Primary healthcare training in the Democratic Republic of the Congo.

Family medicine is a relatively new discipline in the Democratic of the Congo. It was developed under South-South and Churches Collaboration with the aim of responding in a cost-efficient manner to the crisis of health practitioners in mostly Christian and protestant hospitals based in rural areas in the Democratic Republic of the Congo.

Electronic distance based clinical skills training development in family medicine in Namibia.

Workplace-based evaluation is one of the most important, but challenging aspects of medical education. The aim was to improve the assessment of the rural community-based clinical training for undergraduate 3rd and 4th year family medicine students at the University of Namibia (UNAM) and implement a paperless process. An online module was developed on the Moodle platform to include a study guide, an electronic portfolio, and electronic resources (e-books and apps) to replace the current paper version of the logbook. We explored local resources by engaging with students and clinical trainers on how to best conduct the initial implementation. Engagement also entailed motivating students to actively participate in the implementation process. All 3rd and 4th year community-based education end service (COBES) students are now submitting proof of clinical learning electronically with the use of their phones in their online portfolio and using online resources. In addition, students in the practical family medicine module that has been introduced in the 6th year since 2023 are now also using an electronic portfolio and these assessment tools.Contribution: Overall feedback from students and supervisors indicates a positive atmosphere of learning and constructive feedback on performance from all team members, hopefully improving work-based assessments and ultimately patient care. More members of the primary health care team were involved and the carbon footprint has also been decreased.

Evaluating the new family medicine internship programmes in the Western Cape, South Africa.

BACKGROUND:  In 2021, South Africa introduced a new 6-month internship in family medicine and primary care. This study aimed to assess the new rotation at district health facilities in the Western Cape. METHODS:  A descriptive survey of interns and supervisors, as phase-two of an exploratory sequential mixed methods study. Questionnaires were developed from a descriptive exploratory qualitative study. Data were analysed with the Statistical Package for Social Sciences. RESULTS:  Questionnaires were completed by 72 interns (response rate 21%) and 36 supervisors (response rate 90%), across 10 training programmes. Interns felt more independent (97.2%), confident (90.3%) and resilient (91.6%). They learnt to manage undifferentiated and chronic conditions (91.6%), to refer patients (94.3%) and conduct procedures (77.8%). Most interns were not exposed to community-based services (68.0%) and continuity of care (54.1%). Supervision was mostly adequate during the day (79.1%) and afterhours (80.6%). Many interns reported no structured teaching programme (41.7% - 55.6%). Most supervision was from medical officers and registrars. Supervisors saw interns as valuable members of the clinical team (100.0%), who required extra support and administration (42.5%). The majority of interns (75.0%) and supervisors (72.7%) thought the rotation was the right length and the best preparation for community service (67.6%). CONCLUSION:  The rotation met most expectations of the Health Professions Council of South Africa. Programmes need to improve exposure to community-orientated primary care, public health medicine, palliative and ongoing care. Supervision and orientation of interns needs improvement.Contribution: This is the first evaluation of the new family medicine internship programme in South Africa.

The career pathways of new family physicians in South Africa from 2008 to 2022.

BACKGROUND:  Family medicine has trained specialist family physicians in South Africa since 2008, but not investigated their career pathways. The study aimed to determine the career pathways of newly qualified family physicians between 2008 and 2022. METHODS:  A cross-sectional descriptive survey of all 186 family physicians via an electronic questionnaire. RESULTS:  Response rate was 44.6% (83/186). Overall, 9.6% emigrated, 10.8% were no longer practising, and 79.5% were still practising in South Africa. Of the latter, 14.5% were in the private sector, 55.4% in the public sector and 9.6% in both. Of those in the public sector, 33.7% were in specialist family physician posts, 12% in medical officer posts, 4.8% in managerial positions and 4.8% in academic positions. Issues relating to safety and security were important to those working in both sectors and relationships with colleagues in the clinical team, to those in the public sector. Overall, participants practised near or within their province of training and were not equitably distributed. CONCLUSION:  Only a third of graduates were in specialist family physician posts in the public sector. Attention needs to be given to retaining more graduates in such posts to achieve the goals of the national position paper. The proportion in the private sector was lower than expected. The reasons for no longer practising medicine should be further explored.Contribution: This is the first study on the career pathways of family physicians in South Africa since the new speciality was created. Understanding these pathways will assist with human resources for health planning.

Mastering your fellowship: Part 4, 2024.

The 'Mastering your Fellowship' series provides examples of the question format encountered in the written and clinical examinations for the Fellowship of the College of Family Physicians of South Africa (FCFP [SA]) examination. The series is aimed at helping family medicine registrars prepare for this examination. Model answers are available online.

Harmonizing the Tripartite Mission in Academic Family Medicine: A Longitudinal Case Example.

Academic practices and departments are defined by a tripartite mission of care, education, and research, conceived as being mutually reinforcing. But in practice, academic faculty have often experienced these 3 missions as competing rather than complementary priorities. This siloed approach has interfered with innovation as a learning health system in which the tripartite missions reinforce each other in practical ways. This paper presents a longitudinal case example of harmonizing academic missions in a large family medicine department so that missions and people interact in mutually beneficial ways to create value for patients, learners, and faculty. We describe specific experiences, implementation, and examples of harmonizing missions as a feasible strategy and culture. "Harmonized" means that no one mission subordinates or drives out the others; each mission informs and strengthens the others (quickly in practice) while faculty experience the triparate mission as a coherent whole faculty job. Because an academic department is a complex system of work and relationships, concepts for leading a complex adaptive system were employed: (1) a "good enough" vision, (2) frequent and productive interactions, and (3) a few simple rules. These helped people harmonize their work without telling them exactly what to do, when, and how. Our goal here is to highlight concrete examples of harmonizing missions as a feasible operating method, suggesting ways it builds a foundation for a learning health system and potentially improving faculty well-being.

Medical interns' training in family medicine at a district hospital and primary health care clinics in Middelburg, Mpumalanga.

Training of medical interns at the Middelburg district hospital has been introduced as part of the mandatory 6 months' rotation in Family Medicine department since 2021. This report provides an overview of what has been attained in 2021 and 2022. It covers various aspects of the activities medical interns have been exposed to in the Middelburg hospital and the surrounding primary health care clinics.Contribution: Sharing experiences of family medicine training for medical interns in district hospitals is essential because the 6 months' rotation is new for most family physician trainers, especially those in small hospitals and primary health care clinics. Taking into account the paucity of evidence on the topic, the report brings current information that supports that training medical interns in district hospitals and primary health care clinics prepares them to be comfortable and competent clinicians for the generalist work during the community service year ahead.

Equity and Justice in Family Medicine Clinical Care and Teaching Must Incorporate a Reproductive Justice Framework.

Since European settlement, the United States has controlled the reproduction of communities of color through tactics ranging from forced pregnancies, sterilizations, and abortions to immigration policies and policies that separate children from their families. Lesbian, gay, bisexual, transgender, queer (or questioning), asexual, intersex, and gender diverse people (LGBTQIA+) have been persecuted for sexual behavior and gender expression, and also restricted from having children. In response, women of color and LGBTQIA+ communities have organized for Reproductive Justice (RJ) and liberation. The Reproductive Justice framework, conceived in 1994 by the Women of African Descent for Reproductive Justice, addresses the reproductive health needs of Black women and communities from a broad human rights perspective. Since then, the framework has expanded with an intersectional approach to include all communities of color and LGBTQIA+ communities. Notwithstanding, reproductive injustice negatively impacts the health of already marginalized and oppressed communities, which is reflected in higher rates of maternal mortality, infant mortality, infertility, preterm births, and poorer health outcomes associated with race-based stress. While the impact of racial injustice on disparate health outcomes is increasingly addressed in family medicine, Reproductive Justice has not been universally incorporated into care provision or education. Including the RJ framework in family medicine education is critical to understanding how structural, economic, and political factors influence health outcomes to improve health care delivery from a justice and human rights perspective. This commentary describes how an RJ framework can enhance medical education and care provision, and subsequently identifies strategies for incorporating Reproductive Justice teaching into family medicine education.

Machine Learning to Identify Clusters in Family Medicine Diplomate Motivations and Their Relationship to Continuing Certification Exam Outcomes: Findings and Potential Future Implications.

BACKGROUND: The potential for machine learning (ML) to enhance the efficiency of medical specialty boards has not been explored. We applied unsupervised ML to identify archetypes among American Board of Family Medicine (ABFM) Diplomates regarding their practice characteristics and motivations for participating in continuing certification, then examined associations between motivation patterns and key recertification outcomes. METHODS: Diplomates responding to the 2017 to 2021 ABFM Family Medicine continuing certification examination surveys selected motivations for choosing to continue certification. We used Chi-squared tests to examine difference proportions of Diplomates failing their first recertification examination attempt who endorsed different motivations for maintaining certification. Unsupervised ML techniques were applied to generate clusters of physicians with similar practice characteristics and motivations for recertifying. Controlling for physician demographic variables, we used logistic regression to examine the effect of motivation clusters on recertification examination success and validated the ML clusters by comparison with a previously created classification schema developed by experts. RESULTS: ML clusters largely recapitulated the intrinsic/extrinsic framework devised by experts previously. However, the identified clusters achieved a more equal partitioning of Diplomates into homogenous groups. In both ML and human clusters, physicians with mainly extrinsic or mixed motivations had lower rates of examination failure than those who were intrinsically motivated. DISCUSSION: This study demonstrates the feasibility of using ML to supplement and enhance human interpretation of board certification data. We discuss implications of this demonstration study for the interaction between specialty boards and physician Diplomates.

Simulated subacromial injection instruction improves accuracy and skill level: a model for musculoskeletal procedural training.

BACKGROUND: Musculoskeletal (MSK) complaints often present initially to primary care physicians; however, physicians may lack appropriate instruction in MSK procedures. Diagnostic and therapeutic injections are useful orthopedic tools, but inaccuracy leads to unnecessary costs and inadequate treatment. The authors hypothesized that trainees afforded the opportunity to practice on a cadaver versus those receiving visual-aided instruction on subacromial injections (SAI) will demonstrate differences in accuracy and technique. METHODS: During Spring of the year 2022, 24 Internal Medicine and Family Medicine residents were randomly divided into control and intervention groups to participate in this interventional randomized cadaveric study. Each group received SAI instruction via lecture and video; the intervention group practiced on cadavers under mentored guidance. Subjects underwent a simulated patient encounter culminating in injection of latex dye into a cadaveric shoulder. Participants were evaluated based on a technique rubric, and accuracy of injections was assessed via cadaver dissection. RESULTS: Twenty-three of twenty-four participants had performed at least one MSK injection in practice, while only 2 (8.3%) of participants had performed more than 10 SAIs. There was no difference in technique between control 18.4 ± 3.65 and intervention 19.2 ± 2.33 (p = 0.54). Dissections revealed 3 (25.0%) of control versus 8 (66.7%) of intervention injections were within the subacromial space. Chi-Square Analysis revealed that the intervention affected the number of injections that were within the subacromial space, in the tissues bordering the subacromial space, and completely outside the subacromial space and bordering tissues (p = 0.03). The intervention group had higher self-confidence in their injection as opposed to controls (p = 0.04). Previous SAI experience did not affect accuracy (p = 0.76). CONCLUSIONS: Although primary care physicians and surgeons develop experience with MSK procedures in practice, this study demonstrates a role for early integrated instruction and simulation to improve accuracy and confidence. The goal of improving accuracy in MSK procedures amongst all primary care physicians may decrease costs and avoid unnecessary referrals, diagnostic tests, and earlier than desired surgical intervention.

A Quality Improvement Project in Family Medicine Residency Training: Improving Preeclampsia Prevention Through Risk Factor Screening and Low-Dose Aspirin.

Providing aspirin during pregnancy is a critical intervention proven to reduce the rates of preeclampsia in patients at risk. This quality improvement project prepared family medicine residents to use public health strategies to improve screening of pregnant patients at risk for preeclampsia in an underserved population. A preeclampsia awareness campaign was launched utilizing a publicly available toolkit, while a multidisciplinary team implemented systemic clinical changes to increase the rates of preeclampsia risk factor screening and aspirin prescription to prevent preeclampsia. (Am J Public Health. 2024;114(S4):S318-S321. https://doi.org/10.2105/AJPH.2024.307667).