Family Medicine Resident and Faculty Perceptions About the Strengths and Limitations of Telemedicine Training.

Background and Objectives: Telemedicine has become a highly-utilized form of primary care, requiring medical schools and residency programs to develop standardized telemedicine training to meet learners' educational needs. This study highlights specific areas of clinical teaching and faculty development regarded as highly valuable in a family medicine (FM) residency program. Methods: We developed a needs assessment survey instrument based on Accreditation Council for Graduate Medical Education (ACGME) milestones and circulated it to faculty and residents at a suburban FM residency program in August 2020. We mapped each survey question to ACGME core competencies to identify common themes. We performed two-sample t tests to compare perceived self-confidence in faculty assessment and resident performance of key telemedicine clinical skills. Results: A total of 29 respondents (15 faculty, 14 residents) completed the survey. Both residents and faculty expressed comfort with obtaining a focused history, ruling out red flag symptoms, formulating a differential diagnosis, and planning follow-up care. Faculty reported confidence in their ability to provide feedback about medical knowledge and clinical decision making, but also identified a need for better feedback tools. Both faculty and residents identified a need for better teaching of physical exam skills during video visits. There were no statistically significant differences for perceived self-confidence in evaluating and performing key telemedicine skills between faculty and residents, respectively. Conclusion: Development of effective telemedicine educational experiences should emphasize teaching virtual communication and physical exam skills, and developing new approaches to learner evaluation.

Cannabis Essentials: Tools for Clinical Practice.

Cannabis use in the United States is increasing annually in people of all ages. This increase is fueled by state-level legalization, decreased risk perception, and increased social acceptability. Cannabis and its active components, cannabinoids, have been studied for medical uses and marketed in many commercial forms. Cannabis can impair short-term memory, judgment, and coordination, and there is substantial evidence that it can adversely affect multiple organ systems. Cannabinoids have potential adverse drug interactions with commonly prescribed analgesic, psychotropic, and cardiovascular medications. Current evidence supports cannabinoid use only for a limited number of conditions (chemotherapy-induced nausea and vomiting, specific pain and spasticity syndromes, and certain forms of childhood epilepsy); thus, physicians recommending cannabinoids need to weigh the potential harms vs. perceived benefits. The U.S. Preventive Services Task Force recommends universal screening for unhealthy drug use, including cannabis, in adults 18 years and older. However, the American Academy of Family Physicians does not support this recommendation because of the lack of evidence of benefit in screening patients for unhealthy drug use, except for opioid use disorder. Treatment of cannabis use disorder is largely behavioral and requires a patient-centered, multifaceted approach with a focus on patient education. Pharmacotherapy for cannabis use disorder is limited and experimental. Harm reduction strategies and education about cannabis withdrawal syndrome should be provided to patients. Interpretation of urine drug testing for cannabis is challenging because of the persistence of metabolites for four to five days after a single use and for one month after chronic daily use.

Why community physicians teach students (or not): barriers and opportunities for preceptor recruitment.

The recent trend towards ambulatory teaching can pose challenges in terms of recruitment of ambulatory teachers. In order to improve recruitment efforts, we examined the reasons that community preceptors who teach and those who do not teach give for teaching or not teaching students in their offices. Physicians who teach students in their offices report they do so for the enjoyment and for the opportunity to provide teaching to these students. Physicians who do not teach in their offices report constraints of their practice situation, having other non-teaching challenges and being unaware of the teaching possibilities as barriers to teaching. Community preceptors were more likely to be alumni (medical school or postgraduate training) than those who were not preceptors. This study provides insight into the motivators and barriers for ambulatory teachers and has implications for recruiting and rewarding community preceptors.

Novel mutations in the P-protein (glycine decarboxylase) gene in patients with glycine encephalopathy (non-ketotic hyperglycinemia).

Eight novel mutations were found in the P-protein (glycine decarboxylase) gene (GLDC) of the glycine cleavage system (EC 2.1.1.10) by screening five exons of the gene in patients with glycine encephalopathy (NKH). The mutations identified were of eight single base changes: a one-base deletion 1054del A, a splice site mutation IVS18-2A-->G and six amino acid substitutions A283P, A313P, P329T, R410K, P700A, and G762R.