Characterizing posttraumatic stress disorder in primary care using electronic medical records: a retrospective cohort study.

Context: Posttraumatic stress disorder (PTSD) is a chronic mental health disorder associated with significant morbidity and economic cost. Primary care providers are frequently involved in the ongoing management of patients experiencing PTSD, as well as related comorbid conditions. Despite recognized need to enhance PTSD management in primary care settings, knowledge regarding its prevalence in these settings is limited. Objective: To apply a validated case definition of PTSD to electronic medical records (EMRs) of family physicians and nurse practitioners participating in the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). Study Design: Retrospective cross-sectional study. Dataset: This study accessed de-identified EMR from 1,574 primary care providers participating in the CPCSSN. Population Studied: The study population included all patients with at least one visit to a primary care provider participating in the CPCSSN between January 1, 2017 and December 31, 2019 (N = 689,301). Outcome Measures: We identified patients with PTSD and described associations between PTSD and patient characteristics (including sex, age, geography, depression, anxiety, medical comorbidities, substance use and social and material deprivation) using multivariable logistic regression models. Results: Among the 689,301 patients meeting inclusion criteria, 8,213 (1.2%) had a diagnosis of PTSD. Patients with PTSD were significantly more likely to reside in an urban location (84.9% vs. 80.4%; p-value <.0001) and have one or more comorbid conditions (90.8% vs. 70.2%; p-value <.0001). On multivariable logistic regression analysis, patients with depression (OR 4.8; 95%CI 4.6-5.1) and anxiety (OR 2.2; 95%CI 2.1-2.3) had increased odds of having PTSD compared to patients without depression or anxiety. Patients with alcohol (OR 1.8; 95%CI 1.6-1.9) and drug (OR 3.1; 95%CI 2.9-3.3) use disorders had significantly higher odds of PTSD compared to patients without these disorders. Patients in the most deprived neighborhoods based on census data had 4.2 times higher odds of have PTSD (95%CI 3.2-5.43) compared to patients in the least deprived areas. Conclusions: This is the first study to describe PTSD prevalence in a large Canadian sample of primary care patients using an EMR-based case definition. Characterizing patients with PTSD in primary care may improve disease surveillance and inform the interdisciplinary care required to manage PTSD symptoms.

Perspectives of undergraduate and graduate medical trainees on documenting clinical notes: Implications for medical education and informatics.

Ensuring the accuracy of unstructured clinical notes is critical for patient care, research, and quality improvement. Understanding how trainees learn to document these notes and the challenges they encounter are important steps to developing educational and informatics solutions.Authors conducted focus groups to gather the perspectives of 40 medical students (MS) and family and emergency medicine (EM) residents on recording clinical notes in the electronic medical record (EMR). Focus groups were audio recorded, transcribed, and thematically analyzed.Thematic analysis with a deductive approach revealed: a lack of formal education, a shift from information gathering to documenting clinical reasoning with seniority, and barriers to charting development, including variable preceptor expectations and EMR design constraints.Participating trainees report gaps in education around the documentation of notes in the EMR. Future work should explore opportunities to reduce gaps, including more formal education, the creation of specific competencies, and improvements to the EMR.

Stress and Fear: Clinical Implications for Providers and Patients (in the Time of COVID-19 and Beyond).

In light of the coronavirus disease 2019 pandemic, we explore the role of stress, fear, and the impact of positive and negative emotions on health and disease. We then introduce strategies to help mitigate stress within the health care team, and provide a rationale for their efficacy. Additionally, we identify strategies to optimize patient care and explain their heightened importance in today's environment.

Training medical students and residents in the use of electronic health records: a systematic review of the literature.

OBJECTIVE: Our objectives were to identify educational interventions designed to equip medical students or residents with knowledge or skills related to various uses of electronic health records (EHRs), summarize and synthesize the results of formal evaluations of these initiatives, and compare the aims of these initiatives with the prescribed EHR-specific competencies for undergraduate and postgraduate medical education. MATERIALS AND METHODS: We conducted a systematic review of the literature following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analyses) guidelines. We searched for English-language, peer-reviewed studies across 6 databases using a combination of Medical Subject Headings and keywords. We summarized the quantitative and qualitative results of included studies and rated studies according to the Best Evidence in Medical Education system. RESULTS: Our search yielded 619 citations, of which 11 studies were included. Seven studies involved medical students, 3 studies involved residents, and 1 study involved both groups. All interventions used a practical component involving entering information into a simulated or prototypical EHR. None of the interventions involved extracting, aggregating, or visualizing clinical data for panels of patients or specific populations. DISCUSSION: This review reveals few high-quality initiatives focused on training learners to engage with EHRs for both individual patient care and population health improvement. In comparing these interventions with the broad set of electronic records competencies expected of matriculating physicians, critical gaps in undergraduate and postgraduate medical education remain. CONCLUSIONS: With the increasing adoption of EHRs and rise of competency-based medical education, educators should address the gaps in the training of future physicians to better prepare them to provide high quality care for their patients and communities.

Establishing learning objectives for a leadership skills development curriculum in family medicine.

If leadership skills can be developed during post-medical school training, physicians will be better prepared to influence positive change for their patients and communities. Based on both LEADS and CanMEDS Leader competencies, a mixed methods approach was used to identify the most valued leadership constructs and which of these should be prioritized for development in an enhanced family medicine curriculum. The interpersonal skills were identified most often and included: self-awareness/leads self, effective communications, leading change and building teams. While some opportunities to achieve competence in leadership skills already exist in family medicine residency programs, increased attention to providing development opportunities as well as assessment methods and faculty development is necessary in order to support new doctors as leaders. This study identifies over-arching goals to guide curriculum change in order to achieve this.

Satisfaction with civilian family medicine residency training: Perspectives from serving general duty medical officers in the Canadian Armed Forces.

OBJECTIVE: To evaluate satisfaction with civilian residency training programs among serving general duty medical officers within the Canadian Armed Forces. DESIGN: A 23-item, cross-sectional survey face-validated by the office of the Surgeon General of the Canadian Armed Forces. SETTING: Canada. PARTICIPANTS: General duty medical officers serving in the Canadian Armed Forces as of February 2014 identified through the Directorate of Health Services Personnel of the Canadian Forces Health Services Group Headquarters. MAIN OUTCOME MEASURES: Satisfaction with and time spent in 7 domains of training: trauma, critical care, emergency medicine, psychiatry, occupational health, sports medicine, and base clinic training. Overall preparedness for leading a health care team, caring for a military population, working in isolated and challenging environments, and being deployed were evaluated on a 5-point Likert scale. RESULTS: Among the survey respondents (n = 135, response rate 54%), 77% agreed or strongly agreed that their family medicine residency training was relevant to their role as a general duty medical officer. Most respondents were either satisfied or very satisfied with their emergency medicine training (77%) and psychiatry training (63%), while fewer were satisfied or very satisfied with their sports medicine (47%), base clinic (41%), and critical care (43%) training. Even fewer respondents were satisfied or very satisfied with their trauma (26%) and occupational health (12%) training. Regarding overall preparedness, 57% believed that they were adequately prepared to care for a military patient population, and 52% of respondents believed they were prepared for their first posting. Fewer respondents (38%) believed they were prepared to work in isolated, austere, or challenging environments, and even fewer (32%) believed that residency training prepared them to lead a health care team. CONCLUSION: General duty medical officers were satisfied with many aspects of their family medicine residency training; however, military-specific areas for improvement were identified. Many of these areas might be addressed within the context of a 2-year residency program without risking the generalist nature of family medicine training. These findings provide valuable data for residency programs that accept military trainees across the country.