Negotiating a new chair package: context and considerations.

Negotiating a resource package as a potential new department chair is common practice in academic medicine. The foundations for this negotiation include the historical presence of the department in relation to the broader institution, projections for future growth, accounting for mission/vision, resource needs (space, personnel, finances, etc), faculty and staff development, and external partnerships within and outside the institution. Despite similarities in this process across departments, many nuances influence the development of a specific new chair package, such as, department size; desires, perspectives and talents of the incoming chair, the department faculty, the medical school and dean; prevailing agendas and mission imperatives; and the overall priorities of the institution. With strategy and forethought, a new chair package can promote a successful chair tenure and departmental growth. Assembled through the Association of Departments of Family Medicine with input from several dozen department chairs and senior leaders, this is intended to serve as a practical guide to new chair packages for chair candidates.

Patient Perceptions of Video Visits in a Fee-for-Service Model.

INTRODUCTION: We studied perceptions of patients who receive telemedicine services in the fee-for-service setting of an academic medical center's family medicine department. To the best of our knowledge, this study is the first to investigate patient sentiments on both experiential and financial aspects of telemedicine primary care with copayment collection. METHODS: A 53-question cross-sectional digital survey was delivered to patients' e-mail addresses after their telemedicine visit. We tabulated summary statistics and performed 2-sample t-tests to compare survey responses across groups. RESULTS: Of 3,414 potential respondents, 903 responded, corresponding to a 26.7% effective response rate; 797 completed surveys were analyzed. Of these, 91% described their video visit experience as more convenient than office-based care, 74% reported shorter wait times, 87% felt confident about protection of privacy, 29% perceived copayments to be unreasonable, and 91% are willing to use telemedicine again. DISCUSSION: Our findings suggest that telemedicine is a viable alternative to in-person visits and that most patients find a copayment reasonable. The findings suggest that telemedicine offers convenience and consistency with continuity and corroborate previous studies investigating telemedicine viewpoints. Payors should consider copayment in detail when designing telehealth benefits to ensure they do not become a barrier in seeking care.

Describing the Breadth and Scope of Keck Medical Student Primary Care Research Projects.

Introduction: Primary care research is an important field of study within medicine, but little research has characterized medical students' projects on this topic. Second-year medical students at the Keck School of Medicine (KSOM) of University of Southern California are required to complete a research project on a topic of their choice. This study seeks to describe the scope of primary care medical student research conducted by KSOM medical students and specifically Primary Care Program (PCP) pipeline students. The PCP consists of students with a vested interest in primary care, and who we hypothesize are more likely to complete a primary care project. Methods: To assess students' primary care (PC) research output, we reviewed and sorted 1,408 KSOM abstracts between 2014 and 2020 into PC or non-PC. PC projects were then recategorized into more specific PC topics. χ2 analysis determined significance at P<.05. Results: We reviewed abstracts from 1,408 KSOM medical students (n=122 PCP; 1,286 non-PCP). Results revealed that the number of PC research projects conducted by 122 PCP students (67.2%, n=82) was statistically significantly higher than by 1,286 non-PCP students (14.7%, n=189, P<.00001). The most common PC research topics (n= 271) were education (patient/medical, n=71, 26%), health diversity/disparities (n=60, 22%), mental health/psychiatry/behavioral science (n=58, 21%), and community medicine (n=48, 18%). Conclusions: Our study describes the breadth and scope of Keck medical student PC research. Supporting PC research efforts by medical students may increase the proportion of students conducting PC research, students choosing PC careers, and faculty producing PC scholarship.

Student Voices on Leadership Training Needs to Care for Underserved Populations.

INTRODUCTION: Experts suggest that leadership education should begin during medical school. However, little information exists on preferences of medical students on leadership development and particularly of those who want to work with underserved communities. This student-led study surveyed medical students on leadership development skills and perceptions on curricular needs. METHODS: We conducted a cross-sectional study using a 26-question survey with Likert scales, multiple choice, and open-ended questions. We anonymously surveyed 83 students (medical school years 1 through 4) at the Keck School of Medicine of University of Southern California and conducted a one-time focus group with six students to assess leadership aspirations and training needs. We compared student responses based their desire to serve in underserved communities in their careers. RESULTS: Medical student desire to practice in underserved communities was greatest among respondents in their first 2 years (62% and 67%), compared to 36% and 53% for respondents in third and fourth year, respectively. Students interested in underserved communities were statistically more likely (t test 2.07, P=.04) to indicate "My well-being may need to be sacrificed in order to serve as a leader," based on the survey. The survey showed similar top-five leader characteristics (competent, dependable, honest, inspiring, supportive) were valued among all respondents. Optional leadership modules were selected to enhance medical education by the most respondents and could potentially meet their curricular needs. CONCLUSION: Our findings show that medical students welcome leadership training opportunities and prefer optional longitudinal modules. Students who plan to practice in underserved communities have similar preferences on training but may need additional support related to maintaining their well-being.

From the hospital to the streets: Bringing care to the unsheltered homeless in Los Angeles.

Homelessness is a neglected crisis throughout the United States. In Los Angeles (L.A.) County, nearly 59,000 residents are homeless, and the vast majority are unsheltered. An academic institution and L.A county's largest public hospital formed a partnership to launch a Street Medicine (SM) program. SM assists the inpatient team with discharge planning and builds rapport with the patient experiencing homelessness. After discharge, the SM team follows up and brings care to the patient on the streets, often developing a trusting relationship and establishing continuity of primary care. During a 12-month period, SM provided inpatient consults for 206 unsheltered homeless patients.

Losing the wait: improving patient cycle time in primary care.

Inefficient clinic systems leading to prolonged wait times at primary care clinics are a source of frustration for patients, physicians, staff and administration. Measuring and shortening cycle time has the potential to improve patient experience, staff satisfaction and patient access by moving more patients through in a shorter cycle time. Limited studies have demonstrated that improvements can be made to cycle time and may result in improved patient satisfaction. Most of these studies have focused their efforts on improving efficiency at the front end of the cycle. Our aim was to improve cycle time for the whole visit to less than 60 min within 1 year by engaging our team in brainstorming solutions, presenting regular measurements to our team for review and holding regular meetings to plan rapid improvement cycles. Over the course of 1 year (2017), we were able to reduce cycle time by 12% from 71 to 65 min and to improve patient satisfaction with care. Despite the reduction in cycle time, we maintained high satisfaction scores from patients who felt that the doctor spent enough time with them. We learnt the value of engaging our team, frequent measurement for reporting, adequate staffing at the beginning of clinic, and the value of MA staff acting in a flow coordinator role. We have not only maintained this improvement but also made further small gains over the subsequent 2 years, and by April 2019, our cycle time is at 60 min, despite a marked increase in patient volume. Additional work on the time after the patient is roomed and waiting for a doctor, and further analysis of the physician workflow would be important next steps to drive further improvement.

The Abuse Intervention Model: A Pragmatic Approach to Intervention for Elder Mistreatment.

Ten percent of older adults experience elder mistreatment, and it is much more common in older adults with dementia. It is associated with higher rates of psychological distress, hospitalization, and death and, in the United States, costs billions of dollars each year. Although elder mistreatment is relatively common and costly, it is estimated that fewer than 10% of instances of elder mistreatment are reported. Given these data, there is a great need for research on interventions to mitigate elder mistreatment and for a practical model or framework to use in approaching such interventions. Although many theories have been proposed, adapted, and applied to understand elder mistreatment, there has not been a simple, coherent framework of known risk factors of the victim, perpetrator, and environment that applies to all types of abuse. This article presents a new model to examine the multidimensional and complex relationships between risk factors. Theories of elder mistreatment, research on risk factors for elder mistreatment, and 10 years of experience of faculty and staff at an Elder Abuse Forensics Center who have investigated more than 1,000 cases of elder mistreatment inform this model. It is hoped that this model, the Abuse Intervention Model, will be used to study and intervene in elder mistreatment.