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1.
BMC Med Educ ; 24(1): 222, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38429724

RESUMO

BACKGROUND: Reflective capacity is a prerequisite for transformative learning. It is regarded as an essential skill in professional competence in the field of medicine. Our aim was to investigate the reflective capacity and the objects of action (themes) which revealed reflective writing of medical students during a general practice/family medicine course. METHODS: Second-year medical students were requested to write learning diaries during a compulsory course in general practice/family medicine consisting of the principles of the physician-patient relationship. The course included a group session supervised by a clinical lecturer and a 3-day training period in a local health centre. We conducted data-driven content analysis of the learning diaries. In the learning diaries, student observations were most commonly directed to events during the training period and to group sessions. Occasionally, observation was directed at inner experience. RESULTS: The following themes were related to reflective writing: feelings towards the end of life, demanding situations in practice, physician's attitude to patient, student's inner experiences, and physician's well-being. The entries indicated different types of reflective capacity. Three subgroups were identified: 'simple reporting,' 'reflective writing,' and 'advanced reflective writing.' CONCLUSION: Professional growth requires the development of reflective capacity, as it is essential for successful patient care and better clinical outcomes. To develop and enhance the reflective capacity of medical students during their education, the curriculum should provide frequent opportunities for students to assess and reflect upon their various learning experiences.


Assuntos
Educação de Graduação em Medicina , Educação Médica , Estudantes de Medicina , Humanos , Medicina de Família e Comunidade/educação , Aprendizagem
2.
J Am Board Fam Med ; 37(1): 43-58, 2024 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-38448238

RESUMO

INTRODUCTION: Recruiting rural-practicing clinicians is a high priority. In this study, we explored burnout and contributing work conditions among rural, urban, and family practice physicians and advanced practice clinicians (APCs) in an Upper Midwestern health care system. METHODS: The Mini Z burnout reduction measure was administered by anonymous electronic survey in March 2022. We conducted bivariate analyses of study variables, then assessed relationships of study variables to burnout with multivariate binary logistic regression. RESULTS: Of 1118 clinicians (63% response rate), 589 physicians and 496 APCs were included in this study (n = 1085). Most were female (56%), physicians (54%), and White (86%), while 21% were in family practice, 46% reported burnout, and 349 practiced rurally. Rural and urban clinician burnout rates were comparable (45% vs 47%). Part-time work protected against burnout for family practice and rural clinicians, but not urban clinicians. In multivariate models for rural clinicians, stress (OR: 8.53, 95% CI: 4.09 to 17.78, P < .001), lack of workload control (OR: 3.06, 95% CI: 1.47-6.36, P = .003), busy/chaotic environments (OR: 2.53, 95% CI: 1.29-4.99, P = .007), and intent to leave (OR: 2.18, 95% CI: 1.06-4.45, P = .033) increased burnout odds. In family practice clinicians, stress (OR: 13.43 95% CI: 4.90-36.79, P < .001) also significantly increased burnout odds. CONCLUSIONS: Burnout was comparable between rural and urban physicians and APCs. Part-time work was associated with decreased burnout in rural and family practice clinicians. Addressing burnout drivers (stress, workload control, chaos) may improve rural work environments, reduce turnover, and aid rural clinician recruitment. Addressing stress may be particularly impactful in family practice.


Assuntos
Esgotamento Profissional , Clínicos Gerais , Humanos , Feminino , Masculino , Esgotamento Profissional/epidemiologia , Esgotamento Psicológico , Medicina de Família e Comunidade , Inquéritos e Questionários
3.
Fam Med ; 56(3): 185-189, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38467006

RESUMO

BACKGROUND AND OBJECTIVES: The widening gap between urban and rural health outcomes is exacerbated by physician shortages that disproportionately affect rural communities. Rural residencies are an effective mechanism to increase physician placement in rural and medically underserved areas yet are limited in number due to funding. Community health center/academic medicine partnerships (CHAMPs) can serve as a collaborative framework for expansion of academic primary care residencies outside of traditional funding models. This report describes 10-year outcomes of a rural training pathway developed as part of a CHAMP collaboration. METHODS: Using data from internal registries and public sources, our retrospective study examined demographic and postgraduation practice characteristics for rural pathway graduates. We identified the rates of postgraduation placement in rural (Federal Office of Rural Health Policy grant-eligible) and federally designated Medically Underserved Areas/Populations (MUA/Ps). We assessed current placement for graduates >3 years from program completion. RESULTS: Over a 10-year period, 25 trainees graduated from the two residency expansion sites. Immediately postgraduation, 84% (21) were in primary care Health Professional Shortage Areas (HPSAs), 80% (20) in MUA/Ps, and 60% (15) in rural locations. Sixteen graduates were >3 years from program completion, including 69% (11) in primary care HPSAs, 69% (11) in MUA/Ps, and 50% (5) in rural locations. CONCLUSIONS: This CHAMP collaboration supported development of a rural pathway that embedded family medicine residents in community health centers and effectively increased placement in rural and MUA/Ps. This report adds to national research on rural workforce development, highlighting the role of academic-community partnerships in expanding rural residency training outside of traditional funding models.


Assuntos
Internato e Residência , Serviços de Saúde Rural , Humanos , Medicina de Família e Comunidade/educação , População Rural , Estudos Retrospectivos , Área Carente de Assistência Médica , Centros Comunitários de Saúde
5.
Fam Med ; 56(3): 163-168, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38467034

RESUMO

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic began interrupting family medicine residency training in spring 2020. While a decline in scores on the American Board of Family Medicine In-Training Examination (ITE) has been observed, whether this decline has translated into the high-stakes Family Medicine Certification Examination (FMCE) is unclear. The goal of this study was to systematically assess the magnitude of COVID-19 impact on medical knowledge acquisition during residency, as measured by the ITE and FMCE. METHODS: A total of 19,101 initial certification candidates from 2017 to 2022 were included in this study. Annual ITE scores and FMCE scores were reported on the same scale (200-800) and served as the outcome measure. We conducted multilevel regression analysis to determine ITE score growth and FMCE scores compared to cohorts prior to COVID-19. RESULTS: During COVID-19, the increase in ITE scores from postgraduate year 2 (PGY-2) to PGY-3 was 25.5 points less, representing a 57.6% relative decrease; and from PGY-3 ITE to FMCE, it was 8.6 points less, a 12.7% relative decrease, compared with cohorts prior to COVID-19. FMCE scores were 6.6 points less during COVID-19, representing a 1.2% relative decline from the average FMCE score prior to COVID-19. CONCLUSIONS: This study found nonsubstantive COVID-19 impact on FMCE scores, but a considerable knowledge acquisition decline during residency, especially during the PGY-2 to PGY-3 period. While COVID-19 impacted learning, our findings indicated that residencies were largely able to remediate knowledge deficits before residents took the FMCE.


Assuntos
COVID-19 , Internato e Residência , Humanos , Estados Unidos/epidemiologia , Avaliação Educacional , Medicina de Família e Comunidade/educação , Pandemias , Competência Clínica , Medicina Interna/educação
6.
Fam Med ; 56(3): 180-184, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38467035

RESUMO

BACKGROUND AND OBJECTIVES: Toxic stress and trauma are prevalent in the pediatric population. The sequela can be significant, leading to disruptive behaviors in early childhood to chronic medical conditions in adulthood. Two factors that can mitigate negative outcomes of developmental traumatic stress include relational health care and healthy parental relationships. Family physicians are poised to play a significant role in both attenuating factors. Therefore, focused pediatric trauma-informed knowledge and skills training for family medicine residents is important. METHODS: One family medicine residency program added a training module for residents, with two objectives: increase in-exam room trauma-informed interaction skills, and increase knowledge and skills for physicians to coach parents on strengthening the parent-child relationship. The training included didactics and skills training. Knowledge and skills were measured pre- and posttraining. RESULTS: A total of 39 residents participated in the study over 3 years. The knowledge score increased by 4.49 points from pre- to posttraining. The number of trauma-informed interactional skills the residents demonstrated at posttraining had increased significantly. During the pilot, all participants moved from below mastery of skills to full mastery. CONCLUSIONS: After being instructed in best practices in trauma-informed pediatric interactions, residents demonstrated an increased number of behaviors that cultivate pediatric relational health care. Residents demonstrated knowledge and skills gains that denoted their ability to interact with patients and coach parents in evidence-based ways that can mitigate the impact of childhood trauma exposure.


Assuntos
Experiências Adversas da Infância , Internato e Residência , Humanos , Criança , Pré-Escolar , Projetos Piloto , Medicina de Família e Comunidade , Médicos de Família
7.
Fam Med ; 56(3): 190-194, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38467036

RESUMO

BACKGROUND AND OBJECTIVES: The Accreditation Council for Graduate Medical Education (ACGME) requires education on health care disparities (HCD), but research assessing formal curricula is limited. To improve knowledge and confidence in HCD, the family medicine residency program at Darnall Army Medical Center implemented a formal HCD curriculum. METHODS: During the 2021-2022 academic year, starting July 2021, a formal HCD curriculum was implemented for family medicine residents and faculty. Ten lectures on HCDs and implicit bias were given over the course of the year. Residents and faculty were asked to incorporate HCD into their regular continuing medical education lectures. ACGME survey data as well as a pre- and postcurriculum survey were used to assess HCD knowledge and confidence. Descriptive statistics and a paired-sample t tests were calculated to compare pre- to postcurriculum changes. RESULTS: The percentage of residents who reported that they had received HCD education increased from 72% on the 2021 ACGME survey to 100% in 2022 (N=18). We found a significant (P<.05) improvement in knowledge and confidence across 11 of 12 questions on the pre- and postcurriculum survey. CONCLUSIONS: A formal curriculum in a military family medicine residency setting was effective for improving self-reported HCD knowledge and confidence.


Assuntos
Internato e Residência , Militares , Humanos , Disparidades em Assistência à Saúde , Medicina de Família e Comunidade/educação , Educação de Pós-Graduação em Medicina , Currículo
8.
J Am Board Fam Med ; 37(1): 1-3, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38467431

RESUMO

This issue highlights climate change, its effects on patients, and actions clinicians can take to make a difference for their patients and communities. The issue also includes several reports on current trends in family physician practice patterns and the influence of practice structure. Four articles focus on controlled or illicit substances. Noteworthy among them is the description of an innovative yet simple device that allows patients to safely discard unused opioids. Other research covers adverse childhood experiences (ACEs), smoking cessation programs, and the impact of Medicare reimbursement rates on influenza vaccination.


Assuntos
Mudança Climática , Medicina de Família e Comunidade , Idoso , Humanos , Estados Unidos , Medicare , Analgésicos Opioides
10.
Aust J Gen Pract ; 53(3): 121-126, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38437652

RESUMO

BACKGROUND: Sport-related concussion (SRC) is a traumatic brain injury that occurs during sport or exercise activity. SRC is a growing health concern in Australia, with increasing public awareness and presentations to general practitioners being increasingly common. OBJECTIVE: This article will focus on the assessment and management of SRC in general practice, including guidance for returning patients to sport. Concussion prevention, potential long-term complications, and the decision-making process regarding retirement from sport are beyond the scope of this article. DISCUSSION: Recognising concussion can be difficult, as clinical symptoms and signs of SRC can evolve over a period of hours to days. General practitioners should be aware of the range of clinical concussion presentations. The key principles of management include relative rest, followed by a graduated return to cognitive and physical activity. Involvement of a multidisciplinary team can improve symptoms for those patients whose concussion symptoms are prolonged.


Assuntos
Concussão Encefálica , Medicina Geral , Clínicos Gerais , Esportes , Humanos , Medicina de Família e Comunidade , Concussão Encefálica/diagnóstico , Concussão Encefálica/terapia
11.
Aust J Gen Pract ; 53(3): 87, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38437654
12.
Aust J Gen Pract ; 53(3): 146-151, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38437660

RESUMO

BACKGROUND AND OBJECTIVES: Strategies to improve vaccination rates have been implemented with considerable benefits. The main objective of this study was to assess the impact of a supported general practice intervention to 'catch up' overdue children. METHOD: Between 2017 and 2018, a public health nurse visited 23 general practices with high numbers of overdue children to assist staff identify and follow up truly overdue children. A comparison group consisted of a random sample of overdue children from other practices. The intervention was assessed by reviewing Australian Immunisation Register (AIR) records in 2019. RESULTS: Although the intervention group had a significantly higher proportion of children who had their AIR records corrected for vaccines administered prior to the initial practice visit, the intervention did not result in higher vaccination rates. DISCUSSION: Support to general practices can improve vaccination data on the AIR; however, simple reminders alone are unlikely to increase vaccination rates for truly overdue children.


Assuntos
Medicina Geral , Vacinação , Criança , Humanos , Austrália , Imunização , Medicina de Família e Comunidade
13.
Afr J Prim Health Care Fam Med ; 16(1): e1-e3, 2024 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-38426782

RESUMO

Teaching family medicine to medical students is primarily intended to aid in their understanding of the distinctive and significant role that the speciality performs within the healthcare system. Improving medical students' comprehension of family medicine may have an impact on their decision to pursue family medicine as a speciality. It is important to use innovative evidence-based teaching and learning strategies and ensure that medical students receive extra learning opportunities in family medicine. This is a short report highlighting the use of audio-visual aids and case studies to enhance the understanding of family medicine principles among undergraduate medical students attending a private university in Ghana.Contribution: This short report offers family medicine teachers and educators at the undergraduate level an example of how to apply audio-visual aids and case studies to enhance the understanding of family medicine principles among students. The report contributes to the growth of family medicine as a speciality within the African context.


Assuntos
Educação de Graduação em Medicina , Estudantes de Medicina , Humanos , Medicina de Família e Comunidade/educação , Aprendizagem , Recursos Audiovisuais
14.
Medicine (Baltimore) ; 103(10): e37453, 2024 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-38457545

RESUMO

The definition of "nonurgent emergency service visits" is visits to conditions for medical conditions that require attention but are not life-threatening immediately or severe enough to require urgent intervention. This study aims to investigate the reasons why patients choose to self-refer to the emergency service (ES) instead of their primary care health center for nonurgent complaints. The study was carried out in a tertiary hospital. The survey consisted of 2 parts with sociodemographic questions, knowledge of their family physician, and the reason why it has been applied to the ES with multiple choice answers. Of the 325 patients, the mean age was 34.5 years and 54.2% were women. Also, 26 of the patients were reported as "urgent" by the doctor. The main reasons underlying self-referred patients were classified into 4 themes: "urgency" (13.8%), advantages of ES (12.9%); disadvantages of primary care (25.1%), and other (45.9%). The most common reason patients self-refer to the ES was their belief in "being urgent" (61%). In this study, 26.8%, (n = 84) of the patients are not happy with their family physicians, while only 13.2% (N = 43) prioritize the ES advantages.


Assuntos
Serviços Médicos de Emergência , Medicina de Família e Comunidade , Humanos , Feminino , Adulto , Masculino , Serviço Hospitalar de Emergência , Inquéritos e Questionários , Médicos de Família
15.
BMC Med Educ ; 24(1): 262, 2024 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-38459529

RESUMO

BACKGROUND: Geopolitical and socioeconomic challenges limit faculty development and clinical teaching in Palestine and many other developing countries. The first, and still only, Family Medicine (FM) residency program is a four-year program based out of An-Najah University in the West Bank. Training in primary care clinics occurs in the final two years and there are many challenges to adequate supervision in the clinical setting that were exacerbated during the pandemic. To improve the readiness for practice skills of 13 Palestinian FM residents a three-month tutorial program was organized in 2020. A nongovernmental organization (NGO) that has worked to support Family Medicine development in the region engaged experienced British and American General Practitioners trained as tutors to offer online tutorials. We examined the program as a case study to understand the factors that facilitated or impaired a positive virtual learning environment in a middle/low income country. METHODS: The tutors and residents were divided into groups and met virtually between June and September 2020. Evaluations and session reports collected during the program, the text of an online chat, and responses to an online survey two years later were collected. Using thematic analysis techniques, we evaluated the value for the residents at the time and two years later and identified factors that facilitated or impaired a positive virtual learning environment. RESULTS: Themes of knowledge, skills, attitudes, cultural disconnects, and tutorial logistics emerged. The group with the most stable tutor pairing, including one Arabic-speaker familiar with the context, was the most engaged. The all-female group formed a chat group to share real-time case questions during clinical practice and focused on skills (e.g. conducting a thorough medication review) and attitudes (e.g. open to sharing and discussing uncertainties). Other groups were less cohesive. CONCLUSIONS: Transnational tutorials that focused on clinical thinking and decision-making skills were most successful when the tutorial pair was stable, offered familiarity with the language and addressed cultural differences. Intrinsic factors such as lacking the motivation to participate and extrinsic factors such as unstable internet and rolling electric cuts, and clinical structures that made applying new skills challenging were more difficult to address but must be considered.


Assuntos
Árabes , Medicina de Família e Comunidade , Humanos , Feminino , Docentes , Oriente Médio
17.
Can Fam Physician ; 70(3): 161-168, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38499374

RESUMO

OBJECTIVE: To understand the current landscape of artificial intelligence (AI) for family medicine (FM) research in Canada, identify how the College of Family Physicians of Canada (CFPC) could support near-term positive progress in this field, and strengthen the community working in this field. COMPOSITION OF THE COMMITTEE: Members of a scientific planning committee provided guidance alongside members of a CFPC staff advisory committee, led by the CFPC-AMS TechForward Fellow and including CFPC, FM, and AI leaders. METHODS: This initiative included 2 projects. First, an environmental scan of published and gray literature on AI for FM produced between 2018 and 2022 was completed. Second, an invitational round table held in April 2022 brought together AI and FM experts and leaders to discuss priorities and to create a strategy for the future. REPORT: The environmental scan identified research related to 5 major domains of application in FM (preventive care and risk profiling, physician decision support, operational efficiencies, patient self-management, and population health). Although there had been little testing or evaluation of AI-based tools in practice settings, progress since previous reviews has been made in engaging stakeholders to identify key considerations about AI for FM and opportunities in the field. The round-table discussions further emphasized barriers to and facilitators of high-quality research; they also indicated that while there is immense potential for AI to benefit FM practice, the current research trajectory needs to change, and greater support is needed to achieve these expected benefits and to avoid harm. CONCLUSION: Ten candidate action items that the CFPC could adopt to support near-term positive progress in the field were identified, some of which an AI working group has begun pursuing. Candidate action items are roughly divided into avenues where the CFPC is well-suited to take a leadership role in tackling priority issues in AI for FM research and specific activities or initiatives the CFPC could complete. Strong FM leadership is needed to advance AI research that will contribute to positive transformation in FM.


Assuntos
Inteligência Artificial , Medicina de Família e Comunidade , Humanos , Médicos de Família , Canadá
20.
Can Fam Physician ; 70(3): 150, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38499376
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