACGME) competency domains. A defined cohort of residents with a history of academic struggles during medical school or failure on a USMLE exam performed statistically similarly to residents with no such history on assessments across the six ACGME competency domains. CONCLUSIONS: Applicants with a history of academic problems perform similarly in the clinical environment to those without. While a positive correlation between pre-matriculation exams and the ABFM in-training exam was found, this did not extend to clinical assessments across the ACGME competency domains.

Billing by residents and attending physicians in family medicine: the effects of the provider, patient, and visit factors.

BACKGROUND: Medical billing and coding are critical components of residency programs since they determine the revenues and vitality of residencies. It has been suggested that residents are less likely to bill higher evaluation and management (E/M) codes compared with attending physicians. The purpose of this study is to assess the variation in billing patterns between residents and attending physicians, considering provider, patient, and visit characteristics. METHOD: A retrospective cohort study of all established outpatient visits at a family medicine residency clinic over a 5-year period was performed. We employed the logistic regression methodology to identify residents' and attending physicians' variations in coding E/M service levels. We also employed Poisson regression to test the sensitivity of our result. RESULTS: Between January 5, 2009 and September 25, 2015, 98,601 visits to 116 residents and 18 attending physicians were reviewed. After adjusting for provider, patient, and visit characteristics, residents billed higher E/M codes less often compared with attending physicians for comparable visits. In comparison with attending physicians, the odds ratios for billing higher E/M codes were 0.58 (p = 0.01), 0.56 (p = 0.01), and 0.63 (p = 0.01) for the third, second, and first years of postgraduate training, respectively. In addition to the main factors of patient age, medical conditions, and number of addressed problems, the gender of the provider was also implicated in the billing variations. CONCLUSION: Residents are less likely to bill higher E/M codes than attending physicians are for similar visits. While these variations are known to contribute to lost revenues, further studies are required to explore their effect on patient care in relation to attendings' direct involvement in higher E/M-coded versus their indirect involvement in lower E/M-coded visits.

Resident-as-teacher in family medicine: a CERA survey.

BACKGROUND AND OBJECTIVES: Teaching has been increasingly recognized as a primary responsibility of residents. Residents enjoy teaching, and their majority report interest in the continuation of teaching activities after graduation. Resident-as-teacher programs have emerged nationally as a means of enhancing teaching skills. This study examined the current use of residents-as-teachers programs in family medicine residencies through a national survey of family medicine residency program directors. METHODS: This survey project was part of the Council of Academic Family Medicine Education Research Alliance (CERA) 2014 survey to family medicine program directors that was conducted between February 2014 and May 2014. RESULTS: The response rate of the survey was 49.6% (224/451). The majority (85.8%) of residency programs offer residents formal instruction in teaching skills. The vast majority (95.6%) of programs mandated the training. The average total hours of teaching instruction residents receive while in residency training was 7.72. The residents are asked to formally evaluate the teaching instruction in 68.1% of the programs. Less than a quarter (22.6%) of residency programs offer the teaching instruction in collaboration with other programs. "Retreat, workshop, and seminars" were identified as the main form of instruction by 33.7% of programs. In 83.3% of programs not offering instruction, lack of resources was identified as the primary barrier. CONCLUSIONS: The majority of family medicine residency programs provide resident-as-teacher instructions, which reflects increasing recognition of importance of the teaching role of residents. Further research is needed to assess the effectiveness of such instruction on residents' teaching skills and their attitudes toward teaching.