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.

Research interests of family physicians applying for research training.

BACKGROUND: There is an ongoing need for research to support the practice of high quality family medicine. The Family Medicine Discovers Rapid Cycle Scientific Discovery and Innovation (FMD RapSDI) program is designed to build capacity for family medicine scientific discovery and innovation in the United States. Our objective was to describe the applicants and research questions submitted to the RapSDI program in 2019 and 2020. METHODS: Descriptive analysis for applicant characteristics and rapid qualitative analysis using principles of grounded theory and content analysis to examine the research questions and associated themes. We examined differences by year of application submission and the applicant's career stage. RESULTS: Sixty-five family physicians submitted 70 applications to the RapSDI program; 45 in 2019 and 25 in 2020. 41% of applicants were in practice for five years or less (n = 27), 18% (n = 12) were in in practice 6-10 years, and 40% (n = 26) were ≥ 11 years in practice. With significant diversity in questions, the most common themes were studies of new innovations (n = 20, 28%), interventions to reduce cost (n = 20, 28%), improving screening or diagnosis (n = 19, 27%), ways to address mental or behavioral health (n = 18, 26%), and improving care for vulnerable populations (n = 18, 26%). CONCLUSION: Applicants proposed a range of research questions and described why family medicine is optimally suited to address the questions. Applicants had a desire to develop knowledge to help other family physicians, their patients, and their communities. Findings from this study can help inform other family medicine research capacity building initiatives.

Burnout, Depression, Anxiety, and Stress Among Resident Physicians 18 Months Into the COVID-19 Pandemic: A Cross-Sectional Study.

Introduction: Burnout among resident physicians has been an area of concern that predates the COVID-19 pandemic. With the significant turmoil during the pandemic, this study examined resident physicians' burnout, depression, anxiety, and stress as well as the benefits of engaging in activities related to wellness, mindfulness, or mental wellbeing. Methods: A cross-sectional survey of 298 residents from 13 residency programs sponsored by the University of Kansas School of Medicine-Wichita was conducted in October and November 2021. A 31-item questionnaire measured levels of burnout, depression, anxiety, and stress. A mixed method approach was used to collect, analyze, and interpret the data. Descriptive statistics, one-way ANOVA/Kruskal-Wallis tests, adjusted odds ratios (aOR), and immersion-crystallization methods were used to analyze the data. Results: There was a 52% response rate, with 65.8% (n = 102) of the respondents reporting manifestations of burnout. Those who reported at least one manifestation of burnout experienced a higher level of emotional exhaustion (aOR = 6.73; 95% CI, 2.66-16.99; p < 0.01), depression (aOR = 1.21; 95% CI, 1.04-1.41; p = 0.01), anxiety (aOR = 1.14; 95% CI, 1.00-1.30; p = 0.04), and stress (aOR = 1.36; 95% CI, 1.13-1.64; p < 0.01). Some wellness activities that respondents engaged in included regular physical activities, meditation and yoga, support from family and friends, religious activities, time away from work, and counseling sessions. Conclusions: The findings suggested that the COVID-19 pandemic poses a significant rate of burnout and other negative mental health effects on resident physicians. Appropriate wellness and mental health support initiatives are needed to help resident physicians thrive in the health care environment.

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.

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.

Urinary Incontinence.

Urinary incontinence is a common, often undertreated, condition that impacts millions of Americans. Primary care physicians are well equipped to diagnose and treat urinary incontinence. Key to successful treatment is accurately determining the type of incontinence that ails the patient and using patient-reported quality-of-life indicators to guide stepwise treatment.

Erectile Dysfunction.

Erectile dysfunction is a common condition. Many men do not self-report erectile dysfunction symptoms; thus, physicians must ask about sexual health and function to elicit concerns. Although the impact of untreated erectile dysfunction on quality of life should prompt physicians to ask about symptoms, so should the presence of cardiac and metabolic disease. Diagnosis of erectile dysfunction is made in the primary care office, and patients may be treated with oral, intraurethral, or intracavernosal medications; vacuum devices; or penile prosthesis. Treatment should be guided by patient preference with a goal of improving quality of life and mitigating chronic disease risk.

Assessing Work-Related Burnout and Job Satisfaction among Obstetrics and Gynecology Residency Program Coordinators.

INTRODUCTION: This study explored the prevalence of and the relationship between job satisfaction and burnout among obstetrics and gynecology residency program coordinators. METHODS: This cross-sectional study involved members of the American Program Managers of Obstetrics and Gynecology. The Copenhagen Burnout Inventory and Spector's Job Satisfaction Survey were used to measure the participants' burnout and job satisfaction rates respectively. Data were collected between August 2017 and December 2017. The authors used Fisher's exact tests, Spearman's r correlations, and multiple linear regression to analyze the data. RESULTS: There was an 83% (171/207) response rate. Thirteen percent of the coordinators reported high, 70% moderate, and 17% low job satisfaction scores. Thirty-nine percent of the coordinators reported high, 25% moderate, and 36% slight work-related burnout rates. Correlation coefficient showed a significantly negative relationship between job satisfaction and work-rated burnout, (r s [169] = -0.402, p < 0.01). Regression analysis showed co-workers (ß = -0.47) and supervision (ß = -0.16) domains of the job satisfaction scale were significant predictors of work-related burnout (R = 0.55; F[5, 195] = 11.05; p < .001). CONCLUSIONS: The findings highlight the importance of job satisfaction factors, such as support from coworkers and supervisors, in dealing with work-related burnout among residency coordinators.

Emerging Topics in Gastroenterology.

The bacteria and fungi in the human gut make up a community of microorganisms that lives in symbiosis with humans, engaging in numerous diverse interactions that influence health. This article outlines the current knowledge on emerging topics in gastroenterology, including microbiome and probiotics, fecal microbiota transplantation, cyclic vomiting syndrome, eosinophilic esophagitis, and microscopic colitis.

Rural Kansas Family Physician Satisfaction with Caring for Spanish-Speaking Only Patients.

BACKGROUND: Patient satisfaction with the care they receive can be influenced negatively by a language barrier between the physician and patient. However, there is a paucity of information regarding the consequences of a language barrier on physician satisfaction, although this barrier has the potential to decrease physician wellness. This study sought to determine if a language barrier is a source of professional dissatisfaction in family medicine physicians in rural Kansas. METHODS: In a cross-sectional study, members of the Kansas Academy of Family Physicians who practiced in the rural Kansas counties with the highest percentage of Hispanic residents were surveyed. A questionnaire was developed to determine the demographics of the physician, details regarding his or her practice, and percentage of Hispanic and Spanish-speaking only (SSO) patients in their practice. Physicians also were queried as to their level of Spanish-speaking ability, availability of certified interpreters, and their satisfaction with caring for their SSO patients. RESULTS: Fifty-two physicians were identified and sent questionnaires by mail. Eighteen questionnaires were completed and returned, resulting in a 34% response rate. Respondents remained anonymous. In the practices surveyed, 61% of practice settings had a Hispanic-patient population greater than 25%. Only one of the eighteen respondents had greater than 25% of SSO patients in his or her practice. A certified interpreter was used less than 25% of the time in over 75% of the clinical encounters with SSO patients. Seventy-five percent of physicians reported no difficulty establishing trust and rapport with their SSO patients. Eighty-nine percent of respondents rated their relationship with SSO patients as good to excellent, and 83% were satisfied with the care they were able to provide this group. Seventy-eight percent of respondents reported that their ability to care for SSO patients decreased or had no effect on their professional satisfaction. Seventy-eight percent of physicians also rated their overall professional satisfaction in regards to their physician/patient relationship as good to excellent. However, language barriers affected physician-patient relationships, physician satisfaction with care, and professional satisfaction. CONCLUSION: Language barrier affected physician's relationships with SSO patients, led to decreased physician satisfaction with the care they provided and to decreased professional satisfaction.