Expanding Access to Contraceptive Services in a Family Medicine Residency Clinic: The Rapid Access to Contraception Clinic Model.

BACKGROUND AND OBJECTIVES: Learning to provide long-acting reversible contraception (LARC) during family medicine residency is an important step in building capacity for the primary care workforce to meet the reproductive health care needs of communities. We aimed to measure the impact of adding a contraceptive visit type (CVT) allowing for rapid access to contraception (RAC) on family medicine resident LARC procedure numbers. METHODS: Our program created a CVT in which patients were seen only for contraceptive services. We added the CVT to third-year family medicine resident continuity clinic schedules and a block of CVTs (the RAC clinic) to the third-year gynecology rotation. Residents self-reported LARC procedure numbers performed throughout residency, and the totals were compared for graduating residents from 2023 (post-RAC cohort) to 2022 graduates and 2018-2022 graduates (pre-RAC cohort). RESULTS: Post-RAC cohort residents reported a statistically significant increase in intrauterine device (IUD; P=.015) and contraceptive implant (P=.010) removals compared to the 2022 pre-RAC cohort. Insertions of IUDs and contraceptive implants were unchanged when compared to the pre-RAC cohort. IUD removals (P=.004) and insertions (P=.034), and contraceptive implant removals (P=.028) were significantly increased for post-RAC compared to 2022 graduates, with no difference in contraceptive implant insertions (P=.211). CONCLUSIONS: The addition of the CVT and RAC clinic contributed to an increase in LARC removals in both comparisons, and IUD insertions between 2022 and 2023. This clinic model offers an opportunity for other family medicine residency programs to improve access to contraceptive services and increase resident training in LARC management.

Social Determinants of Health Education Within Family Medicine Clerkships: A CERA Study.

BACKGROUND AND OBJECTIVES: Social determinants of health (SDoH) education has gained popularity in undergraduate medical education; however, emphasis varies, and the curricula or assessment methods are not uniform. This study sought to examine the current SDoH teaching and assessment methods within family medicine clerkships and to identify characteristics associated with SDoH curriculum with multicomponent (two or more) teaching strategies and higher Kirkpatrick levels of assessment (Level 3-behavior change and Level 4-results). METHODS: An online survey was conducted through the 2023 Council of Academic Family Medicine Educational Research Alliance (CERA) Clerkship Directors Survey. RESULTS: The survey response rate was 56.8% (96/169). The degree of SDoH emphasis in the medical school was positively associated with the number of teaching strategies (r=0.48; P<.001). We found a trend toward degree of SDoH emphasis being associated with higher Kirkpatrick levels of assessment (H[3]=7.83; P=.05). Having an SDoH faculty champion was associated with more teaching strategies (F[1,77]=8.73; P=.004), more types of assessments (F[1,78]=5.88; P=.018), and higher Kirkpatrick levels of assessment (H[1]=4.46; P=.035). Underrepresented in medicine clerkship director identity was not associated with the number of teaching strategies or higher Kirkpatrick levels of assessment. CONCLUSIONS: Greater degrees of SDoH emphasis and having a faculty champion were associated, or trended toward association, with multicomponent teaching strategies and higher Kirkpatrick levels of assessment, which prepare students to provide SDoH responsive care that could lead to reduction in health inequities.

Developing an electronic portfolio of learning for family medicine training in South Africa.

Workplace-based assessment has become increasingly crucial in the postgraduate training of specialists in South Africa, particularly for family physicians. The development of a Portfolio of Learning (PoL) has been a central focus within the discipline of family medicine for over a decade. Initially, a paper-based portfolio was adopted to collect evidence of learning for 50 out of 85 agreed exit-level outcomes. Stellenbosch University led the conversion of this portfolio into an electronic format, known as e-PoL, utilising Scorion software. The e-PoL was successfully implemented in the Western and Eastern Cape regions and was subsequently adopted nationally under the coordination of the South African Academy of Family Physicians. In 2023, the e-PoL underwent a redesign to gather evidence of learning for 22 entrustable professional activities (EPAs). Key insights from this development process underscore the importance of the PoL in supporting assessment-for-learning rather than merely assessment-of-learning. This necessitates features for feedback and interaction, ensuring that the PoL functions beyond a mere repository of forms. Additionally, the e-PoL should facilitate triangulation, aggregation, and saturation of data points to effectively measure EPAs. Furthermore, the PoL has not only documented learning but has also played a pivotal role in guiding the development of clinical training by explicitly outlining expectations for both registrars and supervisors. While the initial design and development costs are significant, operational costs become affordable when shared across all training programmes.

Implementation and evaluation of a mentorship program in clinical master in family medicine during the COVID-19 pandemic at the Arabian Gulf University: a longitudinal study.

BACKGROUND: We implemented a contextualized innovative mentorship program in the Clinical Master in Family Medicine (CMFM) program established in April 2020 at Arabian Gulf University. In this paper, we describe the process of this program and derive the major challenges faced by trainees and related corrective actions and their outcomes on high-risk trainees for optimal performance. METHODS: We conducted a mixed-method longitudinal study of 80 trainees, analyzing information extracted from the Moodle learning platform about five key performance indicators as well as the contents (quantitative and qualitative) of mentoring meeting reports submitted through a validated online form between 2020 and 2022. We analyzed frequencies and themes of challenges and compared trainees' performance according to time and level of risk. RESULTS: The follow-up of all 80 trainees in two cohorts (40 for each cohort) shows that most are female (93.75%) and the mean age is 30.00 ± 2.19 years with a ratio of mentors to mentees of 1 to 5. Meetings are conducted through phone calls, virtually, and face-to-face in 62%, 29%, and 8.3% respectively. The mean number and duration of meetings are 30.88 ± 2.31 and 20.08 ± 9.50 min respectively. Time management is the most reported challenge (41.3%), followed by health, social, and psychological-related issues in 7.6%, 4.6%, and 3% respectively. We extracted four main themes related to trainees, settings of training, e-Portfolio, and the COVID-19 pandemic. The mentorship program captured 12 trainees at high risk for low academic progress (12%) of whom six graduated on time and the remaining had to repeat a few courses the following terms. The performance of the program is stable over time (mean GPA of 3.30 (SE = 0.03), versus 3.34 (SE = 0.05) for cohorts 1 and 2 in the two years respectively, (P = 0.33). However, it is slightly lower among high-risk trainees compared to the remaining (GPA = 3.35 (SE = 0.03) versus 3.14 (SE = 0.08), P = 0.043) though above the minimum of the threshold of 3 out of 4, required for the master's degree. CONCLUSION: The mentorship program captured the struggling trainees and permitted to implement pertinent corrective actions timely, particularly in the context of a two-year intensive CMFM program during the COVID-19 pandemic.

Video based educational intervention in waiting area to improve awareness about health screening among patients visiting family medicine clinics.

BACKGROUND: Multiple educational modalities have been utilized including leaflet, face-to-face counseling and watching videos in waiting areas for engaging patients. Considering the two challenges of waiting time frustration and lack of health screening awareness, Family Physicians' waiting area are an ideal place to bridge this gap. The objective of this study is to evaluate the effectiveness of video-based health education intervention in improving knowledge about health screening among patients and their families sitting in waiting area of Family Medicine clinics. METHODS: It was a pre and post quasi-experimental study that was conducted in family medicine clinics located at main campus and Outreach centers of a tertiary care hospital. A total of 300 participants were approached during the six month period. The intervention consisted of an educational video on health screening. The content of the video was taken from the recommended preventive care guidelines from CDC and USPSTF. The pre-and post-intervention knowledge of the participants was assessed through a semi-structured coded questionnaire by an interviewer who was trained in data collection. Data was analyzed using SPSS version 26. Pre and post intervention knowledge adequacy was determined using MacNemar's Chi-square test. RESULTS: Total 300 participants voluntarily participated into the study. Median age of the participants was 28 (IQR = 23.25-36.75) years. Majority of participants were males (56%). Following the intervention, there was significant increase in the proportion of participants (51.3% versus 68%) who had understanding of health screening check-up (p < 0.001). Following the study intervention, there was significant increase in proportion of participants who had adequate knowledge related to diabetes (p = 0.045), hypertension (p < 0.001), cholesterol (p < 0.001), cervical cancer (p < 0.001), colon cancer (p < 0.001) and hepatitis B & C (p < 0.001). No significant improvement in breast cancer related knowledge was observed (p = 0.074). Highest post-intervention increase in knowledge from baseline was observed for hypertension (13.3% versus 63.3%) followed by colon cancer (24.3% versus 59.3%), cholesterol (67 versus 96.7%), hepatitis b & C (56.7% versus 77.3%), diabetes (29.7% versus 48%), cervical cancer (1.7% versus 19%), and breast cancer (7.7% versus 18.3%). CONCLUSION: This study highlighted a pivotal role of an educational video intervention in clinic waiting area to improve awareness regarding health screening among patients and their families. Further interventional community based or multicenter studies are warranted to assess the long-term impact of these educational videos on knowledge and utilization of health screening among adult population.

Education for Integration: Dental hygiene student and family medicine residents.

Purpose The integration of oral health and primary care offers promising solutions to overcome barriers hindering patient access to oral health care. However, primary care providers require training in basic preventive oral health care and information regarding interprofessional practice opportunities. The purpose of this feasibility study was to examine the perspective of families, learners, faculty, and administrators who engaged in an interprofessional training experience for family medicine residents and dental hygiene students.Methods Family medicine residents and dental hygiene students participated in an interprofessional oral health integration training experience, which included didactic, preclinical, and clinical components. The clinical experience was conducted during a Medicaid Managed Care clinic session, which included the participation of children who had not undergone a well-child visit within the past year. The care teams were comprised of a family medicine resident and dental hygiene student, who collaborated on the provision of preventive oral health care services, including oral examinations, preventive interventions, patient education, and care coordination. Qualitative data gathered using field notes, focus groups, and key informant interviews were analyzed to identify themes from care team, patient/family, and administrative perspectives.Results The care teams provided preventive health oral health care services to 10 pediatric patients during their well child visit. Patients and family members reported appreciating the convenience and value of the care provided. The experience was well received by family medicine residents, dental hygiene students, and clinical faculty members, who highlighted the value of the experience in expanding access to care. The family medicine residents reported the training and interprofessional practice opportunity to be highly valuable, reporting better preparation for the identification, evaluation, and treatment of oral conditions that they may have otherwise overlooked or misdiagnosed.Conclusions This interprofessional educational experience demonstrates the potential value of integrating preventive oral health in primary care visits for children. This care integration may be especially helpful for populations that experience barriers to oral health care. Results of this study suggest that expanding interprofessional education between dental hygiene programs and family medicine residencies may be beneficial for preparing the future workforce for integrated care. Additional research is needed to formalize training models that support integration and promote interprofessional collaboration and practice.

Impact of general practice/family medicine training on Japanese junior residents:reflective writing analysis using text mining.

BACKGROUND: We previously reported the impact of general practice/family medicine training on postgraduate training in Japan using evaluation criteria standardized nationwide. However, there is a possibility that new insights may be gained by analyzing the reflective reports written by these residents. METHODS: Junior residents who participated in one-month general practice/family medicine training at one of five medical institutions with full-time family medicine specialists between 2019 and 2022 were enrolled in this study. They were assigned to submit a reflective report on their experiences and thoughts every day during the training. We analyzed these reflective writings using text mining and created a co-occurrence network map to see the relationship between the most frequently used words. RESULTS: Ninety junior residents participated in the study. The words that appeared most frequently in the sentences referring to clinical ability included "symptoms," "medical examination," "consultation," "treatment," and "examination." The words of "family" and "(patient) oneself" showed strong association in the co-occurrence network map. CONCLUSION: It was suggested that general practice/family medicine training greatly contributes to the acquisition of clinical abilities and deepens the learning of junior residents not only about patient care but also about family-oriented care.

Primary healthcare training in the Democratic Republic of the Congo.

Family medicine is a relatively new discipline in the Democratic of the Congo. It was developed under South-South and Churches Collaboration with the aim of responding in a cost-efficient manner to the crisis of health practitioners in mostly Christian and protestant hospitals based in rural areas in the Democratic Republic of the Congo.

Electronic distance based clinical skills training development in family medicine in Namibia.

Workplace-based evaluation is one of the most important, but challenging aspects of medical education. The aim was to improve the assessment of the rural community-based clinical training for undergraduate 3rd and 4th year family medicine students at the University of Namibia (UNAM) and implement a paperless process. An online module was developed on the Moodle platform to include a study guide, an electronic portfolio, and electronic resources (e-books and apps) to replace the current paper version of the logbook. We explored local resources by engaging with students and clinical trainers on how to best conduct the initial implementation. Engagement also entailed motivating students to actively participate in the implementation process. All 3rd and 4th year community-based education end service (COBES) students are now submitting proof of clinical learning electronically with the use of their phones in their online portfolio and using online resources. In addition, students in the practical family medicine module that has been introduced in the 6th year since 2023 are now also using an electronic portfolio and these assessment tools.Contribution: Overall feedback from students and supervisors indicates a positive atmosphere of learning and constructive feedback on performance from all team members, hopefully improving work-based assessments and ultimately patient care. More members of the primary health care team were involved and the carbon footprint has also been decreased.

Evaluating the new family medicine internship programmes in the Western Cape, South Africa.

BACKGROUND:  In 2021, South Africa introduced a new 6-month internship in family medicine and primary care. This study aimed to assess the new rotation at district health facilities in the Western Cape. METHODS:  A descriptive survey of interns and supervisors, as phase-two of an exploratory sequential mixed methods study. Questionnaires were developed from a descriptive exploratory qualitative study. Data were analysed with the Statistical Package for Social Sciences. RESULTS:  Questionnaires were completed by 72 interns (response rate 21%) and 36 supervisors (response rate 90%), across 10 training programmes. Interns felt more independent (97.2%), confident (90.3%) and resilient (91.6%). They learnt to manage undifferentiated and chronic conditions (91.6%), to refer patients (94.3%) and conduct procedures (77.8%). Most interns were not exposed to community-based services (68.0%) and continuity of care (54.1%). Supervision was mostly adequate during the day (79.1%) and afterhours (80.6%). Many interns reported no structured teaching programme (41.7% - 55.6%). Most supervision was from medical officers and registrars. Supervisors saw interns as valuable members of the clinical team (100.0%), who required extra support and administration (42.5%). The majority of interns (75.0%) and supervisors (72.7%) thought the rotation was the right length and the best preparation for community service (67.6%). CONCLUSION:  The rotation met most expectations of the Health Professions Council of South Africa. Programmes need to improve exposure to community-orientated primary care, public health medicine, palliative and ongoing care. Supervision and orientation of interns needs improvement.Contribution: This is the first evaluation of the new family medicine internship programme in South Africa.