Identification and Accommodation of ADHD in Family Medicine Residencies: A CERA Study.

BACKGROUND: An increasing number of medical students applying to residency programs request accommodations for attention deficit hyperactivity disorder (ADHD). Early implementation of accommodations for individuals with ADHD during family medicine (FM) residency could help learners and programs, but the number of programs prepared to invite learners to disclose ADHD and to implement accommodations is unclear. OBJECTIVES: The purpose of this study was to describe practices employed by FM residency programs to identify residents who need accommodations for ADHD. We also chose to examine the frequency with which basic categories of ADHD accommodations are used and whether review of technical standards (ie, resident job description) is associated with timing of accommodations. METHODS: We analyzed responses from the 2022 Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of FM residency program directors, which was distributed via email invitation to all US programs accredited by the Accreditation Council for Graduate Medical Education. A total of 298 program directors (44.3%) responded. RESULTS: Approximately one in six FM residency programs are proactive in their identification of learners with ADHD, typically recognizing the need for accommodations during the interview process or orientation. Once the need is identified, most programs implement accommodations within 1 month, and many employ multiple types of accommodations. CONCLUSIONS: While a small subset of programs has developed processes to identify and accommodate ADHD proactively, results suggested that the majority of programs approach accommodation processes on an ad hoc basis. In turn, ad hoc identification precludes a proactive approach, given use of poor performance to identify the need for supports.

Screening for Conscientiousness at Start of Residency: Early Detection of Professionalism Concerns.

Introduction: Early identification of residents who may require remediation could help prevent problems for both individual residents and their programs. Our aim in this project was to identify whether residents prone to challenges with professionalism could be identified early. Methods: For 3 years we tracked onboarding tasks completed by residents between official match and the first day of residency to develop a tool that would help identify residents who may be at risk for problems with timely chart completion and subsequent remediation. We compared residents' "at risk" scores with in-training exam (ITE) scores to differentiate between professionalism (task completion issues) and medical knowledge. Results: Our at-risk tool successfully predicted timely chart completion rates and need for remediation within our residency program (Fischer's exact P<.001), but was not predictive of ITE scores. Discussion: Using readily accessible information, we can identify residents at risk for poor task completion performance, who may benefit from extra support and development in the area of organizational skill. Early identification may increase opportunities for early intervention.

Family Medicine Residency Program Directors' Perception of Curricular Elements Related to Autism: A CERA Study.

BACKGROUND AND OBJECTIVES: The family medicine (FM) approach to health care across the life span is well-suited to providing care for persons living with autism spectrum disorder (ASD). Little is known about ASD curricula in FM residency training and the characteristics of FM residency programs that prepare their residents to care for persons with this disorder. METHODS: Our study questions were part of a larger omnibus survey by the Council of Academic Family Medicine Educational Research Alliance (CERA) with data collection from November 16 to December 18, 2022, from FM residency program directors (PDs). ASD curricula were investigated using 10 questions, with descriptive analyses and nonparametric comparisons between program variables and ASD curriculum. RESULTS: The response rate was 42.18%, with FM PDs reporting that their programs were preparing residents in the care of youth (71.53%) and adults (68.33%) with ASD, but to a lesser extent (58.89%) in facilitating transitions of care. Programs with faculty champions, access to published curricula, sufficient patients with ASD, and engagement of interprofessional faculty reported a higher proportion of resident preparedness. PDs of community-based programs were most confident in their ability to teach ASD care and transitions of care. CONCLUSIONS: Most FM PDs modestly agreed that they are preparing residents to provide care to patients with ASD and their families. PDs of programs with greater access to resources (ie, published curriculum, faculty champions, sufficient patients with ASD, interprofessional faculty experts) believed that their residents were more prepared. Community-based FM educators may help lead the way in providing models for care and education in this regard.

The relationship between a single-item measure of burnout and the Copenhagen Burnout Inventory in family medicine residents.

OBJECTIVE: Burnout during residency education is a phenomenon which requires careful study. A single item for measuring burnout shows promise for its brevity and concordance with the most commonly used measure of burnout, the Maslach Burnout Inventory, but has not been compared to the Copenhagen Burnout Inventory. We compared the single-item measure of burnout question to the Copenhagen Burnout Inventory to assess the convergence between these two measures of burnout. METHOD: Family Medicine residents (n = 32) from three residency programs completed the single-item measure of burnout question and the Copenhagen Burnout Inventory. We compared the single-item measure of burnout measure to the three scales of the Copenhagen Burnout Inventory. RESULTS: Our analyses indicated that the single item measure is highly correlated with personal burnout (r = .76), moderately correlated with patient burnout (r = .58), and not correlated with work burnout (r = .18). CONCLUSIONS: Because the single-item measure of burnout is particularly useful for identifying personal burnout, it may help to identify early signs of burnout amount physicians in training.

How Medical Students Apply Their Biomedical Science Knowledge to Patient Care in the Family Medicine Clerkship.

Medical students enter clerkships with the requisite biomedical science knowledge to engage in supervised patient care. While poised to apply this knowledge, students face the cognitive challenge of transfer: applying knowledge learned in one context (i.e., preclinical classroom) to solve problems in a different context (i.e., patients in the clinic). To help students navigate this challenge, a structured reflection exercise was developed using Kolb's experiential learning cycle as an organizing framework. Students selected a patient encounter (concrete experience), wrote and addressed biomedical science learning objectives related to the care of the patient (reflective observation), reflected on how addressing the learning objectives influenced patient care (abstract conceptualization), and described their attending engaging in a similar process (active experimentation). A directed content analysis of students' written reflections revealed that most students wrote clinical science learning objectives in addition to biomedical science learning objectives. When viewed through the lenses of knowledge encapsulation theory and illness script theory, some students recognized knowledge encapsulation as a process beginning to occur in their own approach and their attendings' approach to clinical reasoning. Students readily applied their biomedical science knowledge to explain the pathophysiologic basis of disease (fault illness script domain) and signs and symptoms (consequence illness script domain), with fewer addressing predisposing conditions (enabling conditions illness script domain). Instances in which students observed their attending applying biomedical science knowledge were rare. Implications for using structured reflective writing as a tool to facilitate student application of their biomedical science knowledge in clerkships are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01697-5.

A Rare Complication of Herpes Zoster: Segmental Zoster Paresis.

Segmental zoster paresis (SZP) is a rare complication of herpes zoster (HZ) that results in focal weakness of the extremity in the myotome that corresponds to dermatomal involvement.We present a case of an 80-year-old female with a resolving HZ rash on her left leg and buttocks that presented with left leg weakness for two weeks. The patient's rash preceded the left leg weakness by two weeks. The exam revealed erythematous macular and crusting lesions in the left L3/L4 distribution. The left thigh was flaccid with 1/5 knee extension strength with an absent patellar reflex. Lumbar spine magnetic resonance imaging (MRI) revealed enhancement of the left L4 roots, suggestive of inflammation or neuropathy. The patient was discharged on gabapentin, amitriptyline, and a two-week prednisone taper. In this case study, we present SZP, a rare complication that occurs in approximately 3% of HZ patients. The majority of SZP cases occur on the face or upper extremity, whereas our patient had SZP of the lower extremity. This case emphasizes the importance of maintaining a comprehensive differential diagnosis and highlights that SZP should be considered in patients who present with acute weakness in an extremity.

Gender-Affirming Care Curriculum in Family Medicine Residencies: A CERA Study.

BACKGROUND AND OBJECTIVES: Family physicians are positioned to provide care for transgender patients, but few are trained in this care during residency. This study examines associations between program directors' (PDs) perceptions/beliefs on transgender health care and inclusion of gender-affirming health care (GAH) in residency curriculum. METHODS: Questions regarding current training in GAH, provision of GAH, competency in GAH delivery, barriers to GAH training, resident desire for GAH training, access to GAH curriculum, and feelings/perceptions about GAH were included in the 2020 Council of Academic Family Medicine Educational Research Alliance (CERA) Program Director Survey. RESULTS: Challenges to including GAH in residency curriculum were inadequate numbers of transgender patients for residents to provide care (35.4%) and lack of faculty expertise in GAH for transgender patients (24.6%). PDs were more likely to include GAH into curriculum when they provided care for transgender patients in their own practice, completed continuing medical education in GAH since completing residency, had confidence in teaching GAH to residents, had residents who requested training on GAH, or had access to a GAH curriculum. PDs who believed that GAH should be a core competency in residency curriculum were more likely to have residents who requested increased education in GAH and wanted to provide GAH to transgender patients in their future practices. CONCLUSIONS: Barriers persist for training family medicine residents in GAH for transgender patients, but further training opportunities for faculty could help to decrease identified barriers. Further research should explore how best to increase family medicine faculty comfort/competence in educating residents in GAH.

Transgender Education in North American Family Medicine Clerkships: A CERA Study.

BACKGROUND AND OBJECTIVES: Transgender persons face many barriers to accessing health care, including identifying a knowledgeable physician. Medical schools have made curricular changes addressing cultural competence in transgender medicine, but changes are inadequate to graduate physicians competent in gender-affirming health care. The aim of this study was to assess the current state of education on the comprehensive health care of transgender patients, including gender-affirming health care (GAH) strategies (hormone therapy, surgical interventions) in US and Canadian family medicine clerkships (FM clerkships) in addition to the beliefs and actions of the directors making those curricular decisions. METHODS: Questions regarding transgender education within FM clerkships were included in the 2018 Council of Academic Family Medicine's Educational Research Alliance (CERA) survey of family medicine clerkship directors. The online survey was distributed via email invitation to 128 US and 16 Canadian FM clerkship directors between June 21, 2018 and August 4, 2018. RESULTS: Seventy-two percent (68/94) of FM clerkship directors agreed transgender health care should be a required part of the medical school curriculum. Sixty-six percent report active advocacy within their institutions for increased curricular time devoted to transgender health care. Fifty-six percent (53/94) treat transgender patients in their own clinical practice, but just 26% agreed they were comfortable teaching transgender health care to medicals students. While the presence of transgender patients within the clinical practice did not have a significant impact on FM clerkship directors' comfort teaching this subject, having transgender friends or acquaintances did. CONCLUSIONS: FM clerkships are primed for inclusion of comprehensive transgender and GAH education in their curriculum. Increasing comfort of FM clerkship directors in teaching this subject area by providing accessible curriculum may encourage further uptake of this content into FM clerkships.

Correction to: "It is this very knowledge that makes us doctors": an applied thematic analysis of how medical students perceive the relevance of biomedical science knowledge to clinical medicine.

An amendment to this paper has been published and can be accessed via the original article.

"It is this very knowledge that makes us doctors": an applied thematic analysis of how medical students perceive the relevance of biomedical science knowledge to clinical medicine.

BACKGROUND: Intensive study of the biomedical sciences remains a core component of undergraduate medical education with medical students often completing up to 2 years of biomedical science training prior to entering clerkships. While it is generally accepted that biomedical science knowledge is essential for clinical practice because it forms the basis of clinical reasoning and decision-making, whether medical students perceive an expanded role for their biomedical science knowledge remains to be examined. METHODS: We conducted a qualitative research study to explore how medical students in the first clerkship year perceived the relevance of biomedical science knowledge to clinical medicine during this pivotal time as they begin their transition from students to physicians. To identify previously unidentified perspectives and insights, we asked students to write brief essays in response to the prompt: How is biomedical science knowledge relevant to clinical medicine? Ten codes and four themes were interpreted through an applied thematic analysis of students' essays. RESULTS: Analysis of students' essays revealed novel perspectives previously unidentified by survey studies and focus groups. Specifically, students perceived their biomedical science knowledge as contributory to the development of adaptive expertise and professional identity formation, both viewed as essential developmental milestones for medical students. CONCLUSIONS: The results of this study have important implications for ongoing curricular reform efforts to improve the structure, content, delivery, and assessment of the undergraduate medical curriculum. Identifying the explicit and tacit elements of the formal, informal, and hidden curriculum that enable biomedical science knowledge to contribute to the development of adaptive expertise and professional identity formation will enable the purposeful design of innovations to support the acquisition of these critical educational outcomes.