Characteristics of family physicians with additional training or focused practices in caring for older adults: Population-based retrospective cohort study.

OBJECTIVE: To identify FPs with additional training and focused practice activities relevant to the needs of older patients within health administrative data and to describe their medical practices and service provision in community-based primary care settings. DESIGN: Retrospective cohort study. SETTING: Ontario. PARTICIPANTS: Family physicians with Certificates of Added Competence in care of the elderly from the College of Family Physicians of Canada or focused practice billing designations in care of the elderly. MAIN OUTCOME MEASURES: Evidence of additional training or certification in care of the elderly or practice activities relevant to the care of older adults. RESULTS: Of 14,123 FPs, 242 had evidence of additional scope to better support older adults. These FPs mainly practised in team-based care models, tended to provide comprehensive care, and billed for core primary care services. In an unadjusted analysis, factors statistically significantly associated with greater likelihood of having additional training or focused practices relevant to the care of older patients included physician demographic characteristics (eg, female sex, having completed medical school in Canada, residential instability at the community level), primary care practice model (ie, focused practice type), primary care activities (eg, more likely to provide consultations, practise in long-term care, refer patients to psychiatry and geriatrics, bill for complex house call assessments, bill for home care applications, and bill for long-term care health report forms), and patient characteristics (ie, older average age of patients). CONCLUSION: The FP workforce with additional training or focused practices in caring for older patients represents a small but specialized group of providers who contribute a portion of the total primary care activities for older adults. Health human resource planning should consider the contributions of all FPs who care for older adults, and enhancing geriatric competence across the family medicine workforce should be emphasized.

Challenges in teacher-student communication during family medicine residency: A qualitative study.

BACKGROUND: Deficiencies in communication among healthcare professionals, recognized by medical educators and healthcare institutions, can negatively impact medical education and clinical practice. Analyzing teacher-resident communication difficulties shed light on this issue and propose practical strategies for its mitigation. OBJECTIVE: To identify common communication challenges between teacher and residents during Family Medicine residency and to analyze their impact on interactions with peers, the work team, and patients. DESIGN: Qualitative study, the critical incident technique was used to collect information of interest. PARTICIPANTS: Seventy teachers, and fifty third-year residents from the Mexican Republic described critical incidents related to their communication experiences during Family Medicine residency. RESULTS: 192 critical incidents were collected (several participants reported more than one incident), comprising 127 reports from teachers, and 65 from residents. Four themes were identified: 1) asymmetric communication, 2) assertive communication, 3) organizational communication, and 4) effective communication. The main challenges identified were abuse of power in communication, lack of communication skills, and the absence of institutional communication channels. These issues significantly impacted learning, work environment, interpersonal relationships, and medical care. CONCLUSION: This study highlights communication issues within Family Medicine residency in Mexico. The issues detected hindered learning and effective collaboration and negatively impacted the work environment, interpersonal relationships, and the quality of medical care. These findings underscore the urgent need to reorient the medical specialty curriculum towards an approach that includes communication skills.

Medical student learning on a distributed training platform in rural district hospitals.

BACKGROUND:  Decentralising medical school training enhances curriculum relevance, exposing students to generalist patient care in diverse contexts. AIM:  The aim of the study was to understand the student experiences of learning during their 7-week Family Medicine rural rotation. SETTING:  Final year medical students who had completed their Family Medicine rotation in November 2022. METHODS:  A qualitative study involving 24 final year students (four semi- structured interviews and four focus group discussions [4 x 5 students]). All interviews were recorded, transcribed verbatim and analysed thematically. RESULTS:  Analysis revealed positive learning experiences and identified the following themes: taking responsibility for learning, the generalist context, teaching and learning in context and managing the learning environment. CONCLUSION:  Active participation in hospital activities, exposure to disorientating dilemmas that challenged assumptions and reflection on these experiences led to transformative learning and knowledge co-construction.Contribution: The study contributes to the discussion and reinforces the advantages of distributed, experiential training, highlighting the positive impact of meaningful participation and transformative learning opportunities.

Perspectives on virtual interviews and emerging technologies integration in family medicine residency programs: a cross-sectional survey study.

BACKGROUND: During the coronavirus disease of 2019 (COVID-19) pandemic, in-person interviews for the recruitment of family medicine residents shifted to online (virtual) interviews. The purpose of this study was twofold: (1) to gather the ideas about virtual interviews of family medicine applicants (interviewees), and faculty and staff who interviewed these applicants (interviewers), and (2) to describe interviewers' and interviewees' opinions of use of emerging technologies such as artificial intelligence (AI) and virtual reality (VR) in the recruitment process as well as during clinical practice. METHODS: This was a cross-sectional survey study. Participants were both interviewers and candidates who applied to the McGill University Family Medicine Residency Program for the 2020-2021 and 2021-2022 cycles. RESULTS: The study population was constituted by N = 132 applicants and N = 60 interviewers. The response rate was 91.7% (55/60) for interviewers and 43.2% (57/132) for interviewees. Both interviewers (43.7%) and interviewees (68.5%) were satisfied with connecting through virtual interviews. Interviewers (43.75%) and interviewees (55.5%) would prefer for both options to be available. Both interviewers (50%) and interviewees (72%) were interested in emerging technologies. Almost all interviewees (95.8%) were interested in learning about AI and VR and its application in clinical practice with the majority (60.8%) agreeing that it should be taught within medical training. CONCLUSION: Although experience of virtual interviewing during the COVID-19 pandemic has been positive for both interviewees and interviewers, the findings of this study suggest that it will be unlikely that virtual interviews completely replace in-person interviews for selecting candidates for family medicine residency programs in the long term as participants value aspects of in-person interviews and would want a choice in format. Since incoming family medicine physicians seem to be eager to learn and utilize emerging technologies such as AI and VR, educators and institutions should consider family physicians' needs due to the changing technological landscape in family medicine education.

Evaluation of Interprofessional Delivery of Diabetes Medication Management Training Among Family Medicine Residents.

OBJECTIVE: Diabetes-related care makes up approximately 24% of outpatient clinic visits. Therefore, confidence and understanding of diabetes management is necessary for family medicine residents. METHODS: We developed a combined lecture and simulation lab curriculum utilizing a registered nurse and pharmacist to deliver education to 20 family medicine learners. Pre and post surveys of the educational material were completed in 2 sections including one gauging medical knowledge and a second part gauging level of comfort. RESULTS: Of the learners who participated, fourteen completed the pre-post surveys. Most (53%) respondents improved their scores, while 20% scored the same 27% scored worse. The overall average score increased 57% to 70% and improvement was statistically significant (P < .05). All learners improved confidence by at least 1 point. CONCLUSION: An interprofessional team utilizing a lecture curriculum focusing on providing education on effective prescribing, medication safety profiles, and resource availability, showed improvement in confidence but mixed knowledge benefit. Further modifications to the curriculum may yield further educational gains.

Kaua'i Rural and Public Health Selective: A Family Medicine Residency First.

Governmental public health professionals and community physicians often have limited understanding of each other's roles and responsibilities. To increase the connection between public health and primary care as well as to incorporate rural health care in graduate medical education training, a new "Kaua'i Rural and Public Health Selective" brings Family Medicine resident physicians (Residents) into the local health department on Kaua'i. This first-time collaboration between the Kaua'i District Health Office (KDHO) and University of Hawai'i John A. Burns School of Medicine (JABSOM) Family Medicine Residency Program advances Residents' understanding of public health and has been well-received by Residents and by department of health staff. Future plans include evaluation and continued incorporation of public health experiences into the core curriculum of a rural Family Medicine residency training program based on Kaua'i.

Family Health Clinical Officers: Key professionals to strengthen primary healthcare in Kenya.

Primary healthcare (PHC) is recognised as the means to achieve universal health coverage, a national priority for Kenya. With only approximately 200 family physicians for a population of over 54 million, innovative solutions for providing quality PHC are needed. Clinical Officers, as mid-level health workers, already provide much of the primary care across Kenya, but without specialised training. To provide highly trained Family Health practitioners, a Higher Diploma in Family Health for Clinical Officers (FHCO) was launched by the government in 2018. With experience in delivering innovative and strategic higher diplomas, AIC Kijabe Hospital has been involved in curriculum development of this new diploma since its inception, and in October 2021 the first cohort of FHCO trainees was admitted to Kijabe College of Health Science, graduating in 2023. The second cohort is underway with plans for an annual intake. The FHCO graduates are running Family Medicine clinics at AIC Kijabe Hospital and its satellite clinics and are heavily involved in teaching. They are well-trained to deliver comprehensive, evidence-based, cost-effective and holistic care. As the programme expands, we expect graduates to be working across the country and leading efforts in enhancing the health and well-being of individuals, families and communities within primary healthcare networks (PCNs). By training FHCOs, this higher diploma is an efficient and cost-effective way to improve PHC, particularly for underserved Kenyans, and thus is a key part of enabling the Kenyan Government to achieve universal health coverage. This model of training could easily be replicated in other countries.

Making family medicine work: Rural community-based and interprofessional medical education.

At the University of the Free State, the 5-year MBChB curriculum had to be complemented with community-based education exposure to meet the requirements of the Health Professions Council of South Africa. Following the faculty leadership's vision, an interprofessional training experience was conceptualised and implemented by a project team from the three schools in the Faculty of Health Sciences (Medicine, Nursing, and Health and Rehabilitation Sciences). For the past decade, 4th-year medical students participated in the 2-week rotation in the rural southern Free State province, of which 1 week is spent with students from other health professions programmes in a structured interprofessional learning experience. The other week focuses on the realities of nurse-driven primary healthcare services in a resource-deprived area, including exposure to the programme-guided care for patients with tuberculosis (TB) or chronic diseases, care for pregnant women and for babies, including vaccinations.

Advice to future family physicians: findings from qualitative interviews with family medicine residents and early-career family physicians.

BACKGROUND: Canadians continue to report challenges accessing primary care. Practice choices made by primary care providers shape services available to Canadians. Although there is literature observing family medicine practice trends, there is less clarity on the reasoning underlying primary care providers' practice intentions. Advice offered by residents and early-career family physicians may reveal challenges they have experienced, how they have adapted to them, and strategies for new residents. In this paper, we examine advice family medicine residents and early-career family physicians would give to new family medicine residents. METHODS: Sixty early-career family physicians and thirty residents were interviewed as part of a mixed-methods study of practice patterns of family medicine providers in Canada. During qualitative interviews, participants were asked, "what advice would you give [a new family medicine resident] about planning their career as a family physician?" We inductively analyzed responses to this question. RESULTS: Advice consisted of understanding the current climate of family medicine (need for specialization, business management burden, physician burnout) and revealed reasons behind said challenges (lack of support for comprehensive clinic care, practical limitations of different practice models, and how payment models influence work-life balance). Subtheme analyses showed early-career family physicians being more vocal on understanding practical aspects of the field including practice logistics and achieving job security. CONCLUSION: Most advice mirrored current changes and challenges as well as revealing strategies on how primary care providers are handling the realities of practicing family medicine. Multi-modal systemic interventions may be needed to support family physicians throughout the changing reality of family medicine and ensure family medicine is an appealing specialty.

Educational needs assessment for health advocate role in family medicine residency training in Turkey: A Delphi study.

BACKGROUND: Health advocacy (HA) involves purposeful actions to inform, mobilise, and organise activities to address social determinants of health affecting individuals or communities. It is a fundamental component of medical practice, deemed mandatory by professional and educational bodies. Therefore, including health advocacy training in pre- and post-graduate medical education is crucial. OBJECTIVES: In this study, we aimed to determine the need for HA training for family physicians (FPs) based on expert opinions. METHODS: We conducted a modified Delphi study with 105 academic experts and active FPs to explore HA training needs. Using a three-round technique, experts first answered five open-ended questions on HA competencies, teaching and assessment methods, learning environments, and integration in residency training. In the second round, statements from the responses were rated on a 5-point Likert scale, in the third round, statements below the 85% consensus level were revised and re-evaluated. RESULTS: The panel consisted of 41 experts (33 academicians, 8 practitioners) who accepted the invitation and completed the study. At the end of the three rounds, consensus was reached on 38 statements for HA competencies, 15 for teaching methods, 8 for assessment methods, and 20 for integration for HA training. CONCLUSION: Competencies for the HA role are very broad in perspective and show commonalities with the FPs' 'professional', 'expert' and 'leader' roles. Longitudinally integration of the HA training into the national 'Family Medicine Residency Training Core Curriculum' through participatory processes and training of FM trainers in HA is strongly recommended.

The competencies expected for the health advocacy role of the family physicians show commonalities with the family physicians' 'professional', 'expert' and 'leader' roles.It is important to longitudinally integrate health advocacy training into the family medicine residency training core curriculum at the national level.

Examination of the Knowledge Levels of Family Medicine Residents in Turkey about Oral and Dental Health.

PURPOSE: To measure the general oral and dental health knowledge level of family medicine residents who are receiving full-time specialty training in Turkey. Primary care physicians can contribute to improving the oral and dental health of patients during general health services. MATERIALS AND METHODS: The fundamentals of oral and dental health that the family medicine physicians should know about were determined, and questionnaire items on these fundamentals were prepared. The sample size was calculated as 296 individuals. The survey was conducted online. The collected data were analysed employing the following tests: chi-squared, Fisher, Kolmogorov-Smirnov, Spearman, ANOVA, Mann-Whitney U, Kruskal-Wallis, and Bonferroni. RESULTS: 302 family medicine residents in various clinics in Turkey participated in the study. The mean age of the participants was 29.6 ± 5.1. The mean knowledge scores of the resident physicians were calculated as 65.2 ± 10.9 (lowest: 27; highest: 92). The majority of resident physicians stated that they did not receive training on oral and dental health during their residency training, and that they agreed with the idea of integrating it into the residency training curriculum. CONCLUSIONS: The general knowledge level of family medicine residents in Turkey about oral and dental health was found to be moderate.