Community-engaged Research Partnerships as Healing Spaces for Health Professionals and Researchers.

Drawing from collective experiences in our capacity building project: Health Equity Activation Research Team for Inclusion Health, we argue that while community-engaged partnerships tend to focus on understanding health inequities and developing solutions, they can be healing spaces for health professionals and researchers. Data were obtained from a 15-month participatory ethnography, including focus groups and interviews. Ethnographic notes and transcripts were coded and analyzed using both deductive and inductive coding. Practices of radical welcome, vulnerability, valuing the whole person, acknowledging how partnerships can cause harm, and centering lived experience expertise in knowledge creation processes were identified as key characteristics of healing spaces. Ultimately, health professionals and researchers work within the same social, political and economic contexts of populations with the worst health outcomes. Their own healing is critical for tackling larger systemic changes aimed at improving the well-being of communities harmed by legacies of exclusion.

The Radical Welcome Engagement Restoration Model and Assessment Tool for Community-Engaged Partnerships.

People experiencing addiction, houselessness, or who have a history of incarceration have worse health outcomes compared with the general population. This is due, in part, to practices and policies of historically White institutions that exclude the voices, perspectives, and contributions of communities of color in leadership, socio-economic development, and decision-making that matters for their wellbeing. Community-based participatory research (CBPR) approaches hold promise for addressing health inequities. However, full engagement of people harmed by systemic injustices in CBPR partnerships is challenging due to inequities in power and access to resources. We describe how an Allentown-based CBPR partnership-the Health Equity Activation Research Team of clinicians, researchers, and persons with histories of incarceration, addiction, and houselessness-uses the Radical Welcome Engagement Restoration Model (RWERM) to facilitate full engagement by all partners. Data were collected through participatory ethnography, focus groups, and individual interviews. Analyses were performed using deductive coding in a series of iterative meaning-making processes that involved all partners. Findings highlighted six defining phases of the radical welcome framework: (a) passionate invitation, (b) radical welcome, (c) authentic sense of belonging, (d) co-creation of roles, (e) prioritization of issues, and (f) individual and collective action. A guide to assessing progression across these phases, as well as a 32-item radical welcome instrument to help CBPR partners anticipate and overcome challenges to engagement are introduced and discussed.

COVID-19 and practice transformation: Building an office-based opioid treatment program in a family medicine residency practice.

INTRODUCTION: This brief report describes how a family medicine residency practice (FMRP) leveraged a resident-led quality improvement project and a grant-funded Addiction Integrated Care Team (AICT) to initiate an office-based opioid treatment (OBOT) program to provide medications for opioid use disorder during the COVID-19 pandemic. METHOD: In 2020, the practice experienced four disruptors that shifted motivation for practice development: (a) The COVID-19 pandemic demanded rapid change in primary care processes/staffing, including pivoting to telehealth/remote practice. (b) The practice's transition to a federally qualified community health center model meant a shift in organizational priorities that required offering OBOT services. (c) External grant resources became available through the AICT program to support practice core for OBOT, and 10 implementation strategies were utilized. (d) A resident champion implemented an OBOT quality improvement project. RESULTS: These efforts resulted in the practice offering the OBOT program and 18 patients receiving OBOT from January 2020 to February 2021, with 10 of 18 patients engaged for 12 months or longer. Further, the cumulative adoption and reach from January 2020 through September 2022 was 15 faculty and 14 residents becoming prescribers and 101 patients served within the OBOT program, respectively. DISCUSSION: FMRPs striving for significant practice transformation, such as implementing an OBOT program during a pandemic, may benefit from synergistic guidance and resources including established theory, strategies from the implementation science literature, and resident-led quality improvement efforts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Emergence of Family Medicine Identity Among First-Year Residents: A Qualitative Study.

BACKGROUND AND OBJECTIVES: As part of a national pilot, the Lehigh Valley Family Medicine Residency Program implemented curricular changes to emphasize family medicine identity. These changes included limiting first-year inpatient experiences, adding "interval" outpatient weeks, and increasing family physician mentorship. This study explores how postgraduate learners describe their professional identities within the context of their chosen specialty, as defined by Family Medicine for America's Health (FMAHealth). METHODS: This qualitative study approached family medicine identity formation from a social constructionist framework using evolved grounded theory. We performed a thematic analysis of focus groups conducted over 12 years with first-year residents (n=73). Then, utilizing a matrix analysis, articulations about professional identity were compared with structural components of the FMAHealth definition of the specialty. Three cohort groups (Preimplementation, Implementation, and Postimplementation) were defined to conduct a longitudinal comparison. RESULTS: Six unique biosketches synthesizing the analyses emerged. Expansion in ability to articulate professional identity was evident not only across, but also within cohort groups. The Preimplementation cohort entered and left their first year identifying as relationship-centered generalists desiring guidance from role models. The Implementation learners used more FMAHealth language to describe their practice, later recognizing the potential it held for patient care. Similarly, the Postimplementation cohort entered with a broader view of family medicine and exited wondering how to help advance its reach. CONCLUSIONS: Curricular changes placing interns within specialty-relevant learning settings coincide with thematic differences in articulations in professional identity. These findings suggest that experiential learning and role modeling contribute to professional identity formation among graduate medical learners.

Using Telemedicine Technology to Assess Physician Outpatient Teaching.

BACKGROUND AND OBJECTIVES: Video conferencing technology (telemedicine) can be applied to many settings within the medical community; we assessed the feasibility of its use in conducting observations of faculty at remote family medicine teaching sites. METHODS: We deployed seven telemedicine units to five family medicine residency sites and two observation stations within our division. Practice managers and physician faculty members received on-site training on the basic functionality of the technology, as well as "best practices" and minor troubleshooting techniques. Quick reference guides and other support documents were developed and provided for each site. During the remote faculty observation, two observers simultaneously viewed the resident being precepted, assessing the faculty member using a standardized tool. After the experience, all participants were asked to complete a survey on the usability of the technology. RESULTS: Nineteen observations were successfully conducted from November 2011 to December 2012. From a qualitative perspective, faculty accepted this as a viable means of faculty development. Minor technical hurdles were captured in the survey and improved upon as staff and faculty became more comfortable with the technology and as our technical capabilities allowed. Overall, the technology was rapidly accepted into the practices. CONCLUSIONS: Video teleconferencing represents a valuable tool that contributes to the development of faculty by making observation available to numerous sites, including remote areas that may have been previously challenging to reach due to logistics. Recent improvements in technology should make the process easier and allow more aspects of the encounters to be readily observed.

Patients with disabilities as teachers.

BACKGROUND AND OBJECTIVES: Medical schools and residencies lack training in communication skills with patients with disabilities, thereby creating potential barriers to care. To address this shortcoming, the Department of Family Medicine at Lehigh Valley Health Network developed an innovative program in which the patients themselves serve as medical educators. The P-DAT (Patients With Disabilities as Teachers) program is designed to teach basic communication skills and disability etiquette to promote sensitivity to issues unique to this patient population. As such, it conforms to the established principles of the patient-centered medical home. METHODS: Two persons with disabilities who were patients of the residency-affiliated clinic underwent training to become educators. In the resulting interactive education session with medical students, the P-DAT educators describe their daily routines and health care experiences while encouraging their learners to ease anxieties in interacting with patients with disabilities by asking questions. RESULTS: The 44 student participants evaluated the program by responding to a series of Likert scale and open-ended questions. Tallies of the post-program survey results reveal that prior to the disability etiquette training a majority (89%) felt uncomfortable in communicating with patients with disabilities. The survey revealed that 98% of respondents found the program beneficial because it increased overall awareness and sensitivity (52%) and improved competency for future interactions with patients (46%). CONCLUSIONS: Although these evaluation results reflect the early stages of P-DAT implementation, the preliminary feedback indicates that medical students are eager to close the gap in their knowledge about disability etiquette so they can improve their care of this patient population.

RAFT (Resident Assessment Facilitation Team): supporting resident well-being through an integrated advising and assessment process.

BACKGROUND AND OBJECTIVES: During medical residency, indicators of well-being decline while rates of burnout increase. As part of a Preparing the Personal Physician for Practice (P4) innovation, this residency program used a relationship-centered periodic resident assessment process to reinforce values of adult learning within the curriculum. It was predicted that the revised assessment process would contribute to an improved educational climate for residents as reflected in global scores of well-being either remaining at the same level or improving throughout residency. METHODS: Resident Assessment Facilitation Team (RAFT) is an innovative feedback process utilizing small-group dialogue that replaces the traditional semi-annual, faculty-wide review of resident performance. As a pilot study to investigate the impact of RAFT, the Arizona Integrative Outcome Scale (AIOS) was used to describe trends in the well-being of P4 resident cohorts from internship through PGY-3. A comparison group was derived from a resident cohort that started before full implementation of the P4 curriculum and also completed the AIOS. RESULTS: ANOVA comparing AIOS scores across PGY cohort groups was not significant. An independent samples t test comparing AIOS scores from the PGY-3 pre-P4 group with those of the PGY-3 post-P4 group was also not significant. Although this pilot study was not powered for a complete inferential analysis, the descriptive data suggest a downward trend in the pre-RAFT group and stable measures of well-being in the post-RAFT group. CONCLUSIONS: The trend in our pilot data suggests a stability of well-being among our residents that contrasts with patterns of resident burnout noted in existing research. The RAFT has become a key feature of our assessment and advising culture that is intended to mitigate the deleterious effects of more autocratic assessment processes. It may also be an important factor in the stability of resident well-being indicated by this pilot.

Generating developmentally appropriate competency assessment at a family medicine residency.

BACKGROUND AND OBJECTIVES: Ten years after the Accreditation Council for Graduate Medical Education's (ACGME) mandate that residency programs evaluate learners' competency, research is needed to guide efforts to meet this challenge. During an innovative residency redesign, the authors developed a process to effectively measure "competence." This particular family medicine residency admits six residents per class year and is sponsored by an academic community hospital. Our objective was to generate developmentally appropriate observable behaviors that assess competencies. METHODS: Eight steps guided the development of this assessment system: (1) Generate residency-specific competencies, (2) Define residency-specific competencies, (3) Identify principles of assessment, (4) Compose and analyze narratives of excellence within each competency, (5) Distill standard statements from narratives and organize into Dreyfus levels of competence, (6) Derive observable behaviors from standard statements to directly correlate behaviors and competency levels, (7) Design assessment tools (based on observable behaviors) for six residency learning sites, and (8) Translate assessment tools for ACGME competencies. RESULTS: The results of this process include an assessment system that (1) features six tools used with strategic frequency throughout the academic year and (2) generates global assessment of residents' performance in both ACGME and residency-specific competencies. CONCLUSIONS: Narrative reflection was an effective method to tie observable behaviors to competencies. The process was time intensive; however, greater efficiency and enthusiasm is expected in the use of these assessment tools, with greater confidence in the program's capacity to assess training outcomes. Future research should include comparison of these tools with those of other programs.

Understanding the role of the promotora in a Latino diabetes education program.

We explore the role of the promotora de salud (health promoter) who provided diabetes self-management education to Puerto Rican diabetics in her community. The education program was developed as a hospital and community-based organization partnership. Information from both Spanish-language focus groups with 35 class participants and an in-depth interview with the promotora indicated patients appreciated having the classes taught in Spanish by a Latina promotora from their community. Respondents reported satisfaction with the program, increased ability to self-manage diabetes, and strengthened connections with other Latino diabetics. Terms patients used for the promotora included comadre, hijita, and buena profesora. Some of these words denote almost kinship-level connections, suggesting that patients were forming strong connections with the promotora. Specific promotora roles were identified but varied among patients, promotora, and the literature. This hospital and community-based organization partnership promotora model appears to be effective for providing chronic disease self-management education in an urban community setting.