Who, What, and Where: Transforming Primary Care Education to Advance Health Equity.

To transform primary care with the goal of achieving health equity, changes in the way the health care workforce is selected, trained, and ultimately delivers care should be expedited. Research has repeatedly shown the immense impact of the social determinants of health and the gaps related to health equity in the United States. Despite this knowledge, health care education and delivery systems have been slow to evolve. The Health Resources and Services Administration established the Academic Units for Primary Care Training and Enhancement to work towards strengthening the primary care workforce. Through their research, the six individual Academic Units (AU) have identified gaps related to health equity in their areas of focus. This article provides recommendations from the AUs on ways primary care health professions education can be transformed to advance health equity and serves as background for the articles to follow in the remainder of the supplement.

Perspectives and Practice in the Identification and Treatment of Opioid Use, Alcohol Use, and Depressive Disorders.

OBJECTIVE: Little research has focused on the treatment of adults with substance use disorders in primary care despite the high occurrence, morbidity, and mortality associated with these disorders. METHODS: An electronic survey was administered to primary care providers in a large health system to assess screening and treatment practices and comfort managing opioid use, alcohol use, and depressive disorders. A total of 146 providers completed the survey (32%). RESULTS: Providers were significantly less likely to screen for or treat opioid use disorders and alcohol use disorders, compared with depression. Providers reported feeling significantly less confident, less prepared, less expected to treat, less sure of the appropriateness of treating, and less able to navigate community resources in the treatment of opioid and alcohol use disorders, compared with depression. CONCLUSIONS: Given the preponderance of substance use disorders in primary care, increased attention to equipping primary care providers to treat these conditions is warranted.

Examining the Feasibility of a Simple Intervention to Improve Blood Pressure Control for Primary Care Patients.

BACKGROUND: Blood pressure control remains a challenge despite the availability of effective antihypertensive agents. OBJECTIVE: This pilot study explored the feasibility of a simple, low-resource intervention to improve blood pressure control. METHODS: A convenience sample was drawn of 56 patients with hypertension from a primary care clinic. A preintervention-postintervention delivered by medical assistants involved prompts to providers to address blood pressure control with a visual aid indicating patients' current and target blood pressure in the context of a traffic light. RESULTS: Patients showed a significant reduction in mean systolic blood pressure (preintervention, 141.5 mm Hg, vs postintervention, 133.0 mm Hg; P = .002) and mean diastolic blood pressure (preintervention, 83.4 mm Hg, vs postintervention, 80.4 mm Hg; P = .049). CONCLUSION: In this pilot study, we established the feasibility of a brief, simple intervention to improve blood pressure control implemented by existing primary care practice clinical support staff, and preliminary data show that it can be effective in improving blood pressure control.

Comparison of textbook to fmCases on family medicine clerkship exam performance.

BACKGROUND AND OBJECTIVES: The use of online learning with virtual cases has become commonplace in medical education. A series of fmCASES has been developed to assist with learning for clerkship students in family medicine. It has not been shown whether this series of cases improves student learning during their clerkship compared to traditional learning modalities. METHODS: We designed an intervention study to replace the traditional family medicine clerkship textbook with the fmCASES curriculum at one medical school. We then compared two consecutive cohorts of family medicine clerkship students by examining their performance on overall and small groups of exam questions at the end of the clerkship. RESULTS: Data were obtained for 95% of students across the 2-year study. Overall performance on the end of clerkship exam was unchanged with the transition to fmCASES. Student performance was variable based on subject area and source of examination question. CONCLUSIONS: Using a set of online cases to replace a traditional textbook did not change overall performance on the end-of-clerkship assessment. However, our findings suggest that students demonstrated proficiency in answering questions that came from the sources they studied from. This finding should be considered when curricula transition to greater use of online learning resources.

Clinical instruction: using the strengths-based approach with nursing students.

Clinical instruction experience can vary significantly based on the needs of the organization and the individual characteristics of instructors and students. Clinical instructors may encounter difficulties in their relationships with students, such as personality conflicts, differences in style and values, and limited skill levels or a lack of interest on the part of students. To reduce obstacles when working with challenging students, a strengths perspective approach is recommended. This framework emphasizes discovering, affirming, and enhancing the capabilities, interests, knowledge, resources, goals, and objectives of individuals. The strengths perspective can provide an innovative framework for working with nursing students, one that emphasizes student empowerment, collaborative learning, and mutual growth. Strength-based strategies for supervision of students in clinical placements are shared, highlighting the practical application of the framework's tenets.