Virtual Interviews: Outcomes and Lessons Learned.

BACKGROUND AND OBJECTIVES: The family medicine residency application process is arduous and competitive. An important part of the application is the in-person interview process, which was affected during the last two interview cycles (2021-2022) due to restrictions imposed by the COVID-19 pandemic. Virtual interviews eliminate traveling costs associated with applications, potentially improving underrepresented minorities' access to interviewing opportunities. Our goal was to assess if virtual interviews at our institution have negative or positive effects on access for underrepresented in medicine (URiM) applicants and our residency match results.   Methods: We analyzed data from 2019-2022 to compare application volumes, applicant demographics, and match results between two in-person cycles (2019 and 2020) and two virtual cycles (2021-2022). Data were analyzed using Pearson χ2 criteria and P=.05 defined significance. Differences between years for expected counts were determined using single sample χ2 tests.  Results: No statistical significance was noted on number of applications by URiM to our program despite decrease costs associated with virtual interview process. The number of URiM applicants matching to our program did not improve by simply implementing virtual interviews when compared to in-person interview seasons in the past. CONCLUSIONS: Virtual interviews at our institution did not increase URiM applications to our program from substantial equivalent medical schools. Further research in this area from programs in other states may enhance our understanding of the impact of virtual interviews on URiM applications to residency and match results.

Resident Visit Productivity and Attitudes About Continuity According to 3 Versus 4 Years of Training in Family Medicine: A Length of Training Study.

BACKGROUND AND OBJECTIVES: Training models in the Length of Training Pilot (LOTP) vary. How innovations in training length affect patient visits and resident perceptions of continuity is unknown. METHODS: We analyzed resident in-person patient encounters (2013-2014 through 2018-2019) for each postgraduate year (PGY) and total visits at graduation derived from the Accreditation Council for Graduate Medical Education reports for each LOTP program. We collected data on residents' perceptions of continuity from annual surveys (2015-2019). We analyzed continuous variables using independent samples t tests with unequal variance and categorical variables using χ2 tests in comparing 3-year (3YR) versus 4-year (4YR) programs. RESULTS: PGY-1 and PGY-2 residents in 4YR programs saw statistically more patients than their counterparts in 3YR programs. In PGY3, 3YR program residents had statistically higher visit volume compared to 4YR program residents. Visits conducted in PGY4 ranged from 832 to 884. The additional year of training resulted in approximately 1,000 more total patient visits. Most residents in 3YR and 4YR programs rated their continuity clinic experience as somewhat or very adequate (range 86.3% to 93.7%), which did not statistically differ according to length of training. CONCLUSIONS: Resident visits were significantly different at each PGY level when comparing 3YR and 4YR programs in the LOTP and the additional year of training resulted in about 1,000 more total visits. Resident perspectives on the adequacy of their continuity clinic experience appeared to not be affected by length of training. Future research should explore how the volume of patient visits performed in residency affects scope of practice and clinical preparedness.

A case-based approach for teaching professionalism to residents with online discussions.

INTRODUCTION: Programs must demonstrate that their residents are taught and assessed in professionalism. Most programs struggle with finding viable ways to teach and assess this critical competency. UTHSCSA Family and Community Medicine Residency developed an innovative option for interactive learning and assessment of residents in this competency which would be transferrable to other programs and specialties. METHODS: The innovative approach uses an asynchronous online format on Blackboard. Threaded discussions on Blackboard require thoughtful reflective writing after case assessment and critical evaluation of other resident posts. Participation, content and progress of all resident postings are monitored by administrative staff and faculty. Faculty can further engage the residents at any point to deepen the discussion and learning. RESULTS: 100% of all senior residents attained the required learning objectives. All were actively engaged in the assignments. Six cases have been developed using a Learning Matrix to demonstrate evaluation areas from the specialty specific competencies. Written feedback from residents verified the validity of case content in context of their current clinical practice. Postings by residents have provided value and insight for the faculty to access the professional development of our Family Medicine residents.  The Clinical Competency Committee evaluates all third year residents using this information specific to the professionalism milestones. By using an asynchronous online approach to case discussion, all residents are involved with all aspects of this curriculum. CONCLUSIONS: More specific measurable learning outcomes are possible using this approach. Resident participation and engagement is easier to track and monitor than a lecture-based format and easier to capture valuable data than relying on evaluation feedback. Our Annual Review process will identify areas for improvement in the existing cases and help create supplemental cases based on a needs assessment by the faculty.

Association of knowledge, attitudes, and behaviors for colon cancer screening in Hispanic patients.

PURPOSE: The purpose of our cross-sectional study was to examine the association between sociodemographic, knowledge, attitude and behavior factors with colon cancer screening among low-income Hispanic patients from an urban family medicine clinic in San Antonio, Texas. METHODS: Using random stratified sampling, 804 patients were surveyed with 274 Hispanic patients meet the eligibility criteria for colon cancer screening (aged > or = 50 years). A 10-page self-administered questionnaire in Spanish or English completed in the clinic waiting room included self-reported colonoscopy, sociodemographic characteristics, health status, knowledge, attitudes, and behaviors toward colon cancer screening. Associations between colonoscopy and patient characteristics were assessed using logistic regression. RESULTS: 62% of patients reported having been tested for colonoscopy. Older Hispanics (age mean=59 + 6.1 SD) were more likely to have a colonoscopy than younger Hispanics (age mean = 56 +/- 4.8 SD) (P < .001). Bivariate analysis showed that patients who discussed colon cancer risk with their doctor (P = .001), did not smoke (P = .004), or encouraged family members or friends to be tested for colon cancer (P < .001) were more likely to be screened. Multiple variable logistic regression analysis showed that older age, having cancer, discussing the risk factors with their doctor, and encouraging family members or friends to get tested were significant predictors for colonoscopy testing in Hispanics. CONCLUSIONS: Colonoscopy screening in a sample of low-income Hispanic patients differed by age and health experience. Intervention programs that increase colon cancer screening in Hispanics patients should concentrate on those aged < 60. Patient education for knowledge, positive attitude, and behaviors may improve colon cancer screening.

The annual program review of effectiveness: a process improvement approach.

BACKGROUND AND OBJECTIVES: All residencies and fellowships are required by the Accreditation Council for Graduate Medical Education (ACGME) and local institutional policy to conduct an annual program review of educational effectiveness. However, a number of family medicine residencies were cited for having an inadequate annual review or for failing to document the review in 2008. The ACGME and university offices of graduate medical education provide program directors some guidance on conducting and documenting annual program reviews, but few articles describe a detailed process for such a review. In this article, the authors describe the systematic process their program uses to conduct and document an annual program review and argue that the annual program review is an excellent way of modeling quality improvement to residents and showing residents and faculty that their input helps improve the residency and the residents' educational experiences. The article also describes metrics included in the process and tells how resident and faculty participation is integrated in the review. Specific outcomes of the process are also described. The authors believe that other residency programs and fellowship programs can adapt this process to conduct annual reviews that improve educational and clinical outcomes.