Family medicine viewed through the public lens: A national cross-sectional study in Lebanon.

Background: Family medicine (FM) is a medical specialty that provides continuing, comprehensive health care for the individual and the family. This study aimed to describe Lebanese citizens' knowledge, attitudes, and practices toward FM as a specialty. Methods: This is a national cross-sectional phone-based survey targeting the knowledge of the public about FM and its scope of practice. Questions were asked whether participants had primary health care doctors and their specialties. Results: A total of 373 participants were included, with a response rate of 85.2%. Two-thirds were aware of the specialty of FM, while only 16.6% of the participants had previously visited a family physician. Most participants (69.7%) had a doctor they regularly consulted. One-third of participants had a general practitioner as their regular doctor. More than 80% of the participants agreed that FM physicians treat all family members with common and chronic diseases. Around 60% to 75% of participants knew that family physicians provide medical care to children, treat patients with psychiatric impairments, and perform minor surgeries. There was a significant gap in the participants' knowledge of FM physicians' role in managing obstetric or gynecologic patients. Conclusion: Despite public awareness of FM, limited understanding and system challenges hinder its utilization in Lebanon. Educational campaigns, government-supported FM practices, and collaborations with public health initiatives are crucial to bridging the knowledge gap and establishing FM as the cornerstone of primary care. This knowledge gap challenges the specialty's identity and necessitates promoting FM as the cornerstone of primary care, potentially requiring a system-wide endorsement.

Utilization of patient portals: a cross-sectional study investigating associations with mobile app quality.

BACKGROUND: Mobile apps facilitate patients' access to portals and interaction with their healthcare providers. The COVID-19 pandemic accelerated this trend globally, but little evidence exists on patient portal usage in the Middle East, where internet access and digital literacy are limited. Our study aimed to explore how users utilize a patient portal through its related mobile app (MyChart by EPIC). METHODS: We conducted a cross-sectional survey of MyChart users, recruited from a tertiary care center in Lebanon. We collected MyChart usage patterns, perceived outcomes, and app quality, based on the Mobile Application Rating Scale (user version, uMARS), and sociodemographic factors. We examined associations between app usage, app quality, and sociodemographic factors using Pearson's correlations, Chi-square, ANOVA, and t-tests. RESULTS: 428 users completed the survey; they were primarily female (63%), aged 41.3 ± 15.6 years, with a higher education level (87%) and a relatively high crowding index of 1.4 ± 0.6. Most of the sample was in good and very good health (78%) and had no chronic illnesses (67%), and accessed the portal through MyChart once a month or less (76%). The most frequently used features were accessing health records (98%), scheduling appointments (67%), and messaging physicians (56%). According to uMARS completers (n = 200), the objective quality score was 3.8 ± 0.5, and the subjective quality was 3.6 ± 0.7. No significant association was found between overall app usage and the mobile app quality measured via uMARS. Moreover, app use frequency was negatively associated with education, socioeconomic status, and perceived health status. On the other hand, app use was positively related to having chronic conditions, the number of physician visits and subjective app quality. CONCLUSION: The patient portal usage was not associated with app quality but with some of the participants' demographic factors. The app offers a user-friendly, good-quality interface to patient health records and physicians, appreciated chiefly by users with relatively low socioeconomic status and education. While this is encouraging, more research is needed to capture the usage patterns and perceptions of male patients and those with even lower education and socioeconomic status, to make patient portals more inclusive.

Efficacy and efficiency of information retrieval of community family physicians at the point of care: exploring the associations with information and computer literacy.

Objective: This study aimed to measure the association between the efficacy/efficiency of digital information retrieval among community family physicians at the point of care and information and computer literacy. Methods: This study is a part of a cross-sectional anonymous online survey-based study among community family physicians who reported no affiliation with an academic institution in eight Arab countries. Results: A total of 72 physicians were included. The mean total score for the information literacy scale was 59.8 out of 91 (SD = 11.4). The mean score was 29.3 (SD = 5.6) out of 55 on the computer literacy scale. A one-way ANOVA revealed a statistically significant association between information literacy and information retrieval efficacy (F (2,69) = 4.466, p = 0.015) and efficiency of information retrieval (F (2.69) = 4.563, p = 0.014). Computer literacy was not associated with information retrieval efficacy or efficiency. Conclusion: The information and computer literacy scores of community family physicians in eight Arab countries are average. Information literacy, rather than computer literacy, is positively associated with the efficacy and efficiency of information retrieval at the point of care. There is room for improvement in evidence-based medicine curricula and continuous professional development to improve information literacy for better information retrieval and patient care.

Effectiveness of a modified Balint group process on empathy and psychological skills employing Kirkpatrick's evaluation framework.

Background: To evaluate, using Kirkpatrick's evaluation model, a modified Balint group (BG) by adding 5-10 min at the end of the session, where the facilitators will debrief the residents about critical themes mentioned in the session. Methods: A quasi-experimental study with a mixed-method design was conducted among family medicine residents over 1 year, using focus groups and validated tools filled by residents and their corresponding patients. The residents' empathy through self and patient evaluation, psychological skills, and satisfaction with the educational activity were measured. Results: The focus group revealed that the residents were aware of the change and considered it a closure to the encounter, helping decrease some uncertainty. Most of the residents did not consider the change helpful. Using validated instruments, BG was ineffective at improving the residents' empathy and psychological skills. There was a statistically significant main effect of time on Psychological Medicine Inventory (PMI) scores, F (1,13) = 7.709, p = 0.016. Conclusion: Debriefing at the end of BG by the facilitators about key themes may help give the residents closure, decrease the uncertainty, and make them more aware of their feelings. Nevertheless, Balint groups are still not very well accepted by the residents, and they prefer direct feedback and support groups.

Telemedicine Competencies in Family Medicine Clerkships: A CERA Study.

BACKGROUND: While the Association of American Medical Colleges (AAMC) designated cross-disciplinary telemedicine competencies, curricular implementation is at disparate stages across medical schools and with significant curricular gaps. We investigated factors associated with the presence of telemedicine curriculum in family medicine clerkships. METHODS: Data were evaluated as part of the 2022 CERA survey of family medicine clerkship directors (CD). Participants answered questions about telemedicine curriculum in their clerkship, including whether it was required or optional, whether telemedicine competencies were assessed, the availability of faculty expertise, volume of visits, student autonomy in visits, CD's attitude about the importance of telemedicine education, and awareness of the Society of Teachers of Family Medicine's (STFM) Telemedicine Curriculum. RESULTS: Ninety-four of 159 CDs (59.1%) responded to the survey. Over one-third of FM clerkships (38, 41.3%) did not teach telemedicine and most CDs (59, 62.8%) did not assess competencies. The presence of telemedicine curriculum was positively associated with CDs' awareness of STFM's Telemedicine Curriculum (P=.032), attitude of CDs toward importance of telemedicine teaching (P=.007), higher level of learner autonomy in telemedicine visits (P=.035), and private medical schools (P=.020). CONCLUSIONS: Almost two-thirds of clerkships (62.8%) did not assess telemedicine competencies, and fewer than one-third of CDs (28.6%) considered telemedicine education as important as other clerkship topics. CDs' attitudes were a significant determinant of whether teaching of telemedicine skills occurred. Awareness of telemedicine education resources and higher learner autonomy in telemedicine encounters may promote integration into clerkship curriculum.

Content analysis of social media regarding obesity as a chronic disease.

Background: Social media is an effective online communication channel. Obesity has been classified as a chronic disease; yet, social media rarely portrays it as such. This study aims to explore the perception of obesity as a chronic disease through content analysis of social media content of obesity-related health organizations and weight loss commercial applications. Methods: Using a codebook adapted from the definition of chronic disease, content analysis was conducted to evaluate a set of posts sampled from 11 health-related organizations and 10 weight loss applications Facebook and Twitter accounts. Descriptive statistics were used to assess the extent obesity was portrayed as a chronic disease. Results: A total of 8,106 posts were extracted: 3,019 posts by organizations and 5,087 by weight loss commercial applications. Only 401 (4.5%) posts/tweets were related to obesity as a chronic disease and were posted by obesity-related health organizations. Only 69 (2.0%) posts from all the organizations' posts directly addressed the idea that obesity is a chronic disease. Almost none of the weight loss commercial apps' social media accounts tackled any aspect of obesity as a disease. Commercial applications' posts revolved mainly around recipes, exercise regimens, and behavioral advice, whereas organizations tackled more complications, treatment, and obesity bias. Conclusion: Using content analysis of social media content, obesity-related health organizations and weight loss applications did not emphasize obesity as a chronic disease on their social media platforms of Facebook and Twitter. Weight-loss commercial applications on social media should include more posts to modify the public's perception regarding obesity as a disease, contributing to health promotion. Further research should explore other social media platforms and posts with specific hashtags posted by the general population.

Development of an assessment tool to measure communication skills among family medicine residents in the context of electronic medical record use.

BACKGROUND: The introduction of the electronic medical record (EMR) has led to new communication skills that need to be taught and assessed. There is scarce literature on validated instruments measuring electronic-specific communication skills. The aim is to develop an assessment checklist that assesses the general and EMR-specific communication skills and evaluates their content validity and reliability. METHODS: Using the SEGUE theoretical framework for communication skills, the assessment checklist items were developed by the Communication Skills Working Group (CSWG) at the family medicine department using a literature review about the positive and negative aspects of EMR use on physician-patient communication. A group of faculty members rated real resident-patient encounters on two occasions, three weeks apart. Patients were asked to fill out the Communication Assessment Tool (CAT) at the end of the encounter. RESULTS: A total of 8 residents agreed to participate in the research, with 21 clinical encounters recorded. The average total score was 65.2 ± 6.9 and 48.1 ± 9.5 for the developed scale and the CAT scale, respectively. The scale reliability was good, with a Cronbach alpha of 0.694. The test-retest reliability was 0.873, p < 0.0001. For the total score on the developed checklist, the intraclass correlation coefficient between raters (ICC) was 0.429 [0.030,0.665], p-value of 0.019. The level of agreement between any two raters on the cumulative score of the 5 subsections ranged from 0.506 (interpersonal skills) to 0.969 (end encounter). CONCLUSION: This checklist is a reliable and valid instrument that combines basic and EMR-related communication skills.

Personal Financial Well-being of Family Medicine Residents and Residency Curricula: A CERA Study.

Introduction: Personal financial wellness is a milestone in graduate medical education. Prior surveys addressing financial wellness have not included family medicine (FM) residents and to date, no literature has explored the relationship between perceived financial well-being and personal finance curriculum in residency. Our study aimed to measure the financial well-being of residents and its association with the delivery of financial curricula in residency and other demographics. Methods: Our survey was included in the Council of Academic Family Medicine Educational Research Alliance (CERA) omnibus survey sent to 5,000 FM residents. We use the Consumer Financial Protection Bureau (CFPB) financial well-being guide and scale to measure financial well-being and categorize into low, medium, and high ranges. Results: Two hundred sixty-six residents (response rate of 5.32%) responded with a mean financial well-being score of 55.7 (SD 12.1), in the medium score range. Financial well-being was positively associated with any form of personal financial curricula in residency, year in residency, income and citizenship. Most residents 204 (79.1%) agreed/strongly agreed that personal financial curricula are important to their education, and 53 (20.7%) never received personal financial curricula. Conclusions: Personal financial well-being scores of family medicine residents are considered medium per the CFPB ranges we assigned. We find a positive and significant association with the presence of personal financial curricula in residency. Future studies should evaluate the effectiveness of different formats of personal finance curriculum in residency on financial well-being.

The use of audio self-hypnosis to promote weight loss using the transtheoretical model of change: a randomized clinical pilot trial.

Background: Few studies suggest the use of hypnosis in weight loss may be beneficial, especially when in conjunction with other lifestyle modifications or cognitive behavioral therapy. The primary aim of this study was to determine the ability of self-hypnosis audiotape to promote weight loss by measuring its effects on the Transtheoretical Model (TTM) of change stages and processes. Methods: This study is a 3-week randomized double-blinded parallel controlled trial among adults who have overweight or obesity. The intervention group listened to a self-hypnosis audio file while the control group listened to a placebo audio file. Results: Forty-six participants completed the 3-week follow-up visit. There was no association between progression across stages of change and self-hypnosis (X2(2, 46) = 1.909, p-value = 0.580). Gender, baseline BMD, and baseline S-weight had no effect on the association between stage change progression and self-hypnosis. The mean difference in weight at 3 weeks was -0.63 ± 0.43 kg in the hypnosis group and 0.0 ± 1.5 kg in the control group, independent t-test, p = 0.148. Conclusion: Self-hypnosis was not associated with a progression in the TTM's stages of change or with weight loss after 3 weeks. As this pilot study was underpowered, further research with larger sample size and an examination of the effect of various self-hypnosis content and duration is recommended.

Weight change-related factors during the COVID-19 pandemic: a population-based cross-sectional study using social cognitive theory.

Background: Published studies during the Coronavirus-19 (COVID-19) pandemic have focused on eating and exercise behaviors and failed to portray a comprehensive understanding of the factors associated with weight change in a setting of a behavioral change framework. This study explores factors associated with weight change during the COVID-19 pandemic among Lebanese residents using the Social Cognitive Theory (SCT) framework, integrating behavioral, environmental, and cognitive factors. Materials & Methods: This study uses a cross-sectional design using an anonymous online survey. Participants were recruited from a tertiary hospital patient portal and social media posts. The survey included four domains: demographics, cognitive, behavioral, psychological, and environmental factors. Multiple validated self-reported instruments were included Generalized Anxiety Disorder-2 items (GAD-2), Patient Health Questionnaire-2 (PHQ-2), General Self Efficacy Scale (GSES), Alcohol Use Disorders Identification Test-Concise (AUDIT-C), and the dietary pattern evaluation tool. Results: A sample of 335 complete responses was obtained. Mean age was 39.0 ± 13.4 years old. Participants were mostly females (n = 224, 66.9%), employed (n = 191, 57.4%), nonsmokers (n = 227, 70.5%), reporting depression (n = 224, 80.3%) and anxiety (n = 242, 84.3%). Mean weight change was -7.0 ± 6.0 kg in the decrease weight group and 6.4 ± 5.0 kg in the increase group. When compared to stable weight, the multinomial logistic model factors that were found to correlate significantly to weight gain were: overeating/binge eating (p-value = 0.001) and unbalanced food pattern (p-value = 0.012). Baseline BMI (p-value = 0.003), anxiety (p-value = 0.020) and smoking (p-value = 0.004) were significant factors of weight loss as compared to stable weight. Conclusions: COVID-19-related weight change is multifactorial and is associated with specific behavior and individual characteristics. Hence, addressing people's behaviors and relationship to food is vital to control weight change during this continuing and future pandemic or natural occurrence.

Sleep pattern and predictors of daily versus as-needed hypnotics use in middle-aged and older adults with insomnia.

INTRODUCTION: This study aims to examine the sleep pattern and predictors of daily vs. as-needed use of hypnotics in middle-aged and older adults with insomnia. METHODS: Patients aged 50-75 who use hypnotics for insomnia were identified via electronic medical records and were recruited. Data about sociodemographics, mood and cognitive screening measures, and questions related to sleep patterns were collected through an interview conducted over the phone. RESULTS: A sample of 66 participants was recruited, of which 69.7% were females. Three quarters (49/66, 74.2%) used hypnotics daily, with 43% (21/49) of daily hypnotics users sleeping more than 8 h per night. Two-fifths (26/66, 39.4%) of participants still had clinically significant insomnia even after taking hypnotics. After adjusting for age, years of hypnotics use, sleeping hours per night, PHQ-2 score, and frequency of pain at night, the logistic regression model showed that younger age (p = 0.023) and longer sleeping hours per night (p = 0.025) were significantly associated with daily hypnotics use when compared to as needed hypnotics use. CONCLUSION: Many hypnotic users still have clinically significant insomnia and poor quality of sleep as reflected by perceived longer sleep duration and more daytime napping which could be related to drug-related residual sedation. Hypnotic use may not be the best solution for insomnia treatment in an older population, and physicians should regularly reassess the use of hypnotics.

The Effectiveness of Combining Nonmobile Interventions With the Use of Smartphone Apps With Various Features for Weight Loss: Systematic Review and Meta-analysis.

BACKGROUND: The effectiveness of smartphone apps for weight loss is limited by the diversity of interventions that accompany such apps. This research extends the scope of previous systematic reviews by including 2 subgroup analyses based on nonmobile interventions that accompanied smartphone use and human-based versus passive behavioral interventions. OBJECTIVE: The primary objective of this study is to systematically review and perform a meta-analysis of studies that evaluated the effectiveness of smartphone apps on weight loss in the context of other interventions combined with app use. The secondary objective is to measure the impact of different mobile app features on weight loss and mobile app adherence. METHODS: We conducted a systematic review and meta-analysis of relevant studies after an extensive search of the PubMed, MEDLINE, and EBSCO databases from inception to January 31, 2022. Gray literature, such as abstracts and conference proceedings, was included. Working independently, 2 investigators extracted the data from the articles, resolving disagreements by consensus. All randomized controlled trials that used smartphone apps in at least 1 arm for weight loss were included. The weight loss outcome was the change in weight from baseline to the 3- and 6-month periods for each arm. Net change estimates were pooled across the studies using random-effects models to compare the intervention group with the control group. The risk of bias was assessed independently by 2 authors using the Cochrane Collaboration tool for assessing the risk of bias in randomized trials. RESULTS: Overall, 34 studies were included that evaluated the use of a smartphone app in at least 1 arm. Compared with controls, the use of a smartphone app-based intervention showed a significant weight loss of -1.99 kg (95% CI -2.19 to -1.79 kg; I2=81%) at 3 months and -2.80 kg (95% CI -3.03 to -2.56 kg; I2=91%) at 6 months. In the subgroup analysis, based on the various intervention components that were added to the mobile app, the combination of the mobile app, tracker, and behavioral interventions showed a statistically significant weight loss of -2.09 kg (95% CI -2.32 to -1.86 kg; I2=91%) and -3.77 kg (95% CI -4.05 to -3.49 kg; I2=90%) at 3 and 6 months, respectively. When a behavioral intervention was present, only the combination of the mobile app with intensive behavior coaching or feedback by a human coach showed a statistically significant weight loss of -2.03 kg (95% CI -2.80 to -1.26 kg; I2=83%) and -2.63 kg (95% CI -2.97 to -2.29 kg; I2=91%) at 3 and 6 months, respectively. Neither the type nor the number of mobile app features was associated with weight loss. CONCLUSIONS: Smartphone apps have a role in weight loss management. Nevertheless, the human-based behavioral component remained key to higher weight loss results.

Information retrieval at the point of care of community family physicians in Arab countries.

This study is based on Jumana Antoun's PhD thesis at Walden University, USA examining the information retrieval behaviour of 72 community family physicians' at the point of care in eight Arab countries in the Eastern Mediterranean. The key findings were that participants looked for digital clinical information at the point of care on average 14.0 times per week with the majority (80.3%) using a mobile phone. Clinical information about medication dosage and side effects was the most sought clinical question, and patient education was the least. Almost half of the participants considered that they often found relevant (55.6%), useful (56.9%) and unbiased (58.3%) information. Whilst none of the factors examined predicted the physicians' self-reported effectiveness and efficiency at information retrieval, the implication for practice points clearly to the barriers and the need for curricula to focus on search strategies using free resources at the point of care.

Patients' acceptance of obesity as a chronic disease: a qualitative study in Lebanon.

OBJECTIVE: This study explores patients' acceptance of obesity as a chronic disease. DESIGN: Cross-sectional, qualitative study using semistructured phone interviews. SETTING: The study was conducted in specialty and primary care clinics from a single central tertiary hospital in Lebanon. Recruitment took place between February and March 2021. PARTICIPANTS AND METHODS: 25 adult patients with overweight or obesity were interviewed and the interviews were analysed thematically. RESULTS: Four themes emerged: (1) patients' knowledge and awareness of obesity are based on their own experience; (2) there is ambivalence or conditional acceptance of obesity as a chronic disease; and patients with overweight or obesity perceived (3) that the role of physicians in obesity management is related to complications and (4) that obesity management is as simple as eating less and exercising more. CONCLUSIONS: The study shows the studied population's ambivalence in accepting obesity as a chronic disease. Individuals with overweight or obesity considered the role of the healthcare professional in obesity conditional on morbid obesity and the presence of medical complications of obesity. Findings of this study advocate for educational campaigns about the nature of obesity as a chronic disease and the role of healthcare professionals in obesity management.

Acceptability of smokers of a conceptual cigarette tracker as wearable for smoking reduction.

OBJECTIVE: The study aims to explore smokers' acceptance of using a conceptual cigarette tracker like a cigarette filter for smoking cessation using the Technology Acceptance Model (TAM). Smokers presenting to the family medicine clinics at a tertiary care center were asked to complete an anonymous questionnaire. RESULTS: A total of 45 participants were included. Two-thirds of the smokers reported that they would like to try such a tracker and perceived its usefulness in reducing the number of daily cigarettes consumed and increasing the motivation to join a smoking cessation program. A range of 40-50% of the participants had a neutral attitude towards the visibility of the tracker and its effect on social acceptance and self-image. The structural equation model with latent variables path analysis showed that only perceived usefulness correlated to the intention to adopt with statistical significance. Visibility was correlated with intention to adopt with a marginal p-value of 0.061. Driven by perceived usefulness, smokers may buy or try a cigarette tracker for smoking reduction or cessation.

Obesity pillars roundtable: Obesity and individuals from the Mediterranean region and Middle East.

Background: The rates of obesity in Mediterranean and Middle East regions are increasing. This may be related to worsening physical inactivity, and gravitation away from more healthful nutrition. Methods: This roundtable discussion includes 4 obesity specialists with experience in the clinical management of obesity. Included in this discussion are citations regarding obesity and populations from the Mediterranean and Middle East regions. Results: Among the most studied nutritional dietary pattern having evidence-based data supporting improved cardiometabolic health is the Mediterranean Diet. Prospective studies such as the PREvención con DIeta MEDiterránea (PREDIMED) study support the cardiometabolic benefits of dietary consumption of plant-based, higher fiber foods having a relatively high proportion of unsaturated fats. Cuisine from the Middle East has both similarities and some differences compared to the Mediterranean Diet. Interim analyses of the PREDIMED-Plus study suggest the Mediterranean Diet plus caloric restriction and physical activity intervention reduces body weight and improves cardiometabolic risk factors. As with any dietary intake, Mediterranean and Middle Eastern food choices and preparation affect their nutritional healthfulness. Conclusion: The panelists of this roundtable discussion describe their practical diagnostic processes and treatment plans for patients with obesity from the Mediterranean Region and Middle East.

Women family physicians' working conditions and career satisfaction: a multinational study.

BACKGROUND: As the proportion of women in family medicine increases, their well-being and job satisfaction become concerns. OBJECTIVES: This study aimed to uncover the working conditions and career satisfaction of women family physicians across multiple countries. METHODS: A cross-sectional survey of the WONCA Working Party on Women and Family Medicine listserv members to assess working conditions and career satisfaction, with snowballing recruitment. Aspects of physician job satisfaction were measured using the validated Physician Work-Life Survey and calculated as the sum of the scores of each positive item divided by the total number of questions and multiplied by 10. The association between satisfaction and the continent and the country income level was performed using a one-way ANOVA test (P < 0.05). RESULTS: A total of 315 participants across 49 countries responded to the survey with 205 complete responses. Women family physicians reported high overall career satisfaction (8.2 ± 2.3) but were less satisfied with some aspects of their career such as pay (5.3 ± 3.4), personal time (3.5 ± 2.6), and administrative tasks (3.2 ± 3.7). Despite the widespread experience of sexism at work, satisfaction with personal career aspects was universal at the continent and income level, while satisfaction with other career aspects relevant to relationships in work environment and resources varied. CONCLUSION: Women family physicians around the world are overall satisfied with their careers. However, variation in certain working conditions among countries leaves room for improvement, drawing attention to the need for national review of working environments and pay scales.

Effect of a discordant opinion offered by a second opinion physician on the patient's decision for management of spinal disc disease.

BACKGROUND: Factors that influence a patient's decision for spinal surgery and selection of the spine surgeon have not been studied in the context of a Second Opinion (SO). Providing insight into these factors will guide surgeons in their discussion of treatment options with patients. OBJECTIVE: This study aims to assess the impact of a discordant SO on the final decision of patients as compared to their initial preference regarding spinal disc disease treatment for chronic neck and low back pain. PATIENT INVOLVEMENT: Patients in this study engage in clinical vignettes designed to induce decisional conflict. METHODS: A cross-sectional study using clinical vignette-based questionnaires was presented to patients at the Family Medicine, Orthopedic, and Neurosurgery clinics at a university-based tertiary academic medical center. RESULTS: A total of 246 patients participated in the study (response rate, 66.8%). Irrespective of the initial offered treatment, most patients wanted to consult a SO (64.2%). Most patients preferred conservative treatment to surgery after getting the initial recommendation (78.5%) and after getting a discordant SO (56.5%). There was an association between the agreement of the patient with the initial recommendation and the effect of the SO on the final decision of patients (p < 0.001). Patients who disagreed with the initially offered treatment were more likely to abide by their initial decision after the SO (80.8%) as compared to those who were in agreement (17.7%), while those who agreed with the initially offered treatment were more likely to change their decision (39.5%) or to take a third opinion (42.9%). DISCUSSION: A discordant SO may validate patients' wishes when they disagree with the initially offered treatment and may lead to confusion when they agree with the initial physicians' recommendations. PRACTICAL VALUE: As patients tend to abide by their initial preference, physicians should explicitly consider patients' wishes when discussing options for management of spinal disc disease.

To Post or Not to Post: Does Applicants' Social Media Affect Family Medicine Resident Recruitment?

BACKGROUND AND OBJECTIVES: Current literature on review of applicant social media (SoMe) content for resident recruitment is scarce. With the recent increase in the use of privacy settings, and the cost of the recruitment process, the aim of this study was to describe the practice and outcomes of review of applicant SoMe in resident recruitment and its association with program director or program characteristics. METHODS: This study was part of the 2020 Council of Academic Family Medicine's Educational Research Alliance (CERA) annual survey of family medicine residency program directors (PDs) in the United States. RESULTS: The overall response rate for the survey was 39.8% (249/626). About 40% of PDs reported reviewing applicant SoMe content. The majority (88.9%) of programs did not inform applicants of their SoMe review practices. The most common findings of SoMe review were that the content raised no concerns (38/94; 40.4%) or was consistent with the application material (34/94; 36.2%). Forty PDs (17.0%) have ever moved an applicant up or down the rank list based on SoMe review. Review of applicant SoMe was not statistically associated with program size, program type, PD age, PD SoMe use, or program SoMe use. CONCLUSIONS: SoMe review has not become routine practice in family medicine resident recruitment. The outcome of SoMe review was mostly consistent with the applicant profile without any concerns and only very few changed the ranking order. This calls for more studies to explore the value of SoMe review for resident selection regarding its effect on future performance.