Evaluation of a Novel Equity-Focused Curriculum for Early-Stage Medical Students.

OBJECTIVES: Medical school curricula have increasingly incorporated topics and content related to health equity and affiliated social determinants of health. However, there is limited literature to guide how programs might measure the success of these initiatives. Previous studies assessed medical student attitudes and perceived knowledge, preparedness, and skills. Based on self-reported measures of these attributes, we compared within-group and between-group differences at the onset of a novel equity-focused curriculum implementation. METHODS: A multi-component approach to "thread" lectures, panel discussions, and other content dedicated to health equity concepts was assessed using adapted versions of two validated survey instruments of the measured constructs. Baseline data were collected prior to coursework and at follow-up early in students' second year assessed change attributable to the equity-focused curriculum thread, with additional comparison to a cohort of second-year students who had no exposure to the curriculum. Data were collected at the beginning of academic years 2021-2022 and 2022-2023. RESULTS: The multivariate analysis of variance indicated significant change over time (p < 0.001) with the analyses of variance identifying students' perceived current skills and topic knowledge increasing over time. No significant differences were found between two separate groups of M2 students. CONCLUSIONS: Students' perceived skills at working with diverse patient populations and knowledge of topics focused on health equity increased across the study, despite a much smaller response rate for the same student cohort at follow-up. Students' perception that they are prepared to care for patients of diverse backgrounds was unaffected. Attitudinal assessment revealed a ceiling effect at baseline, which should be explored further with longitudinal assessment. For the ongoing effort to evaluate the success of equity-focused curricula and programs, this study contributes evidence of change on some but not all outcomes, and can help guide other programs in determining which outcomes best reflect areas of programmatic need and impact.

Adverse Childhood Experiences.

Adverse childhood experiences are found in adults regardless of race, socioeconomic level, or education. They can be identified in a clinical environment by answering a retrospective questionnaire . Adverse childhood experiences are clearly linked to high-risk health behaviors and multiple chronic diseases. Extensive knowledge exists about the severe impact of adverse childhood experiences in adults. Identification efforts have begun for children showing the prevalence and categories of abuse. National surveillance surveys capture prevalence data for children at the state level. The for Disease Control and Prevention has distributed prevention strategies to decrease the likelihood of adverse childhood experiences in children.

The role of rural communities in the recruitment and retention of women physicians.

Rural communities in the United States have a shortage of primary care physicians. Women physicians are more likely than male physicians to choose primary care specialties but less likely to locate in rural areas. With an increasing proportion of women physicians, it is important to understand community characteristics that encourage their recruitment and retention. This qualitative study explored community characteristics that influenced successful rural practice. We conducted telephone interviews with 25 women family physicians in rural practice in the United States in 2012. Interviews continued until saturation of themes was reached. Data were analyzed using immersion and crystallization. Community themes associated with successful rural practice included: fit with the community; spouse/partner fit with the community; relationships with individuals; and relationships with the community. Family ties, training experience within the community, social networks, and investment in the community were positive factors, while political/cultural differences were negative. Community integration arose from compatibility between the physicians' goals and community characteristics, opportunities for a spouse/partner, friendships, and a feeling of community purpose. This information can be used by rural communities to recruit and retain physicians, and by physicians, medical students, and those who advise them to promote successful rural practice.

Parental Leave Policies and Practices of US Family Medicine Residency Programs.

BACKGROUND AND OBJECTIVES: Adequate parental leave policies promote a supportive workplace environment. This study describes how US family medicine (FM) residency program parental leave policies compare to reported leave taken by residents and faculty. METHODS: This is a descriptive study of questions from a 2017 Council of Academic Medicine Educational Research Alliance (CERA) survey of accredited US FM program directors. RESULTS: The overall survey response rate was 54.6% (261/478). Paid maternity leave policies varied widely (0 to >12 weeks; mean=5.3 weeks for faculty and 4.5 weeks for residents); paid paternity leave ranged from 0 to 12 weeks (mean=2.7 weeks for faculty and 2.4 weeks for residents). Some FM programs reported offering residents (29.1%) and faculty (28.5%) no paid maternity leave; 37.2% offered residents and 40.4% offered faculty no paid paternity leave. Both female and male faculty took significantly less leave than was offered (maternity leave: faculty 0.6 weeks less, P<.01; residents 0.5 weeks less, P<.01; paternity leave: faculty 1.6 weeks less, P<.01; residents 0.6 weeks less, P<.01). The amount of paid and total maternity and paternity leave surrendered by residents was strongly correlated with the amount surrendered by faculty in the same program (correlation coefficients 0.46-0.87, P<.01). Residents in smaller programs, and programs with a rural focus, surrendered more parental leave. CONCLUSIONS: Programs vary widely in their parental leave offerings, and FM residents and faculty frequently take less parental leave than offered. As the amount of leave taken by residents and faculty at the same institution is correlated, institutional culture may contribute to parental leave use.

Teach students, Empower patients, Act collaboratively and Meet health goals: an early interprofessional clinical experience in transformed care.

PURPOSE: Transformation of care teaching is often didactic and conceptual instead of practical and operational. Clinical environments, slow to transform, limit student exposure to key experiences that characterize transformed care. We describe the design and implementation of TEAM Clinic (Teach students, Empower patients, Act collaboratively, Meet health goals) - an early clinical learning experience to address this gap. METHODS: The TEAM Clinic curriculum was based on a review of existing curricula and best practice recommendations for the transformation of care. Three key elements were selected as the focus for a low-volume, high-service clinic: patient centeredness, interprofessional collaboration and team-based care. Learners and medically and socially complex patients were recruited for voluntary participation and completed anonymous surveys about the experience during and afterward. RESULTS: Nine first-year medical students, two first-year social work students and one pharmacy resident were integrated into the interprofessional team. Students were assigned roles adapted to their level and skill set; deliberate interprofessional pairing was assigned to broaden perspectives on scope and role of team members. Upon completion of this two-semester experience, 11 of the 12 learners returned surveys; all rated the experience as positive (strongly agree or agree) on the Authentic Clinical Interprofessional Experience - Evaluation of Interprofessional Site tool. Patient surveys indicated satisfaction with multiple aspects of the visit. CONCLUSION: TEAM Clinic provided a practical example of transformation of care teaching in a not-yet-transformed environment. Logistical barriers included space, schedule and staffing. Facilitators included alignment with the goals of core curricula and faculty. Limitations included that this description of these curricula and this pilot come early in our longitudinal development of TEAM Clinic, constraining our ability to measure behavioral changes around interprofessional education, teamwork or patient centeredness. Next steps would examine the trajectory to these outcomes in the preclinical student group.

Women in rural family medicine: a qualitative exploration of practice attributes that promote physician satisfaction.

INTRODUCTION: The USA needs more rural physicians. Although women represent half of all US trained medical students, the rural physician workforce has remained predominantly male. Insight is needed into what makes rural practice attractive for women and which practice characteristics allow women physicians to practice successfully in rural areas. This study's purpose was to examine aspects of the practice environment that impact women physicians' professional satisfaction and commitment to rural medicine. METHODS: Twenty-five women family physicians practicing in rural areas of the USA were interviewed by phone using a semi-structured format. Transcribed interviews were analyzed using an immersion and crystallization approach. Emergent themes were identified, coded, and discussed until team consensus was attained. Interviews continued until saturation of themes was reached. RESULTS: Three themes emerged from the data, in relationship to practice and employment attributes that contribute to US women physicians' professional satisfaction and willingness to remain in a rural setting: professional relationships, practice characteristics, and support during times of transition. Participants placed high importance on professional relationships, both within and outside of their rural practice. Rural women physicians enjoyed practicing an expanded scope of care, valued loan repayment opportunities, and appreciated supportive practice partners. Importantly, women physicians who found themselves struggling to maintain rural careers often had experienced difficulty during times of practice transition, including maternity leaves. CONCLUSIONS: Understanding practice attributes valued by successful rural women family physicians in the USA will help rural health systems, practices, and physicians-in-training to develop and evaluate opportunities that will best contribute to successful rural practice. Supporting women physicians during periods of practice transition may improve retention.

Roadmap for creating an accelerated three-year medical education program.

Medical education is undergoing significant transformation. Many medical schools are moving away from the concept of seat time to competency-based education and introducing flexibility in the curriculum that allows individualization. In response to rising student debt and the anticipated physician shortage, 35% of US medical schools are considering the development of accelerated pathways. The roadmap described in this paper is grounded in the experiences of the Consortium of Accelerated Medical Pathway Programs (CAMPP) members in the development, implementation, and evaluation of one type of accelerated pathway: the three-year MD program. Strategies include developing a mission that guides curricular development - meeting regulatory requirements, attaining institutional buy-in and resources necessary to support the programs, including student assessment and mentoring - and program evaluation. Accelerated programs offer opportunities to innovate and integrate a mission benefitting students and the public. ABBREVIATIONS: CAMPP: Consortium of accelerated medical pathway programs; GME: Graduate medical education; LCME: Liaison committee on medical education; NRMP: National residency matching program; UME: Undergraduate medical education.

CERA: Clerkships Need National Curricula on Care Delivery, Awareness of Their NCC Gaps.

BACKGROUND AND OBJECTIVES: The Society of Teachers of Family Medicine's (STFM) National Clerkship Curriculum (NCC) was created to standardize and improve teaching of a minimum core curriculum in family medicine clerkships, promoting the Triple Aim of better care and population health at lower cost. It includes competencies all clerkships should teach and tools to support clerkship directors (CDs). This 2014 CERA survey of clerkship directors is one of several needs assessments that guide STFM's NCC Editorial Board in targeting improvements and peer-review processes. METHODS: CERA's 2014 survey of CDs was sent to all 137 CDs at US and Canadian allopathic medical schools. Primary aims included: (1) Identify curricular topics of greatest need, (2) Inventory the percent of family medicine clerkships teaching each NCC topic, and (3) Determine if longitudinal or blended clerkship have unique needs. This survey also assessed use of NCC to advocate for teaching resources and collaborate with colleagues at other institutions. RESULTS: Ninety-one percent of CDs completed the survey. Sixty-four percent reported their clerkship covers all of the NCC minimum core, but on detailed analysis, only 1% teach all topics. CDs need curricula on care delivery topics (cost-effective approach to acute care, role of family medicine in the health care system, quality/safety, and comorbid substance abuse). CONCLUSIONS: Single-question assessments overestimate the percentage of clerkships teaching all of the NCC minimum core. Clerkships need national curricula on care delivery topics and tools to help them find their curricular gaps.

Rural Women Family Physicians: Strategies for Successful Work-Life Balance.

PURPOSE: Women family physicians experience challenges in maintaining work-life balance while practicing in rural communities. We sought to better understand the personal and professional strategies that enable women in rural family medicine to balance work and personal demands and achieve long-term career satisfaction. METHODS: Women family physicians practicing in rural communities in the United States were interviewed using a semistructured format. Interviews were recorded, professionally transcribed, and analyzed using an immersion and crystallization approach, followed by detailed coding of emergent themes. RESULTS: The 25 participants described a set of strategies that facilitated successful work-life balance. First, they used reduced or flexible work hours to help achieve balance with personal roles. Second, many had supportive relationships with spouses and partners, parents, or other members of the community, which facilitated their ability to be readily available to their patients. Third, participants maintained clear boundaries around their work lives, which helped them to have adequate time for parenting, recreation, and rest. CONCLUSIONS: Women family physicians can build successful careers in rural communities, but supportive employers, relationships, and patient approaches provide a foundation for this success. Educators, employers, communities, and policymakers can adapt their practices to help women family physicians thrive in rural communities.

The theory of planned behaviour in medical education: a model for integrating professionalism training.

CONTEXT: Teaching and evaluating professionalism remain important issues in medical education. However, two factors hinder attempts to integrate curricular elements addressing professionalism into medical school training: there is no common definition of medical professionalism used across medical education, and there is no commonly accepted theoretical model upon which to integrate professionalism into the curriculum. OBJECTIVES: This paper proposes a definition of professionalism, examines this definition in the context of some of the previous definitions of professionalism and connects this definition to the attitudinal roots of professionalism. The problems described above bring uncertainty about the best content and methods with which to teach professionalism in medical education. Although various aspects of professionalism have been incorporated into medical school curricula, content, teaching and evaluation remain controversial. We suggest that intervening variables, which may augment or interfere with medical students' implementation of professionalism knowledge, skills and, therefore, attitudes, may go unaddressed. DISCUSSION: We offer a model based on the theory of planned behaviour (TPB), which describes the relationships of attitudes, social norms and perceived behavioural control with behaviour. It has been used to predict a wide range of behaviours, including doctor professional behaviours. Therefore, we propose an educational model that expands the TPB as an organisational framework that can integrate professionalism training into medical education. We conclude with a discussion about the implications of using this model to transform medical school curricula to develop positive professionalism attitudes, alter the professionalism social norms of the medical school and increase students' perceived control over their behaviours.

CAM Curriculum Activities to Enhance Professionalism Training in Medical Schools.

Enhancing the professionalism of graduates is a major objective of most health care education institutions today. Educating conventional health care providers about complementary and alternative medicine (CAM) may directly and indirectly improve trainee professionalism by expanding trainees' knowledge and appreciation of diverse health care beliefs and practices, improving physician-patient communication, enhancing self-care, and increasing sense of competence and job satisfaction. A survey based on professional competencies proposed by the Consortium of Academic Health Centers for Integrative Medicine was administered to the grantees of the National Institutes of Health, National Center for Complementary and Alternative Medicine R-25 CAM education project initiative. The survey's aim was to identify project activities that taught professionalism skills. All projects reported curricular features that enhanced trainee professionalism, with substantial percentages of project effort directed toward professionalism-related activities.

Using complementary and alternative medicine curricular elements to foster medical student self-awareness.

PURPOSE: To determine the value that the National Center for Complementary and Alternative Medicine (NCCAM)-funded Education Project leaders placed on self-awareness objectives among their curricular activities, to identify projects' rationales for inclusion of self-awareness activities, and to describe curricular elements used to teach self-awareness. METHOD: A survey was distributed to the NCCAM Education Project grantees in October 2006. Survey items sought to identify project directors' perceived importance of self-awareness activities in complementary and alternative medicine (CAM) curricula, rationales for inclusion of self-awareness activities, and activities to foster self-awareness. Invited reports described in more depth the specific activities in three of the projects. RESULTS: Fourteen of 15 reporting NCCAM educational projects rated activities to promote self-awareness as highly or very highly valued components, and all projects incorporated numerous strategies to enhance self-awareness. Learning objectives ranged from basic knowledge about mind-body relationships and psychoneuroimmunology, to evidence and indications for mind-body interventions, to training in self-application, to training for intervention with patients. Specific strategies that increase students' self-awareness included evidence-based CAM activities to help students recognize personal biases that may impair critical thinking; personal health experiences to expand definition of health beliefs; and mind-body medicine skills groups to personally integrate the use of mind-body techniques for wellness and stress management. CONCLUSIONS: Incorporating some of these CAM curricular activities, didactically or experientially, may be a unique way to foster student self-awareness and personal growth.