A Focus on Climate Change and How It Impacts Family Medicine.

This issue highlights climate change, its effects on patients, and actions clinicians can take to make a difference for their patients and communities. The issue also includes several reports on current trends in family physician practice patterns and the influence of practice structure. Four articles focus on controlled or illicit substances. Noteworthy among them is the description of an innovative yet simple device that allows patients to safely discard unused opioids. Other research covers adverse childhood experiences (ACEs), smoking cessation programs, and the impact of Medicare reimbursement rates on influenza vaccination.

Lingering Impact of COVID-19, Preventive Care Considerations, and US Health System Challenges.

This issue includes articles on the lingering impact of COVID-19, often negative but occasionally positive, on patients, treatment, practices, and health care personnel. Other articles inform on prevention, such as awareness of lung cancer screening among women undergoing screening mammography; failures on sports preparticipation physicals; advance care planning as prevention; and screening for social risk factors. Another article reports on patient experiences of legal recreational cannabis in Washington State. There is a review of perinatal depression recognition and treatment. Two articles separately identify the difficulties of the congressionally created Medicare Advantage & Pharmaceutical Benefit Managers.

Practicing Family Medicine in a Pandemic World: Lessons for Telemedicine, Health Care Delivery, and Mental Health Care.

In this issue of the Journal, several articles evaluate the strengths and weaknesses of telemedicine. Evidence demonstrates that telemedicine is not equally effective for all clinical situations. Another set of articles report research on the delivery of health care: electronic reminders for physicians, standing orders, guideline use, and screening for social determinants of health. Two studies report on the effects of the pandemic on the mental health of subpopulations. The impact of changing insurance status on chronic disease diagnoses, the implications of eliminating the X-waiver, and trends in early career family physician salaries are also studied.

Is injectable PrEP superior to oral therapy for HIV protection?

An RCT of HIV preexposure prophylaxis compared long-acting injectable cabotegravir with traditional daily oral tenofovir-emtricitabine-with clear results.

Thinking and Practicing Thoughtfully and Thoroughly.

One of the unique characteristics of family medicine is that although we cannot meet every specific need of each patient at each visit we continuously advance the health of the communities that surround our practices. Family physicians aim to improve overall health outcomes across our practice populations, not just individual by individual, nor just for those who arrive in our office for care. We strive to care for individuals who fall through the cracks, for the social circles who surround our patients, such as family members or neighbors; we implement systems to facilitate the broad scope and needed intensity of care; and we build collaborations that assist in population care. Family medicine improves outcomes for everyone, including the unseen. This JABFM issue epitomizes many of these distinguishing characteristics of family medicine-what does it take (how)? When? Where?

Education, trust, and likelihood to vaccinate against COVID-19 among patients with diabetes in the American South.

OBJECTIVE: The purpose of this study was to explain the relationship among education, likelihood to vaccinate for COVID-19, and trust in healthcare providers among patients living with diabetes in the American South. METHODS: Explanatory iterative sequential mixed methods design combined retrospective chart review, self-report surveys, and qualitative interviews. RESULTS: Analysis of covariance revealed that severity of diabetes was not linked to vaccine acceptance. Overall, patients reported higher likelihood to vaccinate if their healthcare providers strongly recommend the vaccine. People with "some college" education reported lowest likelihood to vaccinate, before and after their healthcare providers' strong recommendation. Integrated analysis revealed the complexity of patient-provider trust and vaccination decisions. CONCLUSIONS: In the context of COVID vaccination, particularly as conspiracy theories entered the mainstream, measures of trust in the system may be a clearer indicator of vaccine decision making than trust in personal physician. PRACTICE IMPLICATIONS: The nonlinear relationship between education and likelihood to vaccinate challenges providers to talk to patients about knowledge and understanding beyond a superficial, quantitative screening question about education. Health systems and public health officials need to find strategies to build trusting relationships for patients across systems, such as community health workers.

Infrastructure Features Associated With Increased Department Research Capacity.

PURPOSE: Although researchers have identified factors associated with research capacity in academic medicine departments, less is known about how a department builds research capacity over time. The Association of Departments of Family Medicine's Research Capacity Scale (RCS) can be used by departments to self-categorize into five capacity levels. Our current study aimed to describe the distribution of infrastructure features and to evaluate how the addition of infrastructure features influences movement of a department along the RCS. METHOD: An online survey was sent to US family medicine department chairs in August 2021. Survey questions asked chairs to categorize their department's research capacity in 2018 and 2021 and also about the presence of infrastructure resources and changes in these features across 6 years. RESULTS: The response rate was 54.2%. Departments identified substantial variation in research capacity. Most departments classified into the middle three levels. Departments in higher levels were more likely than those at lower levels to have any of the infrastructure resources in 2021. Department size, as measured by full time faculty, was highly associated with department level. From 2018 and 2021, 43% of responding departments climbed at least one level. Of these, more than half added three or more infrastructure features. Adding a PhD researcher was the feature most associated with increasing research capacity (P<.001). CONCLUSIONS: Most departments that increased their research capacity added multiple additional infrastructure features. For chairs of departments without a PhD researcher, this additional resource may be the most impactful investment to increase research capacity.

Research Addressing the Ongoing Changes in the Practice of Family Medicine.

The articles in this issue are divided into 3 categories: 1) increasing our understanding of people's (patients') behaviors; 2) changing how we practice Family Medicine; and 3) rethinking common clinical problems. These categories include multiple topics: nonprescription antibiotic use, recording electronic smoking/vaping, virtual wellness visits, an electronic pharmacist consult service, documenting social determinants of health, medical-legal partnerships, local professionalism, implications of peripheral neuropathy, harm-reduction informed care, decreasing cardiovascular risk, persistent symptoms, and colonoscopy harm.

Research Representing the Changing Landscape of Family Medicine.

Family medicine continues to evolve in response to new technologies, new theories, and new problems to address. This issue of JABFM includes studies on the integration of artificial intelligence into primary care, thoughts on how medicine can address climate change, and some novel approaches to important issues in family medicine. Studies on medication assisted therapy, continuity of care, and periodontitis are among the original research in this issue. In addition, research on screening for social needs, updated guidelines, and case reports are included.

How to Sponsor, Coach, and Mentor: A Qualitative Study With Family Medicine Department Chairs.

BACKGROUND AND OBJECTIVES: The goal of this study was to explore how to use sponsoring, coaching, and mentoring (SCM) for faculty development by clarifying the functions embedded in SCM. The study aims to ensure that department chairs can be intentional in providing those functions and/or playing those roles for the benefit of all their faculty. METHODS: We used qualitative, semistructured interviews in this study. We followed a purposeful sampling strategy to recruit a diverse sample of family medicine department chairs across the United States. Participants were asked about their experiences receiving and providing sponsoring, coaching, and mentoring. We iteratively coded audio recorded and transcribed interviews for content and themes. RESULTS: We interviewed 20 participants between December 2020 and May 2021 to identify actions associated with sponsoring, coaching, and mentoring. Participants identified six main actions sponsors perform. These actions are identifying opportunities, recognizing an individual's strengths, encouraging opportunity-seeking, offering tangible support, optimizing candidacy, nominating as a candidate, and promising support. In contrast, they identified seven main actions a coach performs. These are clarifying, advising, giving resources, performing critical appraisals, giving feedback, reflecting, and scaffolding (ie, providing support while learning). Finally, participants identified six main actions the mentors perform. The list includes checking in, listening, sharing wisdom, directing, supporting, and collaborating. CONCLUSIONS: We present SCM as an identifiable series of actions that need to be thought of and performed intentionally. Our clarification will help leaders purposefully select their actions and allows opportunity for evaluating their effectiveness. Future research will explore developing and evaluating programs that support learning how to provide SCM in order to enhance the process of faculty development and provide it equitably.

Family Physicians Can/Should Do: What? Where? And How?

This issue's teasers: A broad scope of care by family physicians could be incentivized and has positive outcomes. Family physicians could do more dermoscopy-a mixed specialty group of experts provide information on diagnosis with associated features and proficiency standards for primary care clinicians. Clinicians could trust more, and do less, such as adult measles-mumps-rubella boosters. Family physicians differ from pediatricians on how to deliver vitamin D to newborns. Practice scope varies by location. Is monetary incentive a key to incentivize COVID vaccination? A new, useful, easy functional status questionnaire. This issue also includes articles on both adult and pediatric obesity, a systematic review of social determinants of health and documentation thereof, plus more.

The Power of One Word to Paint a Halo or a Horn: Demonstrating the Halo Effect in Learner Handover and Subsequent Evaluation.

PURPOSE: Learner evaluation based upon direct observation is a cornerstone of modern competency-based medical education. Learner handover has become a widely accepted practice. Cognitive attribution bias is a potential threat to the validity of learner evaluation following learner handover. METHOD: In this 2 x 2 (learner handover: halos/horns x learner gender: man/woman) factorial, nonequivalent comparison group experimental design, registered attendees at a national medical education conference watched 1 of 2 videos (depicting a woman learner or man learner) of simulated learner-patient encounters. Data were collected on April 30 and May 1, 2022. Participants received learner handover conditioning before watching the video. The conditioning was randomized to suggest the learner they were about to watch was either "above-average" (halos) or "below-average" (horns). Following the video, participants completed an evaluation form. RESULTS: Participants rated the learner in a video encounter preceded by a horns statement significantly lower than the learner in a video encounter preceded by a halo statement, F (1,65) = 10.15, P < .01, η 2 = .14, horns mean adj = 12.49 (CI 11.34, 13.63), halo mean adj = 15.10 (CI 13.93, 16.28). This represented a scoring difference of 2.61 points on a 30-point scale. More years of teaching experience was negatively associated with the score, F (1,65) = 13.44, P < .001, η 2 = .17. CONCLUSIONS: Learner conditioning differing by a single word, labeling a learner as either "above-average" or "below-average" resulted in a large difference in scoring by medical educators.

Gray Hair.

In this narrative medicine essay, a chair of a family medicine department views the wide generation gap between him and his medical students as an unexpected turn from what he had imagined he would feel upon becoming a senior physician.

Clinically Useful Family Medicine Research.

What is next for family medicine? After the long, rough road since the beginning of the COVID-19 pandemic, other topics are again receiving renewed attention. Family medicine researchers continue to consider issues important to our patients and practices. There is a collection of clinical research on children's health care. One article outlines practical actions to move medical academia past racism. The need for physician trust in patients is also often overlooked. Other articles address how to improve the practice of family medicine and a framework for thinking about legal and ethical issues in sports medicine. Three in-depth clinical reviews cover lumps and bumps of wrists and hands, spondylosis/spondylolistheses, and vitamin D association with specific disease entities.

Mental Health of Patients and Clinicians Before and During the COVID-19 Pandemic.

The mental health of patients and clinicians before and during the pandemic are investigated and reported by multiple investigators. Improving health through practice change is challenging but possible. Telehealth increased dramatically since the beginning of the pandemic; what is its future?

Patient Decision-Making About Self-Disclosure of a Type 2 Diabetes Diagnosis: A Qualitative Study.

Background: Effective self-management of type 2 diabetes requires receiving support, which can result from disclosing the diagnosis to a support network, including coworkers, family, and friends. As a primarily invisible disease, diabetes allows people to choose whether to disclose. This study qualitatively explores the factors that influence a person's decision to disclose diabetes to others. Methods: Research coordinators recruited 22 interview participants, ranging in age from 32 to 64 years, whose medical records included a diagnosis code for type 2 diabetes. Participants received care from one of two U.S. medical centers. Semi-structured interviews lasted approximately 1 hour and were audio-recorded and professionally transcribed. Verification strategies such as memo-keeping and maintaining methodological coherence/congruence were used throughout analysis to promote rigor. Results: In patients' descriptions of their decision-making processes regarding whether to disclose their diagnosis, six themes emerged. Three motivations prompted open disclosure: 1) to seek information, 2) to seek social support, and 3) to end the succession of diabetes, and the other three motivations prompted guarded disclosure: 4) to prepare for an emergency, 5) to maintain an image of health, and 6) to protect employment. Conclusion: Based on our findings, we recommend three communicative actions for clinicians as they talk to patients about a diabetes diagnosis. First, clinicians should talk about the benefits of disclosure. Second, they should directly address stereotypes in an effort to de-stigmatize diabetes. Finally, clinicians can teach the skills of disclosure. As disclosure efficacy increases, a person's likelihood to disclose also increases. Individuals can use communication as a tool to gain the knowledge and support they need for diabetes self-management and to interrupt the continuing multigenerational development of diabetes within their family.