Current Procedural Practices of Family Medicine Teaching Physicians.

BACKGROUND AND OBJECTIVES: Proficiency in procedural care achieved during residency is a major driver of family physician scope of practice. To date, no inventory exists of the advanced procedures and clinical skills performed by teaching family physicians. This study comprises the first such survey and assesses the attitude of respondents toward the importance of family physicians performing procedures. METHODS: We sent a clinical skills inventory to a convenience sample of teaching family physicians employed at 18 medical school-affiliated, community, and military residency programs across the United States. RESULTS: The overall response rate was 46% (N=337). Respondents performed a median of 12 advanced procedures and clinical skills (IQR: 8-18). Endorsed procedures ranged from skin biopsy (n=316, 93.8%) and joint injection (n=279, 82.8%) to colonoscopy (n=21, 6.2%) and cesarean delivery (n=23, 6.8%), and reported skills ranged from medication-assisted treatment (n=181, 53.7%) to highly active antiretrovial therapy (n=35, 10.4%). Gender and career stage were associated with statistically significant differences in endorsement of specific procedures. For example, fracture management was more likely to be performed by late- versus early-career faculty (54.1% vs 24.2%, P<.001) and by male versus female respondents (54.9% vs 24.2%, P<.001). Most respondents (84.3%) agreed that future family physicians should learn procedures and advanced clinical skills. CONCLUSIONS: Family medicine teaching faculty perform a wide array of procedures and advanced skills. Apparent differences by career stage and gender identity in the performance of some of the procedural and skill areas may portend a shift in the procedural training of future family physicians.

Patient Satisfaction with Professional Continuous Glucose Monitoring in a Diverse Family Medicine Clinic: A Pilot Study.

Primary care providers (PCPs) manage a large portion of patients with diabetes. Continuous glucose monitoring (CGM) can give detailed information about glucose trends to improve treatment and safety. We conducted a prospective cohort pilot study to understand patient experience with the use of professional CGM in a primary care practice with a high volume of diverse, non-English speakers. Eligible patients were on an insulin regimen and either had an A1c above goal or whose PCPs had concerns for hypoglycemia. Surveys were collected prior to the intervention to assess the acceptability of the patient's self-monitoring blood glucose efforts and after the intervention to assess their experience of using the CGM. Participants at baseline had a mean A1c of 10.6% and a high amount of emotional distress as measured on the Problem Areas in Diabetes (PAID) scale. Post-intervention, patients reported their experience with professional CGM was positive and, overall, as acceptable of an intervention as their previous self-monitoring blood glucose practice. Professional CGM can serve as an additional, acceptable tool for PCPs to better understand how to help patients achieve diabetes blood glucose goals. Ambulatory care pharmacists are well positioned to lead this effort in clinics.