Virtual Recruitment Effects on Matched Residents in Family Medicine: Experiences From Central Pennsylvania.

Background and Objectives: As a result of the COVID-19 pandemic, interviews during the 2021 US residency match were conducted virtually, a practice again recommended and repeated by many programs in 2022. The impact of virtual interviews on recruitment and match outcomes has recently been of interest, with results showing the virtual format to be mostly well received by applicants due to cost, travel, and scheduling benefits. Few studies have looked at pre/posttransition comparisons of applicant geographic and demographic data. We compared objective match outcomes between in-person and virtual interviews across three residency programs. Methods: We conducted a retrospective cross-sectional analysis of National Residency Matching Program data between 2015-2022 across three family medicine residency programs. Primary outcomes were fill rate, average rank position, distance from program, and percentage of underrepresented in medicine demographic status for matched applicants. We compared aggregate in-person data (2015-2019) to aggregate virtual data (2020-2022) for each program using χ2, Fisher Exact test, or 2-tailed t tests to 95% confidence. Results: Saint Joseph Hospital in Reading, Pennsylvania, a 3-year community-based university affiliated program, had significantly more unfilled positions during virtual recruitment (P=.0058). Mount Nittany Medical Center in State College, Pennsylvania, a 3-year community based university-affiliated program, had a significant difference in distance of matched residents' current address (P=.048). Virtual interviews were not associated with significant differences in average position on rank list, average distance from permanent address zip code, or percentage of underrepresented in medicine (URiM) demographic status for matched applicants. Conclusions: The impact of virtual interviewing on unfilled positions and geographic data is likely site specific and generally small, as some programs had significant structural changes. Further research is needed to confirm the generalizability of these results and explore future comparisons of demographic and geographic characteristics of matched applicants pre/posttransition to the virtual format.

Primary Care Residency Perspectives on Medical Student Performance Evaluations.

Introduction: With the transition of the United States Medical Licensing Examination (USMLE) Step 1 exam to pass-fail, residency directors are exploring alternative objective approaches when selecting candidates for interviews. The Medical Student Performance Evaluations (MSPE) portion of the application may be an area where objectivity could be provided. This study explored program directors' (PDs) perspectives on the utility of the MSPE as a discriminating factor for residency candidate selection. Methods: We invited PDs of primary care residencies listed in the American Medical Association FRIEDA database to participate in a mixed-methods study assessing opinions on the MSPE, and the importance of student skills and application components when considering a candidate for interview. We obtained summary statistics for Likert-scale responses. We used inductive thematic analysis to generate themes from open-ended comments. Results: Two hundred forty-nine PDs completed the survey (response rate=15.9%). Patient communication (83.6%) and teamwork (81.9%) were rated as very/extremely important skills, and being a graduate of a US medical school in the past 3 years (73.1%), no failures on board exams (58.2%), and MSPEs (54.8%) were rated as very/extremely important application components. Six hundred seventy-eight open-ended comments yielded themes related to desire for more transparency and standardization, importance of student attributes and activities, and other important components of applications. Conclusion: PDs place a high value on the MSPE but find it limited by concerns over validity, objectivity, and lack of standardization. The quality of MSPEs may be improved by using a common language of skill attainment such as the Association of American Medical Colleges' Entrustable Professional Activities and using the document to discuss students' other attributes and contributions.

Assessment of a Recognition Program in an Academic Family Medicine Department.

BACKGROUND AND OBJECTIVES: Burnout is prevalent among clinicians and faculty. We sought to understand the impact of a recognition program designed to reduce burnout and affect engagement and job satisfaction in a large academic family medicine department. METHODS: A recognition program was created in which three clinicians and faculty from the department were randomly selected each month to be recognized ("awardees"). Each awardee was asked to honor a person who had supported them (a "hidden hero" [HH]). Clinicians and faculty not recognized or selected as an HH were considered "bystanders." Interviews were completed with 12 awardees, 12 HHs, and 12 bystanders for a total of 36 interviews. We used content analysis to qualitatively evaluate the program. RESULTS: Assessment of the "We Are" Recognition Program resulted in the categories of impact (subcategories: process positives, process negatives, and fairness of program) and HHs (subcategories: teamwork and awareness of the program). We conducted interviews on a rolling basis and made iterative changes to the program based on feedback. CONCLUSIONS: This recognition program helped create a sense of value for clinicians and faculty in a large, geographically dispersed department. It represents a model that would be easy to replicate, requires no special training or significant financial investment, and can be implemented in a virtual format.

Assessment of Agenda Setting With ACGME Milestones in Family Medicine Residents.

BACKGROUND AND OBJECTIVES: Family medicine residents are scored via milestones created by the Accreditation Council for Graduate Medical Education (ACGME) on various clinical domains, including communication. Communication involves a resident's ability to set an agenda, but this is rarely taught in formal education. Our study aimed to examine the relationship between ACGME Milestone achievement and ability to set a visit agenda, as measured by direct observation (DO) forms. METHODS: We examined biannual (December, June) ACGME scores for family medicine residents at an academic institution from 2015-2020. Using faculty DO scores, we rated residents on six items corresponding to agenda setting. We used Spearman and Pearson correlations and two-sample paired t tests to analyze results. RESULTS: We analyzed a total of 246 ACGME scores and 215 DO forms. For first-year residents, we found significant, positive associations between agenda-setting and the total Milestone score (r[190]=.15, P=.034) in December, and in individual (r[190]=.17, P=.020) and total communication scores (r[186]=.16, P=.031), in June. However, for first-year residents, we found no significant correlations with communication scores in December or in the total milestone scores in June. We found significant progression for consecutive years in both communication milestones (t=-15.06, P<0.001) and agenda setting (t=-12.26, P<.001). CONCLUSIONS: The significant associations found in agenda setting with both ACGME total communication and Milestone scores for first-year residents only, suggests that agenda setting may be fundamental in early resident education.

Understanding Nutritional Knowledge and Experiences in Families With a Child Newly Diagnosed With Type 1 Diabetes.

Nutrition is an integral part of diabetes management. Caregiver nutritional knowledge has been implicated in glycemic management of youth with type 1 diabetes. This study assessed the nutritional knowledge of parents/caregivers of children newly diagnosed with type 1 diabetes. Findings suggest there is a need for more targeted support and training during the initial diagnosis and a desire for more technology-related resources such as virtual nutritionist-guided grocery shopping visits. Integrating these interventions into routine care for children with type 1 diabetes will help address the current gaps in caregiver nutritional literacy and their ability to provide appropriate care.

Effects of Early COVID-19 Restrictions on Resident Well-being and Burnout.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has contributed to burnout among residents, a population already at increased risk for heightened stress and work-related fatigue. Residency programs were also forced to alter schedules and educational objectives. We assessed how social distancing restrictions (specifically self-isolation) enacted early in the COVID-19 pandemic affected family medicine (FM) resident well-being and burnout. Our FM department created a 2-week reserve rotation as a response to the need to socially distance and protect the residents. We explored how the reserve rotations impacted their experiences. METHODS: A purposive sample of FM residents were recruited in May and June of 2020. Qualitative interviews explored well-being and burnout, changes in education and provision of patient care, and overall adaptation to the pandemic. We employed interpretative phenomenology to analyze the interviews. RESULTS: We interviewed six out of 24 residents before saturation was reached. Qualitative analysis revealed themes related to positive and negative consequences of the pandemic, including uncertainty/fear of the unknown, schedule/life changes, communication, and adapting to a new routine. CONCLUSIONS: The COVID-19 pandemic placed an additional burden on residents, a group already at increased risk for burnout. While uncertainty and disruptions in work and home life were significant stressors, this cohort demonstrated adaptability and resilience that was facilitated by peer support and effective communication. These factors, along with the reserve rotation with decreased clinical responsibilities, led to an improved sense of well-being and decreased feelings of burnout.

Challenges in Effective Faculty and Provider Recognition to Enhance Engagement.

BACKGROUND AND OBJECTIVES: Burnout is associated with reduction in patient care time and leaving academic medicine, and is prevalent among faculty, residents, and advanced practice providers. Recognition may positively impact workplace well-being and reduce attrition. The objective of this study was to understand needs and preferences regarding recognition among faculty and providers in a large academic department. METHODS: A survey including quantitative and qualitative elements was sent to faculty and providers to identify whether additional recognition was needed and, if so, to seek potential opportunities to improve recognition, with mixed-methods assessment of results. RESULTS: Fifty-two participants completed the survey (35.9% response rate; 53.8% female, 59.6% faculty); 26.9% reported performing duties at work that are not being recognized, and 19.2% reported seriously considering leaving the institution because they did not feel appreciated. Females were more likely to want tangible goods as a source of recognition (P=.008). While providers preferred to have recommendations for recognition made by office staff (P=.007), associate professors did not (P=.005). Qualitative responses to the survey also revealed concerns regarding favoritism and risk of feeling unappreciated if a recognition system is perceived as unfair. CONCLUSIONS: This survey demonstrated a deficit of recognition and a lack of consensus regarding how or when faculty and providers should be recognized. There were concerns regarding fairness of recognition. Efforts to enhance recognition should avoid assumptions about faculty and provider preferences, and should be attuned to fairness and inclusion.

Loneliness in Primary Care Patients: Relationships With Body Mass Index and Health Care Utilization.

PURPOSE: Rates of loneliness and obesity have increased in recent decades. Loneliness and obesity independently have been found to be risk factors for negative physical and mental health outcomes. This study examined the rates and interrelationships of loneliness, body mass index (BMI), and health care utilization in a primary care setting. METHODS: A cross-sectional survey of adult patients presenting for outpatient care at 7 family medicine clinical practices in Pennsylvania was conducted. Survey questions included self-reported measures of loneliness, height/weight, number of health care visits, and potential confounders (eg, sociodemographic variables, health status). Bivariate and multivariable linear regression models were used to analyze associations among loneliness, BMI, and health care utilization. RESULTS: In all, 464 eligible patients returned surveys for an overall response rate of 26%. Mean (standard deviation) loneliness score was 4.2 (1.7), mean BMI was 30.4 (7.6), and mean number of visits in year prior was 2.7 (3.6). On bivariate analysis, BMI was positively associated with loneliness (effect estimate: 0.50; P=0.03). On multivariable analysis, BMI was negatively associated with attending religious services and self-reported physical health and positively associated with self-reported mental health (P<0.05 for all), but not associated with loneliness. While not associated with loneliness, health care utilization was negatively associated with Hispanic ethnicity, marital status, and self-reported physical health (P<0.05 for all). CONCLUSIONS: Given the detrimental effects loneliness and obesity have on health outcomes, it might be prudent for health care providers to prioritize health concerns for their patients by assessing loneliness and counseling regarding associated risks, particularly in patients with obesity.

Determining the Perception and Willingness of Primary Care Providers to Prescribe Advanced Diabetes Technologies.

Advanced diabetes technologies have produced increasingly favorable outcomes compared to older treatments. Disparities in practice resources have led to a treatment disparity by clinical setting, where endocrinologists typically prescribe far more such technologies than primary care providers (PCPs). Fully automated artificial pancreas systems (APS), which combine technologies to deliver and adjust insulin dosing continuously in response to automatic and continuous glucose monitoring, may be more straightforward for PCPs to prescribe and manage, therefore extending their benefit to more patients. We aimed to assess willingness of PCPs to prescribe advanced diabetes technologies through a cross-sectional survey of PCPs from 4 geographically diverse centers. While respondents were uncomfortable initiating (63 of 72, 88%) or adjusting (64 of 72, 89%) traditional insulin pumps, their views on APS were quite different: 71 of 76 (93%) saw advantages to prescribing APS by PCPs rather than only endocrinologists. Most would consider prescribing APS for type 1 diabetes (58 of 76, 76%) and type 2 diabetes (52 of 76, 68%). No differences were seen among attendings, residents, or nurse practitioners. APS were much more acceptable than traditional insulin pumps among this primary care sample. If successful, primary care management of closed-loop APS would greatly increase access to such therapies and reduce disparities among those patients who face more difficulty accessing subspecialty care than they do primary care.