On Track for Success: An Innovative Behavioral Science Curriculum Model

A healthy lifestyle is fundamental for the prevention and treatment of cardiovascular disease and other noncommunicable diseases (NCDs). Investment in primary prevention, including modification of health risk behaviors, could result in a 4-fold improvement in health outcomes compared with secondary prevention based on pharmacological treatment. The American Heart Association (AHA) emphasized the importance of lifestyle in its 2020 goals for cardiovascular health promotion and disease reduction. In addition to defining “cardiovascular health” based on criteria for blood pressure and biochemical markers (lipids and glycemia), the AHA Strategic Planning Committee further identified lifestyle characteristics of central importance: nutrition, physical activity, smoking, and maintenance of a healthy body weight.1 The World Health Organization estimated that ≈80% of NCDs could be prevented if 4 key lifestyle practices were followed: a healthy diet, being physically active, avoidance of tobacco, and alcohol intake in moderation.2 To support healthy lifestyle initiatives, major changes are necessary at the societal level to improve population health. Numerous strategies might help to create a culture that promotes and facilitates healthy behaviors, including creating laws and regulations, mounting large-scale public awareness and education campaigns, implementing local community programs, and providing individual counseling.3 Physicians are uniquely positioned to encourage individuals to adopt healthy lifestyle behaviors: Approximately 80% of Americans visit their primary care physician at least once a year. Physicians directly communicate with their patients during clinical encounters across numerous settings, and research indicates that patients highly value recommendations provided by their physicians.4,5 However, data further indicate that lifestyle counseling does not routinely occur in physicians’ offices, thereby representing a lost opportunity. Physicians report that they perform lifestyle counseling during ≈34% of clinic visits.4 Patients, in turn, report an even lower frequency of physician lifestyle counseling. For example, obese patients reported receiving physical activity and …

Meeting scholarly activity requirements continues to be a challenge in many family medicine (FM) residency programs. Studies comprehensively describing FM resident scholarship have been limited. We sought to identify institutional factors associated with increased scholarly output and meeting requirements of the Accreditation Council for Graduate Medical Education (ACGME). Our goals were to: (1) describe scholarly activity experiences among FM residents compared with ACGME requirements; (2) classify experiences by Boyer's domains of scholarship; and (3) associate experiences with residency program characteristics and scholarly activity infrastructure. This was a cross-sectional survey. The survey questions were part of an omnibus survey to FM residency program directors conducted by the Council of Academic Family Medicine Educational Research Alliance (CERA). All ACGME-accredited US FM residency program directors, identified by the Association of Family Medicine Residency Directors, were sampled. Of the 691 eligible program directors, 298 (43%) completed the survey. The respondents reported that 25% or more residents exceeded ACGME minimum output, 17% reported that 25% or more residents published their work, and 50% reported that 25% or more residents delivered conference presentations. Programs exceeding ACGME scholarship requirements exhibit robust infrastructure characterized by access to faculty mentorship, scholarly activity curricula, Institutional Review Board, medical librarian, and statistician. These findings suggest the need for codified ACGME requirements for scholarly activity infrastructure to ensure access to resources in FM residency programs. By fostering FM resident engagement in scholarly activity, programs help to create a culture of inquiry, and address discrepancies in funding and output among FM residency programs.

ABSTRACTOBJECTIVE To describe the sociodemographic profile and analyze the migratory characteristics of the members of the Residency Programs in Family Medicine in 2020 in Brazil.METHODS The study follows a cross-sectional observational design of a quantitative nature from the perspective of the members of the Residency Programs in Family Medicine. Questionnaires adapted for each participating group were developed, applied through an online platform.RESULTS Most participants are female and white. Most supervisors and preceptors were residents of Residency Programs in Family Medicine, however, there are some who are not specialists in the field. Most participants are based in capitals or metropolitan regions. In relation to retention, 41.1% of supervisors and 73.1% of preceptors are affiliated to a program in the same municipality where they lived. For most resident physicians, the place of residence coincides with the place of birth and/or graduation (57.4%), and 48.5% are in the same place of graduation.CONCLUSIONS The research reinforces the need for policies to promote the migration of residents to Residency Programs in Family Medicine outside capital cities and metropolitan regions, as well as encouraging the retention of graduates trained outside large urban centers so that they can contribute to distribution and provision of doctors where they are still needed.

Recent graduates of the University of South Carolina School of Medicine (n=108) evaluated the clinical relevancy of their behavioral science curriculum. The results indicate that a body of behavioral science data are clinically relevant to physicians regardless of their specialty. Additional behavioral science content areas are clinically relevant for practitioners in particular medical specialties. Suggestions are made for the role of behavioral science material in continuing medical education.

Quality Improvement Models in Residency Programs.

ABSTRACTBackground: The prevalence of opioid use disorder (OUD) has increased sharply. Office-based opioid treatment with buprenorphine (OBOT) is effective but often underutilized because of physicians' lack of experience prescribing this therapy. Little is known about US residency training programs' provision of OBOT and addiction medicine training. Methods: The authors conducted a survey of residency program directors (RPDs) at all US residency programs in internal medicine, family medicine, and psychiatry to assess the frequency with which their residents provide care for OUD, presence and features of curricula in OBOT and addiction medicine, RPDs' beliefs about OBOT, and potential barriers to providing OBOT training. Results: The response rate was 49.5% (476 of 962). Although 76.9% of RPDs reported that residents frequently manage patients with OUD, only 23.5% reported that their program dedicates 12 or more hours of curricular time to addiction medicine, 35.9% reported that their program encourages/requires training in OBOT, and 22.6% reported that their program encourages/requires obtaining a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine. Most RPDs believe that OBOT is an important treatment option for OUD (88.1%) and that increased residency training in OBOT would improve access to OBOT (73.7%). The authors also found that programs whose RPD had favorable views of OBOT were more likely to provide OBOT and addiction medicine training. Psychiatry programs were most likely to provide OBOT training and their RPDs most likely to have beliefs about OBOT that were positive. Commonly cited barriers to implementing OBOT training include a lack of waivered preceptors (76.9%), competing curricular priorities (64.1%), and a lack of support (social work and counseling) services (54.0%). Conclusions: Internal medicine, family medicine, and psychiatry residents often care for patients with OUD, and most RPDs believe that increased residency training in OBOT would increase access to this treatment. Yet, only a minority of programs offer training in OBOT.

In response to growing recognition of the role played by behavioral and social factors in health and disease, the National Institutes of Health and The Robert Wood Johnson Foundation asked the Institute of Medicine to conduct a study of medical school education in the behavioral and social sciences. The study included a review of the approaches used by medical schools to incorporate the behavioral and social sciences into their curricula, development of a prioritized list of behavioral and social science topics for future inclusion in those curricula, and an examination of ways in which barriers to the incorporation of behavioral and social science topics can be overcome. The committee finds that existing databases provide inadequate information on behavioral and social science curriculum content, teaching techniques, and assessment methodologies in U.S. medical schools and recommends development of a new national behavioral and social science database. It also recommends that medical students be provided with an integrated behavioral and social science curriculum that extends throughout the 4 years of medical school. The committee identifies 26 topics in six behavioral and social science domains that it believes should be included in medical school curricula. The six domains are mind-body interactions in health and disease, patient behavior, physician role and behavior, physician-patient interactions, social and cultural issues in health care, and health policy and economics.To help overcome multiple barriers to the incorporation of the behavioral and social sciences into medical school curricula, the committee recommends that the National Institutes of Health or private foundations establish behavioral and social sciences career development and curriculum development awards. Moreover, concerned that the U.S. Medical Licensing Examination currently places insufficient emphasis on test items related to the behavioral and social sciences, the committee recommends that the National Board of Medical Examiners ensure that the exam adequately covers the behavioral and social science subject matter recommended in this report.

STFM’s strategic plan challenges the Society to be the leader in developing programs and services to help residencies improve family medicine education and teaching. STFM members have emphasized the need for cost-and time-effective ways to offer learning opportunities, meet ACGME requirements, and enhance the knowledge and skills of faculty. To meet this need, STFM introduced the Residency Faculty Boot Camp. This series of online, interactive learning experiences covers the most-requested teaching topics, including Dealing With Difficult Residents, Pearls of Precepting, and Providing Feedback to Learners. Each module includes a presentation, videos, and interactive quizzes. Residency programs that purchase the package receive instant updates as participants complete each course. For details, visit http://www.stfm.org/bootcamp. The new ACGME program requirements in family medicine (Milestones) will require competency assessment of residents. Residencies are being asked to focus more on resident performance and less on the numbers of procedures performed. In early 2012, STFM launched a Resident Competency Assessment Toolkit. The toolkit contains the background, tools, and training to help residency programs demonstrate resident competence and ensure that graduates have the knowledge, skills, and abilities required to perform their roles in society. More information can be found at http://www.stfm.org/rctoolkit. STFM has offered and will continue to offer train-the-trainer workshops on competency assessment at family medicine conferences and through personalized faculty development training, such as STFM’s On-the-Road workshops. STFM and the Association of Family Medicine Residency Directors (AFMRD) recently launched a multi-year collaborative to build an online resource of peer-reviewed, competency-based curriculum on core topics taught in family medicine residency programs. The Residency Curriculum Resource, which will be organized by post-graduate year (PGY), will serve as a repository of materials that can be implemented and used to satisfy ACGME requirements. Content will be managed by a senior editor and a 6-member editorial board. The project will include 2 phases. Phase 1 will convert AAFP’s “Recommended Core Curriculum Guidelines for Family Medicine Residents” into a dynamic web interface organized by PGY, with links to content to address core-learning objectives. Faculty will be able to use the content to standardize teaching and to ensure residents gain competence in the areas outlined in the guidelines. Phase 1 content will be free to all STFM and AFMRD members. During phase 2, AFMRD and STFM members will submit teaching materials they have developed for lectures and presentations or that they have created specifically for the Residency Curriculum Resource. Submissions will be peer reviewed and refined. Authors with accepted publications will update their content annually. Access to Phase 2 content will be subscription-based. Subscription fees will cover the costs of website updates, the editorial process, and the purchase of licensed content. In addition, STFM offers a number of valuable resources to help residency programs with faculty development, scholarship, and leadership: All levels of faculty can receive up-to-date faculty development training by attending the STFM Annual Spring Conference. It offers hundreds of presentations specifically geared for residency program faculty. The Conference on Practice Improvement offers residencies an opportunity to learn as teams about topics central to practice redesign and the patient-centered medical home. Faculty and residents can access tools and mentoring to meet ACGME scholarly activity requirements using the CAFM Educational Research Alliance. The STFM Resource Library offers instant access to more than 700 residency-specific resources on a variety of topics, including the patient-centered medical home and practice redesign. The Resource Library also offers interactive wikis on family medicine research, teaching teen health, and behavioral science basics. Residencies can develop faculty leaders through enrollment in one of STFM’s leadership development opportunities, such as the Emerging Leaders and the Behavioral Science/Family Systems Educator Fellowship. These leadership opportunities provide education and experience to help future faculty leaders rise to the next level. Current research on residency innovation is available through Family Medicine’s recent dedicated issue on residency redesign. TeachingPhysician.org connects residency programs with community preceptors. The web resource streamlines training with videos, tips, answers to frequently asked questions, and links to in-depth information on precepting. STFM is strengthening its offerings to help residencies successfully meet today’s challenges as they train tomorrow’s family physicians. We invite residency faculty to explore the wealth of STFM offerings and offer feedback on challenges that are not yet being met. We strive to be the go-to resource for all family medicine educators.

Writing workshops and narrative experiences for medical trainees can be a useful way to approach certain issues in their education. This article describes a brief writing exercise that can be used for physicians in training to help them recognize issues of countertransference in the doctor-patient relationship. While these issues are generally covered as part of residents’ behavioral science curriculum, this exercise allows trainees to use a creative method in order to uncover them. To date, this exercise has been used in two residency programs with residents informally expressing improved understanding of their own experience with patients.

Increasing the number of underrepresented minorities in medicine (URM) has the potential to improve access and quality of care and reduce health inequities for diverse populations. Having a diverse workforce in residency programs necessitates structures in place for support, training, and addressing racism and discrimination. This study examines reports of discrimination and training initiatives to increase diversity and address discrimination and unconscious bias in family medicine residency programs nationally. This survey was part of the Council of Academic Family Medicine Educational Research Alliance (CERA) 2018 national survey of family medicine residency program directors. Questions addressed the presence of reported discrimination, residency program training about discrimination and bias, and admissions practices concerning physician workforce diversity. We performed univariate and bivariate analyses on CERA survey response data. We received 272 responses to the diversity survey items within the CERA program director survey from 522 possible residency director respondents, yielding a response rate of 52.1%. The majority of residency programs (78%) offer training for faculty and/or residents in unconscious/implicit bias and systemic/institutional racism. A minority of program directors report discrimination in the residency environment, most often reported by patients (13.2%) and staff (7.2%) and least often by faculty (3.3%), with most common reasons for discrimination noted as language or race/skin color. Most family medicine residency program directors report initiatives to address diversity in the workforce. Research is needed to develop best practices to ensure continued improvement in workforce diversity and racial climate that will enhance the quality of care and access for underserved populations.

In response to growing recognition of the role played by behavioral and social factors in health and disease, the National Institutes of Health and The Robert Wood Johnson Foundation asked the Institute of Medicine to conduct a study of medical school education in the behavioral and social sciences. The study included a review of the approaches used by medical schools to incorporate the behavioral and social sciences into their curricula, development of a prioritized list of behavioral and social science topics for future inclusion in those curricula, and an examination of ways in which barriers to the incorporation of behavioral and social science topics can be overcome. The committee finds that existing databases provide inadequate information on behavioral and social science curriculum content, teaching techniques, and assessment methodologies in U.S. medical schools and recommends development of a new national behavioral and social science database. It also recommends that medical students be provided with an integrated behavioral and social science curriculum that extends throughout the 4 years of medical school. The committee identifies 26 topics in six behavioral and social science domains that it believes should be included in medical school curricula. The six domains are mind-body interactions in health and disease, patient behavior, physician role and behavior, physician-patient interactions, social and cultural issues in health care, and health policy and economics.To help overcome multiple barriers to the incorporation of the behavioral and social sciences into medical school curricula, the committee recommends that the National Institutes of Health or private foundations establish behavioral and social sciences career development and curriculum development awards. Moreover, concerned that the U.S. Medical Licensing Examination currently places insufficient emphasis on test items related to the behavioral and social sciences, the committee recommends that the National Board of Medical Examiners ensure that the exam adequately covers the behavioral and social science subject matter recommended in this report.

Adequate parental leave policies promote a supportive workplace environment. This study describes how US family medicine (FM) residency program parental leave policies compare to reported leave taken by residents and faculty. This is a descriptive study of questions from a 2017 Council of Academic Medicine Educational Research Alliance (CERA) survey of accredited US FM program directors. The overall survey response rate was 54.6% (261/478). Paid maternity leave policies varied widely (0 to >12 weeks; mean=5.3 weeks for faculty and 4.5 weeks for residents); paid paternity leave ranged from 0 to 12 weeks (mean=2.7 weeks for faculty and 2.4 weeks for residents). Some FM programs reported offering residents (29.1%) and faculty (28.5%) no paid maternity leave; 37.2% offered residents and 40.4% offered faculty no paid paternity leave. Both female and male faculty took significantly less leave than was offered (maternity leave: faculty 0.6 weeks less, P<.01; residents 0.5 weeks less, P<.01; paternity leave: faculty 1.6 weeks less, P<.01; residents 0.6 weeks less, P<.01). The amount of paid and total maternity and paternity leave surrendered by residents was strongly correlated with the amount surrendered by faculty in the same program (correlation coefficients 0.46-0.87, P<.01). Residents in smaller programs, and programs with a rural focus, surrendered more parental leave. Programs vary widely in their parental leave offerings, and FM residents and faculty frequently take less parental leave than offered. As the amount of leave taken by residents and faculty at the same institution is correlated, institutional culture may contribute to parental leave use.

Most family medicine (FM) residency programs continuously recruit faculty, though little is known about their recruitment practices. In this study, we sought to define to what extent FM residency programs are relying on recruitment of program graduates, regional programs, or programs outside their region for filling faculty roles and to compare these data across program characteristics. As part of a large 2022 omnibus survey of FM residency program directors, we asked specific questions regarding the percentage of FM faculty who were graduates of that program, a program in the region, or a distant program. We aimed to determine to what extent respondents attempted to recruit their own residents to faculty positions and to identify additional program offerings and characteristics. The response rate was 41.4% (298/719). Programs reported hiring more of their own graduates compared to regional or distant graduates, and 40% prioritized recruiting their own graduates for open positions. Those who prioritized recruiting their own graduates were significantly more likely to have a higher percentage of their graduates on faculty as were larger, older, more urban programs and those offering clinical fellowships. The existence of a faculty development fellowship was significantly associated with having more faculty from regional programs. Programs that aim to improve faculty recruitment from their own graduates should consider prioritizing internal recruitment. They also may consider the development of both clinical and faculty development fellowships for local and regional hires.

Integrating behavioral health services into primary care has a strong evidence base, but how primary care training programs incorporate integrated behavioral health (IBH) into care delivery and training has not been well described. The goal of this study was to evaluate factors related to successful IBH implementation in family medicine (FM) residency programs and assess perspectives and attitudes on IBH among program leaders. FM residency programs, all which are required to provide IBH training, were recruited from the American Academy of Family Physicians National Research Network. After completing eligibility screening that included the Integrated Practice Assessment Tool (IPAT) questionnaire, 14 training programs were included. Selected practices identified 3 staff in key roles to be interviewed: medical director or similar, behavioral health professional (BHP), and chief medical officer or similar. Forty-one individuals from 14 FM training programs were interviewed. IPAT scores ranged from 4 (Close Collaboration Onsite) to 6 (Full Collaboration). Screening, outcome tracking, and treatment differed among and within practices. Use of curricula and trainee experience also varied with little standardization. Most participants described similar approaches to communication and collaboration between primary care clinicians and BHPs and believed that IBH should be standard practice. Participants reported space, staff, and billing support as critical for sustainability. Delivery and training experiences in IBH varied widely despite recognition of the value and benefits to patients and care delivery processes. Standardizing resources and training and simplifying and assuring reimbursement for services may promote sustainable and high quality IBH implementation.

BackgroundThe family medicine residency program consists mainly of clinical rotations in other specialties and the family medicine-specific training. We conducted this study to investigate how family medicine residents evaluated their training program that include family-oriented medicine, clinical preventive medicine, behavioral science and research in primary care.MethodsIn 2009, third-year residents of 129 training hospitals in Korea were surveyed to investigate the current state and their expectation of the residency program. The contents of questionnaires included training periods, conferences, procedures, interview techniques, outpatient and inpatient consultations, and written thesis.ResultsTotal 133 out of 142 residents (93.7%) responded that 3 years of training is ideal or pertinent. Residents responded that the types of conference that they need most are journal review (81%), staff lecture (73.2%), and clinical topic review (73.2%), in that order. Procedures and interview techniques that the residents want to learn most were gastroscopy (72.5%), abdominal ultrasonography (65.2%), and pain management (46.4%). Hospitals where family medicine residents do not see hospitalized patients or patients in the outpatient clinic were 7.9% and 6.5%, respectively, whereas hospitals that maintain continuous family medicine outpatient clinics were only 40.8%. Education in outpatient clinic and articlewriting seminars was done less frequently in the secondary hospitals than in the tertiary hospitals.ConclusionEvaluation and quality improvement of family medicine training program as well as specialty rotations should be considered in order to foster better family physicians. The efforts have to be made to minimize the difference in quality of each family medicine residency program.