Family Medicine Resident Education About Health Disparities Associated With Incarceration: A CERA Research Study.

BACKGROUND AND OBJECTIVES: We submitted research questions to the Council of Academic Family Medicine Educational Research Alliance (CERA) to assess the format of family medicine resident education about health disparities associated with incarceration and the perceived efficacy of efforts to prepare graduates for competent care of formerly incarcerated patients in practice. We think this is a universal problem, and current efforts are insufficient. METHODS: We evaluated data as part of the fall 2022 CERA survey of program directors (PDs). We reviewed descriptive statistics, generated comparative analysis, and reported relational analysis. We analyzed internal structure with principal component analysis and inter-item reliability. RESULTS: A total of 286 out of 678 (42%) eligible PDs completed the survey. Most respondents felt that educating residents about health disparities associated with incarceration was important and that residents would welcome that education. However, PDs lacked existing curricula. PDs did not think that medical school graduates were well-prepared in this area, and ambivalence existed about whether residency graduates were well-prepared to treat formerly incarcerated patients upon graduation. Comparative analysis revealed differences in responses based on the type of program, the program and community size, and the PD demographics. CONCLUSIONS: PDs acknowledged the importance of training residents about health disparities associated with incarceration and about care for formerly incarcerated patients in practice. However, they identified a gap between what was currently offered and what is needed to impact perception of resident readiness upon graduation. This training was felt to be most important in university-based programs with 31+ residents in US communities of greater than 150,000 people. We found no difference based on geographic location.

The Importance of Correctional Health Care Curricula in Medical Education.

We designed an anonymous survey to identify knowledge gaps regarding correctional medicine and health disparities for justice-affected patients and distributed it to medical students. Fifty-six percent of the 140 students who responded (14% response rate) had some interaction with the criminal justice system and/or a justice-affected person. Most students somewhat agreed to having knowledge of health risks/disparities related to incarceration. Most were unaware of correctional medicine as a subspecialty. A majority felt comfortable providing care to justice-affected patients and on average agree this population should have equal access to health care. There was a statistically significant correlation between students who considered correctional medicine as a career and belief that these patients should have equal health care access, with the importance of including correctional health care in medical education. We agree with the growing body of literature that concludes there is a need for correctional health care curricula in medical education.

Comparative Analysis of the American Board of Family Medicine and American College of Osteopathic Family Physicians In-Training Examinations.

BACKGROUND AND OBJECTIVES: Family medicine residency programs accredited by the Accreditation Council for Graduate Medical Education and the American Osteopathic Association typically require their residents to take the American Board of Family Medicine's In-Training Examination (ITE) and the American College of Osteopathic Family Physicians' In-Service Examination (ISE). With implementation of the single accreditation system (SAS), is it necessary to administer both examinations? This pilot study assessed whether the degree of similarity for the construct of family medicine knowledge and clinical decision making as measured by both exams is high enough to be considered equivalent and analyzed resident ability distribution on both exams. METHODS: A repeated measures design was used to determine how similar and how different the rankings of PGY-3s were with regard to their knowledge of family medicine as measured by the ISE and ITE. Eighteen third-year osteopathic residents participated in the analysis, and the response rate was 100%. RESULTS: The correlation between ISE and ITE rankings was moderately high and significantly different from zero (rs=.76, P<0.05). A Wilcoxon signed rank test indicated that the median ISE score of 62 was not statistically significantly different than the median ITE score of 71 (Z=-0.74, P=0.46, 2-tailed). CONCLUSIONS: The lack of a difference on statistical analysis of ISE scores and the ITE scores of the PGY-3 residents suggests that the cohort of osteopathic residents in family residency programs and the cohort of residents in ACGME-accredited programs seem to be of comparable ability, therefore there is no clear justification for administering both examinations.

Teaching resident physicians the power of implicit bias and how it impacts patient care utilizing patients who have experienced incarceration as a model.

Over 2 million adults in the United States are incarcerated and over 650,000 return to the community each year. This disparate population is known to have an elevated burden of chronic disease and lower socioeconomic status. Medical residency training about care of incarcerated or previously incarcerated patients is significantly lacking in the United States. Curriculum can be developed and implemented in residency programs to help physicians learn how to work with this population, be sensitive to their unique needs, and achieve positive health outcomes. This article describes a method for "educating the educators" based on a workshop presented at a peer-reviewed national conference during the fall of 2016. Attendees participated in exercises addressing assumptions, expectations, bias, and worldview and increased their ability for self-reflection when interacting with patients who are or have experienced incarceration. In this session, strategies were identified that engaged the patient with the goal to aid in patient retention and compliance. Future steps include development of a formal curriculum for training in this area, incorporation into existing community medicine rotations or electives, and establishment of structured transition clinics where residents can be exposed to this population on a more regular basis and improve their overall health outcomes.

Teaching resident physicians to work with the previously incarcerated patient.

Over 2 million adults in the United States are incarcerated and over 650,000 return to the community each year. This disparate population is known to have an elevated burden of chronic disease and lower socioeconomic status. Medical residency training about care for incarcerated or previously incarcerated patients is significantly lacking in the United States. Curriculum can be developed and implemented in residency programs to help physicians learn how to work with this population, be sensitive to their unique needs, and achieve positive health outcomes. This article describes a method for "educating the educators" based on a workshop presented at a peer-reviewed national conference during the fall of 2016. Attendees participated in exercises addressing assumptions, expectations, bias, and worldview and increased their ability for self-reflection when interacting with patients who are or have experienced incarceration. In this session, strategies were identified that engaged the patient with the goal to aid in patient retention and compliance. Future steps include development of a formal curriculum for training in this area, incorporation into existing community medicine rotations or electives, and establishment of structured transition clinics where residents can be exposed to this population on a more regular basis and improve their overall health outcomes.

Cervical cancer screening: How our approach may change.

Accumulating evidence has begun to alter priorities in testing modalities and in testing intervals, and further changes may be on the way.

Premenstrual Syndrome and Premenstrual Dysphoric Disorder.

Premenstrual disorders affect up to 12% of women. The subspecialties of psychiatry and gynecology have developed overlapping but distinct diagnoses that qualify as a premenstrual disorder; these include premenstrual syndrome and premenstrual dysphoric disorder. These conditions encompass psychological and physical symptoms that cause significant impairment during the luteal phase of the menstrual cycle, but resolve shortly after menstruation. Patientdirected prospective recording of symptoms is helpful to establish the cyclical nature of symptoms that differentiate premenstrual syndrome and premenstrual dysphoric disorder from other psychiatric and physical disorders. Physicians should tailor therapy to achieve the greatest functional improvement possible for their patients. Select serotonergic antidepressants are first-line treatments. They can be used continuously or only during the luteal phase. Oral contraceptives and calcium supplements may also be used. There is insufficient evidence to recommend treatment with vitamin D, herbal remedies, or acupuncture, but there are data to suggest benefit from cognitive behavior therapy.