Use of Signaling in Family Medicine Residency Interviewing.

BACKGROUND AND OBJECTIVES: Although signals have been used in the residency application process by other specialties, family medicine residency directors have not previously participated. With applicant signal information available for the first time in the 2023-2024 application cycle, the current study describes family medicine residency program directors' intended use of signals and provides benchmarking descriptive data that may help inform best practices and future studies. METHODS: A total of 691 of the 745 family medicine program directors in US family medicine residency programs accredited by the Accreditation Council for Graduate Medical Education were surveyed. We used ꭓ2 and Pearson correlation analyses to examine how program directors of family medicine residency programs intended to use signaling and their perceived impact of signaling on the residency interviewing process. RESULTS: Most program directors indicated that applicant signals would assist them in deciding who to invite for an interview and would be a positive factor in a holistic review process. However, program directors also noted that rotation experience or geographic ties would be more powerful inducements to interview or rank a specific candidate. Program directors did not indicate a belief that signals would decrease interview season stress or workload. CONCLUSIONS: Signals may play an important role in the residency application process for family medicine in 2023-2024. While signals are not anticipated to decrease application workload or stress, a signal may be an important mechanism for a specific applicant to distinguish themselves with a program.

'Just the Way it Was': Perspectives on Sexual Harassment in Medical School and #MeToo of Women Graduating Prior to 1975.

Introduction: The purpose of this study was to assess gender-based mistreatment during medical education recalled by women who attended medical school between 1948 and 1975 and their perspectives on the #MeToo movement. Methods: Methods included a qualitative analysis of video-recorded structured interviews. Results: The 37 participants graduated in classes of 2-20% women. They described pervasive, multi-faceted gender-based mistreatment during training. Twenty (54%) disclosed personal experience of serious sexual mistreatment. Interviewees stressed that attitudes and behaviors toward women and trainees, now regarded as unacceptable, were previously widely accepted or tolerated. The majority (86%) expressed overall positive opinions of their training. Twenty-eight (76%) supported the #MeToo movement, four (11%) had negative opinions, and five (13.5%) were ambivalent or unwilling to comment. Seventeen (46%) were concerned that #MeToo damaged working relationships, twelve (32%) were concerned about overreach, and eight (22%) about false accusations. Conclusions: This group of older female physicians reported extensive experience of gender-based mistreatment and strong support of #MeToo. Nevertheless, about one quarter of the group did not support the #MeToo movement and even supporters expressed high rates of concern about the movement going too far, falsely accusing men of inappropriate behavior, and damaging working relationships. The interviewees did not want their medical training to be characterized as entirely negative, or to be portrayed as victims.

Resident Physicians' Perceptions of Trauma Informed Care: Findings from a Small-scale Descriptive Study.

Introduction: Screening for adverse childhood experiences (ACEs) is a significant component of trauma informed care (TIC), as intervention can mitigate negative health outcomes. However, as few as 4% of physicians with pediatric patients screen and intervene for all ACEs. The authors of this study sought to: 1) understand resident physicians' perceptions of TIC; 2) identify areas of training needed to improve screening and intervention of ACEs. Methods: This descriptive study occurred in a large Midwestern Family Medicine residency and involved a convenience sample of 38 resident physicians. Participants completed a survey, which included a total of 22 Likert-scale and open-ended questions. Descriptive frequencies were used to represent Likert-scale responses, and the open-ended questions were analyzed utilizing a thematic analysis approach. Results: Participants identified screening for ACEs as useful. However, they reported a lack of confidence in their ability to screen and intervene. Barriers to screening and intervention also were noted and included lack of time, discomfort in assessment, perceived inability to help, insufficient knowledge and skills, and competing primary care recommendations. Conclusions: Family Medicine residents identified the screening and intervention of ACEs to be important. However, lack of confidence, competing primary care recommendations, and concern for receptiveness can deter residents from screening and intervention. Based on this study's findings, the authors recommend that graduate medical education focuses on building systems of training that provide learners with the knowledge, skills, and resources to routinely screen and intervene for ACEs in primary care.

Pediatric COVID-19 Vaccination: A Description of Adverse Events or Reactions Reported in Kansans Aged 6 to 17.

Introduction: There have been widespread concerns about the safety of the COVID-19 vaccines, particularly when it comes to pediatric populations, and it is important to provide information for parents and guardians to make informed decisions. This study sought to identify the adverse events or reactions (AERs) associated with the COVID-19 vaccines in Kansans aged 6 to 17. Methods: The U.S. Department of Health and Human Services' "Vaccine Adverse Event Reporting System" (VAERS) database was searched from May 11, 2021, to April 30, 2022, for AERs related to COVID-19 vaccines in adolescents ages 6 to 17. Results were grouped by vaccine manufacturer and patient gender. Results: A total of 159 individuals reported 409 AERS, with an average of 2.6 per person (± 1.7; median = 2; range 1 to 10). Females (n = 95) reported 237 AERs, with an average of 2.5 each (±1.7; median = 2; range 1 to 8), while males (n = 64) reported 172 AERs, with an average of 2.7 each (±1.8; median = 2; range 1 to 8). The most common adverse event associated with Pfizer® vaccination was syncope/fainting. Conclusions: COVID-19 vaccines have undergone intensive monitoring and safety regulations since the onset of the coronavirus. With over 591 million doses administered, there was compelling evidence that the COVID-19 vaccines are safe and effective. Informing the public about the potential AERs of the COVID-19 vaccines in children can help to alleviate vaccine hesitancy and strengthen vaccination confidence.

Interviewing for Family Medicine Residency: In-Person, Virtual, or Hybrid?

BACKGROUND AND OBJECTIVES: This study aimed to assess the impact of interviewing format changes on the family medicine (FM) residency interviewing process. Specifically, we compare applicant cost and time expenditures in traditional in-person, virtual-only, and hybrid interview years. We also report student perceptions of the virtual-only and hybrid interview processes. METHODS: Applicants for first-year FM residency positions via the National Resident Matching Program (NRMP) completed a survey questionnaire in 2019-2020 (in-person interviewing only), 2020-2021 (virtual only), and 2021-2022 (hybrid). Statistical analyses included analysis of variance for questions related to applications, interviews, ranked programs, cost, and time spent. We used thematic analysis to code narrative comments about the interviewing experience for the virtual-only and hybrid years. RESULTS: Seventy-one FM applicants responded (response rate 63.4%). Costs for the in-person interview year were significantly higher ($2,394.70±$1,961.20) than the virtual ($646.80±$846.60, P=.0001) and hybrid years ($903.30±$793.40, P=.001). Days spent per applicant on in-person interviews was also significantly higher (25.9±7.9,) than virtual (14.9±7.6, P=.0001) and hybrid years (14.3±7.0, P<.0001). For virtual and hybrid years, thematic analyses identified five categories: "feelings related to interviewing," "suggestions for future," "convenience/logistics of interviewing," "perceived fit of program," and "cost/time of interviewing," that further elucidated applicant experiences. CONCLUSIONS: Virtual interviewing works well for overall cost and time, but other aspects such as perceived fit with programs and equity need to be considered before residency programs adopt fully virtual or hybrid interviewing in future years.

The Impact of Virtual Interviewing During the COVID-19 Pandemic on the Residency Application Process: One Institution's Experience.

PURPOSE: To assess the impact of virtual interviewing during the COVID-19 pandemic on the residency application process and to compare applicant costs and time spent interviewing during the 2020-2021 application cycle with prior years. METHOD: Fourth-year medical students at the University of Kansas School of Medicine applying for first-year residency positions via the National Resident Matching Program Match completed an electronic 46-item survey after submitting their rank lists during each application cycle from 2015-2016 to 2020-2021. The authors used descriptive statistics and t tests to analyze and compare responses to demographics questions and questions regarding number of submitted applications, offered and completed interviews, ranked programs, costs, and time spent interviewing. They used thematic analysis to code respondents' narrative comments about the virtual interviewing experience. RESULTS: From 2015-2016 to 2020-2021, 994 (of 1,190; 83.5%) respondents completed the survey. From 2019-2020 to 2020-2021, the average total cost of applying to residency per applicant dropped by $3,566 (P < .001) and the average time spent interviewing dropped by 13.3 days (P < .001). At the same time, the average number of applications per applicant dropped by 3.4, and applicants completed the same number of interviews and ranked 2.3 fewer programs, none of which were statistically significant differences. Narrative comments from 113 (79%) respondents in 2020-2021 revealed 4 themes related to virtual interviewing: convenience of time and cost, positive aspects of the process, negative aspects of the process, and overall impressions of the program. CONCLUSIONS: Virtual interviewing during the 2020-2021 application cycle resulted in an approximately 80% reduction in cost for applicants and an approximately 50% decrease in time spent interviewing compared with previous years but was not associated with large increases in number of submitted applications, completed interviews, or ranked programs. Applicants generally perceived virtual interviewing as positive although they raised notable concerns.

The COVID-19 Vaccines: A Description of Adverse Events of Reactions Reported in Kansas.

Introduction: Coronavirus disease 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and has spread rapidly throughout the world since its discovery in 2019. Three vaccines (Pfizer-BioNTech, Moderna/NIAID/BARDA, and Johnson & Johnson's Janssen) have been developed for use in the U.S. to aid in the fight against this virus, but have been scrutinized intensely for their efficacy and safety. It is important to understand and interpret the adverse events or reactions (AERs) associated with these vaccines in an objective and analytical manner. The goal of this descriptive study was to provide a resource outlining AERs associated with the three available vaccines in Kansas. Methods: Reports were obtained from the Vaccine Adverse Event Reporting System (VAERS), representing AERs observed in Kansas from December 11, 2020 to May 13, 2021. All data were screened and coded, and descriptive statistics were used to describe AERs based on vaccine manufacturer, patient age and biological sex, and reported deaths. Results: Only 0.00068% of COVID-19 vaccine doses given in Kansas were associated with an AER (1,445/2,120,350). There were 4,297 individual AERs reported, and the most common were fatigue/tiredness (266; 6.2%), tingling/itching (251; 5.9%), fever (226; 5.3%), hives (223; 5.2%), and muscle/joint pain (209; 4.9%). Only 0.002% of COVID-19 vaccine doses in Kansas were associated with a death (38/2,120,350). The majority of VAERS reports were by females (1,139; 78.8%) and those aged 30 to 39 years (297; 20.6%). Conclusions: No reported AERs were unexpected compared to national data, and no VAERs report provided a causal relationship between vaccine administration and death. Vaccines are, and will continue to be, essential tools to fight COVID-19 in the quest to reach herd immunity. Providing a resource of potential AERs could aid in individual decisions to receive a vaccine and may help in the control of COVID-19. Future studies may include describing reported AERs for children under age 12 as the vaccines become available for those age groups, as well as reporting AERs for those who have received the vaccine after our study time period.

Unintended Consequences? Assessing the Impact of Curricular Change on Medical Student Participation in a Student-Run Free Clinic.

INTRODUCTION: In a prior qualitative study of the impact of a new (ACE) medical school curriculum, students and faculty reported decreased participation in the student-run free clinic (SRFC) attributed to more intensive scheduling and more frequent testing compared to the previous (Legacy) curriculum. MATERIALS AND METHODS: To verify and understand this perception formed during curriculum reform, we conducted a mixed method study to measure student participation in the SRFC before and after curricular change and assessed student beliefs and motivations about SRFC participation using focus groups. RESULTS: Overall SRFC participation did not decrease among students in the ACE cohort following curriculum change. Additionally, both Legacy and ACE groups showed lower participation during test weeks, but the decrease was not significantly different between the ACE and Legacy cohorts. Focus groups confirmed the pervasive misbelief that SRFC participation was indeed lower among ACE students and attributed to reduced student discretionary time plus increased preparation time for frequent testing. Focus groups also revealed several "values" about volunteering at the SRFC which should be endorsed and promoted by schools considering curricular change. Participants valued the SRFC for educational items that were most effectively taught in the SRFC, notably social determinants of health, interprofessional practice, and interviewing with medical interpreters. They also valued the SRFC for professional validation, opportunities to apply course content, practice clinical skills, form important professional relationships, and provide community service. CONCLUSIONS: Our findings validate the value of SRFC experience as reported by students and demonstrate that, contrary to misbeliefs, participation was not negatively impacted by curricular reform.

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.

Origin Storytelling in Faculty Well-being: A Pilot Study.

BACKGROUND AND OBJECTIVES: In 2020, approximately 47% of family physicians reported burnout. For physicians, professional burnout is implicated in damage to relationships, increased rates of alcohol and/or substance abuse, depression, and suicide. Professional isolation can be a major contributor to burnout. Organizational interventions targeted at promoting workplace community and collegiality have been effective in decreasing professional isolation. This study sought to decrease professional isolation and promote collegiality among family medicine faculty through an origin storytelling group. METHODS: Family medicine faculty of a residency program in the Midwestern United States were invited to participate in an 8-week origin storytelling group. At the end of the study, individual interviews were offered for participants to reflect on the perceived impact of the process. Additionally, 1 year poststudy, open-ended email responses were invited to assess lasting effects of collegiality. RESULTS: Fifty percent (12/24) of eligible faculty members participated in the study. Participants who completed one-on-one structured interviews shared their perspectives of the study, which allowed for the importance of the study and next directions to be identified. One-year postcompletion of the study, participants described continued changes they experienced from these groups, via open-ended, email response. CONCLUSION: Storytelling groups can provide acceptable, valuable, and easily-implemented contributions to initiatives that enhance physician faculty well-being.

Time and Financial Costs for Students Participating in the National Residency Matching Program (the Match©): 2015 to 2020.

INTRODUCTION: The purpose of this study was to provide information to assist students, faculty, and staff in making critical career-determining decisions regarding the residency NRMP "Match©" process. METHODS: A 47-item survey questionnaire was developed and piloted on a regional medical school campus in 2015. The revised questionnaire was distributed each year from 2016 to 2020 to fourth-year medical students after rank lists had been submitted. The questionnaire incorporated a request for comments about the interviewing experience and suggestions to improve the process. This narrative feedback was coded using a thematic analysis. RESULTS: The overall response rate was 86.1% (897/1,042). Annual response rates ranged from 70.0% in 2020 to 97.0% in 2018. Respondents' average age was 27.3 (± 2.7) years and 50.0% (448/897) were male. Most applied to family medicine (164/897; 18.2%) and internal medicine (140/897; 15.6%). Eight specialties had fewer than ten applicants over the six-year period. The number of students applying to individual specialties fluctuated annually, but no specialty showed a consistent upward or downward trend over the study period. CONCLUSIONS: This study found huge differences in numbers of applications, expenses, and days interviewing. Students crave more guidance, a more efficient system, transparent communication with programs, and less pressure during the process. Reducing escalating volumes of applications is central to improving the system. Despite efforts to inform applicants better, student behavior is unlikely to change until they feel safe in the belief that lower and more realistic numbers of applications and interviews are likely to result in securing an appropriate residency position.

Characteristics Sought When Hiring Faculty in Family Medicine Residency Programs.

BACKGROUND AND OBJECTIVES: Faculty shortages are a significant concern in family medicine education. Many family medicine residency programs need to recruit faculty in the coming years. As a result, family medicine faculty and resident physicians will be interviewing candidates to fill these vacancies. Little is known about the characteristics valued in a family medicine residency faculty candidate. METHODS: Using a cross-sectional survey of family medicine faculty and resident physicians in family medicine residency programs in Kansas, we attempted to define which characteristics are most valued by current faculty members and resident physicians in family medicine residency programs during the faculty hiring process. RESULTS: Of 187 invited respondents, 93 completed the survey (49.7% response rate). Twenty-five characteristics, grouped into five domains of relationship building, clinical, teaching, research and administrative skills, were rated as either not important, important, or very important. Building and maintaining healthy relationships was the most important characteristic for faculty, residents, males, and females. Administrative characteristics were the lowest ranked domain in our survey. DISCUSSION: These results provide an important snapshot of the characteristics valued in faculty candidates for family medicine residency programs. Understanding the paradigm used by existing faculty and resident physicians in family medicine residency programs when considering new faculty hires has an important impact on faculty recruitment and faculty development programs.

Kansas Family Physicians Perceptions of Parental Vaccination Hesitancy.

INTRODUCTION: In the past few decades, patients expressing the idea that vaccines are unsafe or unneeded have been experienced increasingly by physicians and other healthcare providers. Discussions with patients regarding their reasons for vaccine refusals are important, as it may provide information that can be utilized in an intervention to increase vaccination rates and combat the spread of diseases that are making a resurgence in the United States. The main objective of this study was to explore the perceptions of family physicians as to why parents in Kansas may be vaccine hesitant. METHODS: An electronic survey was distributed to family physicians in the State of Kansas via the University of Kansas School of Medicine-Wichita Family Medicine Research and Data Information Office (FM RADIO). Several aspects of physician perceptions regarding patients' vaccine hesitancy were measured in this study, including vaccines that are most often refused, reasons for refusing vaccinations, as well as what responses physicians employ when presented with vaccine concerns. RESULTS: The majority of physicians surveyed have experienced vaccine hesitancy or refusal in their practice, and the human papillomavirus (HPV) and flu vaccines were reported to be the primary vaccines refused for children. In addition, physicians reported frequently employing various practices in response to vaccine refusals, including requiring parents to sign a form (40%) and dismissing families from their practice (1.5%). Physician perceptions on the reasons as to why parents/guardians refuse vaccinations also were measured, and the most common response was that parents possess a fear of long-term complications for their children as a result of vaccines (74%). Additionally, the three most commonly refused vaccines were HPV, influenza, and measles, mumps, and rubella. CONCLUSION: Physicians must not only deal with time constraints that vaccine hesitant discussions require, but also must try and implement discussions or interventions suited to the varying reasons why parents/guardians refuse vaccines to convince parents of their safety. The results suggested that vaccine refusals by parents/guardians seemed to be affecting Kansas family physicians' clinics in more than one way. This study could be a useful tool to help physicians better understand why vaccine refusals occur and be able to combat unwarranted concerns about vaccines.

Impact of a Mindfulness-Based, Workplace Group Yoga Intervention on Burnout, Self-Care, and Compassion in Health Care Professionals: A Pilot Study.

OBJECTIVE: To investigate whether a workplace, group mindfulness-based yoga intervention could help manage burnout and improve wellbeing among health care professionals. METHODS: A total of 43 health care professionals participated in 8-week supervised workplace, group mindfulness-based yoga activities. The authors used a single-sample, pre-post design. At two points in time (baseline and postintervention), participants completed a set of online measures assessing burnout, depression, anxiety, stress, resilience, and compassion. The authors used linear mixed model analysis to assess changes in outcome measures. RESULTS: Participants had improvements after the 8-week intervention. At postintervention, they had significantly better scores on personal accomplishment, depression, anxiety, stress, perceived resilience, and compassion. Participants had a positive perception of the yoga intervention. CONCLUSION: Group mindfulness-based yoga program may be convenient and low-cost approach to support health and wellbeing among health care professionals.

Issues Faced by Senior Women Physicians: A National Survey.

Background: As the first large numbers of female physicians complete their careers, information is needed to enable institutions and individuals to optimize the final career phase and transition to retirement of these women, as well as to help younger women physicians prepare for later phases of their careers. Materials and Methods: To identify the leading issues for older female physicians, a 34-item electronic questionnaire covering heath, finances, preparation for and attitudes about retirement, caretaking responsibilities, life-work integration, various aspects of discrimination and harassment, professional isolation, and work-related stress and burnout-incorporating standardized measures of career satisfaction was distributed through the Kansas Medical Society and nationally through the American Medical Association Senior Physicians Section newsletter to female physicians older than 60 years in 2018. A total of 155 physicians self-identified as eligible and completed at least half of the survey. Results: Respondents were 60-87 years of age, mean 70.4 (±6.4) years. The majority reported good health and being financially well prepared for retirement. Twenty percent were caretakers for grandchildren, parents, or spouses. Measures of career and job satisfaction were reasonably high, despite negative work environment and burnout scores. Problems with family/career balance, age- and gender-based discrimination and harassment, salary inequity, and professional isolation persisted throughout their careers, but diminished in frequency for senior women. Conclusions: Issues faced by younger women physicians do not disappear with age or seniority. To recruit and support female physicians, issues such as balancing family/work responsibilities, combating harassment and bias, and promoting healthy work environments must be addressed throughout their entire careers.

The Only Woman in the Room: Oral Histories of Senior Women Physicians in a Midwestern City.

Introduction: The female students of the 1960s and 1970s have been at the forefront of issues for women in medicine throughout their careers. They have personally experienced the diverse challenges and opportunities that have continued to arise, for women in medicine over the past 50 years. Capturing their stories can provide a unique contribution to the history of women in medicine, especially in documenting the crucial transitional decades during which women entered the profession in increasing numbers. Their experiences can also inform programs to improve the careers of current and future women in medicine. Materials and Methods: We partnered with the Medical Society of Sedgwick County to invite all women who had been members before 1990 and still lived in the area to participate in focus groups about their experiences in medical school and residency. Interviews were recorded, and the recorded discussions and field notes were analyzed by using a thematic analysis approach Results: Discussions revolved around several topics, including motivations to become a physician, family attitudes, experiences during medical school and residency, and experiences with co-workers and patients. Illustrative quotes were selected for the themes identified. Discussion: This project illuminates the motivations, attitudes, and experiences of a diverse group of women who entered medical school in the 1960s and 1970s. Although they came from very different backgrounds and trained in a variety of institutions and specialties, their stories revealed consistent themes, many of which remain relevant for female physicians. Conclusion: This unique cohort of women were part of the major transition from times when women were rare in medicine to being at least half of physician trainees. Their experiences should be used to inform the profession moving forward.

How Much Do Family Medicine Residency Programs Spend on Resident Recruitment? A CERA Study.

BACKGROUND AND OBJECTIVES: Resident recruitment is one of the most important responsibilities of residency programs. Resource demands are among the principal reasons for calls for recruitment reform. The purpose of this study was to provide a national snapshot of estimated costs of recruitment among US family medicine programs. The aim was to provide data to assist programs in securing and allocating resources to manage the increasingly challenging recruitment process. METHODS: Questions were part of a larger omnibus survey conducted by the Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA). Specific questions were asked regarding how many interviews each program offered and completed; interview budget; additional funds spent on recruitment; reimbursements; and resident, faculty, and staff hours used per interviewee. RESULTS: The response rate was 53% (277/522). Program directors estimated that residents devoted 6.4 hours (95% CI 6, 7) to each interview, faculty 5.6 hours (95% CI 5, 6), and staff 4.4 hours (95% CI 4, 5). The average budget for interviewing per program was $17,079 (±$19,474) with an additional $8,274 (±$9,615) spent on recruitment activities. The average amount spent per applicant was $213 (±$360), with $111 (±$237) in additional funds used for recruitment. Programs were more likely to pay for interviewee meals (82%) and lodging (59%) than travel (3%). CONCLUSIONS: As individual programs face increasing pressure to demonstrate value for investment in recruiting, data generated by this national survey enables useful comparison to individual programs and sponsoring organizations. Results may also contribute to national discussions about best practices in resident recruitment and ways to improve efficiency of the process.