Longitudinal Interleaved Residency Training: A Consensus Definition.

BACKGROUND AND OBJECTIVES: Cognitive benefits of longitudinal curricula and interleaving have been demonstrated in several disciplines. However, most residency curricula are structured in a block format. There is no consensus definition as to what constitutes a longitudinal program, making comparative research on curricular efficacy a challenge. The objective of our study was to arrive at a consensus definition of Longitudinal Interleaved Residency Training (LIRT) in family medicine. METHODS: A national workgroup was convened and utilized a Delphi method between October 2021 and March 2022 to arrive at a consensus definition. RESULTS: Twenty-four invitations were sent, and 18 participants initially accepted. The final workgroup (n=13) was representative of the nationwide diversity of family medicine residency programs in terms of geographic location (P=.977) and population density (P=.123). The following definition was approved: "LIRT is a curricular design and program structure that offers graduated, concurrent clinical experiences in the core competencies of the specialty. LIRT models the comprehensive scope of practice and continuity that defines the specialty; applies training methods that enhance long-term retention of knowledge, skills, and attitudes across all dimensions and locations of care delivery; and accomplishes program objectives through employment of longitudinal curricular scheduling and interleaving with spaced repetition." Additional technical criteria and definitions of terms are elucidated in the body of this article. CONCLUSIONS: A representative national workgroup crafted a consensus definition of Longitudinal Interleaved Residency Training (LIRT) in family medicine, a program structure with a basis in emerging evidence-based cognitive science.

Harm reduction and recovery services support (HRRSS) to mitigate the opioid overdose epidemic in a rural community.

BACKGROUND: Rural areas in the United States (US) are ravaged by the opioid overdose epidemic. Oconee County, an entirely rural county in northwest South Carolina, is likewise severely affected. Lack of harm reduction and recovery resources (e.g., social capital) that could mitigate the worst outcomes may be exacerbating the problem. We aimed to identify demographic and other factors associated with support for harm reduction and recovery services in the community. METHODS: The Oconee County Opioid Response Taskforce conducted a 46-item survey targeting a general population between May and June in 2022, which was mainly distributed through social media networks. The survey included demographic factors and assessed attitudes and beliefs toward individuals with opioid use disorder (OUD) and medications for OUD, and support for harm reduction and recovery services, such as syringe services programs and safe consumption sites. We developed a Harm Reduction and Recovery Support Score (HRRSS), a composite score of nine items ranging from 0 to 9 to measure level of support for placement of naloxone in public places and harm reduction and recovery service sites. Primary statistical analysis using general linear regression models tested significance of differences in HRRSS between groups defined by item responses adjusting for demographic factors. RESULTS: There were 338 survey responses: 67.5% were females, 52.1% were 55 years old or older, 87.3% were Whites, 83.1% were non-Hispanic, 53.0% were employed, and 53.8% had household income greater than US$50,000. The overall HRRSS was relatively low at a mean of 4.1 (SD = 2.3). Younger and employed respondents had significantly greater HRRSS. Among nine significant factors associated with HRRSS after adjusting for demographic factors, agreement that OUD is a disease had the greatest adjusted mean difference in HRSSS (adjusted diff = 1.22, 95% CI=(0.64, 1.80), p < 0.001), followed by effectiveness of medications for OUD (adjusted diff = 1.11, 95%CI=(0.50, 1.71), p < 0.001). CONCLUSIONS: Low HRRSS indicates low levels of acceptance of harm reduction potentially impacting both intangible and tangible social capital as it relates to mitigation of the opioid overdose epidemic. Increasing community awareness of the disease model of OUD and the effectiveness of medications for OUD, especially among older and unemployed populations, could be a step toward improving community uptake of the harm reduction and recovery service resources critical to individual recovery efforts.

Distinguishing Asthma and COPD in Primary Care: A Case-based Approach.

Asthma and chronic obstructive pulmonary disease (COPD) affect more than 40 million Americans, cost more than $100 billion annually, and together constitute the fourth-leading cause of death in the United States. Distinguishing between asthma and COPD can be difficult; accurate diagnosis requires spirometry that demonstrates a characteristic pattern. Asthma is diagnosed if airway obstruction on spirometry is reversible (greater than 12% and greater than 200 mL improvement in forced expiratory volume in one second [FEV1]) with administration of bronchodilators or through the observation of bronchoconstriction (reduction in FEV1 of 20% or greater) with a methacholine challenge. COPD is diagnosed if airway obstruction (FEV1/forced vital capacity [FEV1/FVC] ratio less than 70%) on spirometry is not reversible with bronchodilators. Although not considered a separate diagnosis, asthma-COPD overlap can be a useful clinical descriptor for patients displaying diagnostic features of both diseases. In these cases, spirometry will show reversibility after administration of bronchodilators, which is consistent with asthma, and the persistent baseline airflow limitation that is more characteristic of COPD. Treatment should follow Global Initiative for Asthma guidelines and Global Initiative for Chronic Obstructive Lung Disease guidelines. In patients with asthma-COPD overlap, pharmacotherapy should primarily follow asthma guidelines, but pharmacologic and nonpharmacologic approaches specific to COPD may also be needed.

Community Attitudes Toward Opioid Use Disorder and Medication for Opioid Use Disorder in a Rural Appalachian County.

PURPOSE: To evaluate community attitudes concerning opioid use disorder (OUD) and medication for opioid use disorder (MOUD) in a rural community, and to plan educational initiatives to reduce stigma surrounding OUD and treatment. METHODS: Dissemination of a 24-question survey to people living in a rural community followed by comparative analysis of survey results between 2 groups classified by recognition of OUD as a real illness. FINDINGS: Three hundred sixty-one individuals responded. Overall, 69% agreed that OUD is a real illness. Respondents recognizing OUD as a real illness were less likely to agree that individuals with OUD are dangerous (P = .014), more likely to agree that MOUD is effective (P < .001), that individuals with OUD should have the same right to a job (P < .001), and that naloxone should be administered for every overdose every time (P = .002). CONCLUSIONS: Significant stigma exists toward individuals with OUD in rural communities, and recognizing OUD as a real illness is associated with less stigmatizing attitudes and better understanding of MOUD. Further study should focus on how to effectively convince communities that OUD is a real illness.