Board-certified Family Physicians Research Articles

Integration of Telehealth in Routine Perinatal Care: A Model of Care for Primary Healthcare Clinics in Saudi Arabia.

This study aims to introduce a new model of antenatal/postnatal care that integrates virtual clinics with the current model of care, including a discussion on the current model, pre-existing barriers, and prenatal framework, and the need for transition to telehealth beyond the pandemic. In antenatal primary health care centers, such as King Abdulaziz Medical City (KAMC), low-risk antenatal/postnatal care receives clinical care through complete physical attendance in antenatal/postnatal clinics in primary care clinics for pregnancy follow-up and in tertiary hospitals for fetal ultrasound and invasive procedures if needed. Pregnancy is confirmed through a regular family medicine (FM) clinic where risk assessment through history, physical examination, and investigations are carried out. If the pregnant woman is at low risk, she will be started on folic acid, 1 mg or 5 mg based on the risk assessment (if it was not received before). Pregnant women will be given a telehealth appointment for the lab results. Concomitantly, the pregnant women will receive an appointment in the antenatal clinics, which board-certified family physicians run. High-risk patients will be referred to the hospital for further care. Current postnatal care is delivered through regular booking with the FM clinic through physical attendance sometimes, and virtual care is provided upon physican/patientrequest. Current care meets the past quality care and patient expectations. However, with the current Saudi Vision 2030 and after the experience with virtual care during the COVID-19pandemic, the current services need to move a step forward to meet the rapidly developing medical care/needs in Saudi Arabia. Various challenges must be addressed, and new models must be included in clinical care for pregnant and postnatal women. Introducing virtual antenatal/postnatal care to the current care could be a new era in maternity primary health care; this model will move the clinical care provided to pregnant/postnatal women a step forward that meets the excellence of high-quality, evidence-based medical care.

Defining Essential Topics and Procedures for Korean Family Medicine Residency Training

BackgroundThis study aims to create a comprehensive list of essential topics and procedural skills for family medicine residency training in Korea.MethodsThree e-mailed surveys were conducted. The first and second surveys were sent to all board-certified family physicians in the Korean Academy of Family Medicine (KAFM) database via e-mail. Participants were asked to rate each of the topics (117 in survey 1, 36 in survey 2) and procedures (65 in survey 1, 19 in survey 2) based on how necessary it was to teach it and personal experience of utilizing it in clinical practice. Agreement rates of the responses were calculated and then sent to the 32 KAFM board members in survey 3. Opinions on potential cut-off points to divide the items into three categories and the minimum achievement requirements needed to graduate for each category were solicited.ResultsOf 6,588 physicians, 256 responded to the first survey (3.89% response rate), 209 out of 6,669 to the second survey (3.13%), and 100% responded to the third survey. The final list included 153 topics and 81 procedures, which were organized into three categories: mandatory, recommended, and optional (112/38/3, 27/33/21). For each category of topics and procedures, the minimum requirement for 3-year residency training was set at 90%/60%/30% and 80%/60%/30%, respectively.ConclusionThis national survey was the first investigation to define essential topics and procedures for residency training in Korean family medicine. The lists obtained represent the opinions of Korean family physicians and are expected to aid in the improvement of family medicine training programs in the new competency-based curriculum.

Care for caregivers- a mission for primary care

BackgroundThe number of elderly people living in the community who are limited in daily activities is increasing worldwide. This generates prolonged care, which usually falls on one family member, the family caregiver. Caregivers are prone to develop psychosocial and physical symptoms. As a result, the World Health Organization (WHO) issued a clear directive to assess and support these caregivers.The main goals of this study were to assess primary care physicians’ (PCP) awareness to caregivers’ health risks and the extent that they recommended preventive measures to maintain the health of the caregivers. As no suitable instrument existed, a secondary goal was to develop a scale to measure physicians’ awareness to caregivers’ health and preventive treatment and test it’s psychometric properties.MethodsData were collected from a convenience sample of 201 PCP interviewed with structured questionnaires.ResultsThe participants’ mean age was 48.5 ± 11.2 years and 53.5% were female. Only 48.5% were Israel medical graduates and 72% were board-certified family physicians. Nearly 34% had been primary caregivers of family members.Most physicians (83.6%) were aware of the primary caregiver’s high-risk for morbidity and mortality, and recommended preventive care. On a multivariate regression, PCP's higher level of risk awareness, their country of medical school and board certification were significant for explaining recommendations for preventive care. However, being a primary caregiver for a sick family member neither contributed significantly to the physicians’ awareness to caregiving risks nor to their preventive care.ConclusionAlthough a high percentage of physicians were aware and concerned about caregivers’ health, their preventive care activities were relatively passive. PCPs should take a more active and preventive role for maintaining caregivers’ health.

Revisiting Medical Professionalism and ABFM's Guidelines for Professionalism, Licensure, and Personal Conduct in a New Era

In June, the American Board of Family Medicine (ABFM) published revised Guidelines for Professionalism, Licensure, and Personal Conduct (Guidelines) after more than a year of careful study and deliberation. Our goal was to improve the clarity of the process by which board-certified family physicians

The Nutrition-Focused Physical Examination: Added Value for Patients and Clinicians

The Nutrition-Focused Physical Examination: Added Value for Patients and Clinicians

Primary Care Perceptions and Practices on Discussion and Advice Regarding Sexual Practices.

The United States has experienced an increase in sexually transmitted infections (STIs) in the past decade, a trend that may be influenced by communication gaps between family physicians and patients. We sought to identify factors that hinder discussion about safe sexual practices and STIs, understand physicians' perceptions of their role in preventing STIs, and explore methods of initiating discussions on sexual health. From April 30, 2016 to September 1, 2016, family physicians at our institution were given written surveys with 22 questions to answer and rank in order of their best practice. The survey assessed participants' age, sex, level of medical education, and possible barriers to initiating discussion and offering advice on safe sexual practices. All of the participants identified time constraints and the presence of a patient's spouse, parents, or siblings as the most common barriers. Other barriers included fear of embarrassing patients and feeling inadequately knowledgeable about the sexual practices of lesbian, bisexual, gay, and transgender patients. All of the participants reported that patients rarely object to discussing sexual behaviors. Our study identified several barriers that family physicians may face when initiating discussions and advising patients on safe sexual practices. To prevent new cases of STIs, it is important to work around these barriers to improve physician-patient communication. This can be further improved by providing continuous learning opportunities for medical students, residents, and board-certified family physicians on ways to appropriately counsel patients on safe sexual practices.

Experience of Family Physicians in Practice Transformation Networks.

To help health care practices transition away from fee-for-service reimbursement and toward value-based payment, the Transforming Clinical Practice Initiative was launched in October 2015. It was designed to provide clinicians support through peer-based Practice Transformation Networks (PTNs). A group of American Board of Family Medicine board-certified family physicians enrolled in PTNs described their expectations of and experiences with PTN participation; we analyzed open-text comments. Physicians expected and experienced PTN support in informatics and data, team building, and workflow and care coordination; however, expectations regarding patient care and engagement, costs and payment reform, and population and panel health were described less frequently.

Comparison of AR, ITS, CBT, and Didactic Training and Evaluation of Retinopathy-Based Diagnosis.

To test the relative efficacy of adaptive and fixed simulator training vs. adaptive and fixed computer-based training (CBT) vs. traditional lecture. Ninety-two board certified Family Physicians were given a pretest, followed by training under one of five randomly assigned training conditions: (i) adaptive CBT; (ii) non-adaptive CBT; (iii) adaptive simulator; (iv) non-adaptive simulator; and (v) lecture. Subjects were given a post-test immediately after training and again in 6 weeks. In the adaptive groups, the content presented to subjects was a function of the subjects' knowledge and performance, under control of a MOODLE LMS. In the lecture component, a physician projected images identical to the images in the CBT component of the study. No significant differences (p = 0.89 for ANOVA) in baseline knowledge between the five groups, based on pretest scores; In each of the five groups, our intervention resulted in immediate changes in knowledge (95% CI), based on analysis of pretest and PostTest1 scores; and, with the exception of subjects with non-adaptive, simulator intervention, all groups had significant decay in knowledge between the first and second post-tests (95% CI). Periodic simulator intervention could result in significant knowledge retention over extended periods of time.

American Board of Family Medicine Rolls Out Family Medicine Certification Longitudinal Assessment (FMCLA) as 2019 Pilot

In response to requests from board-certified family physicians, American Board of Family Medicine (ABFM) has announced a new pilot program for 2019 to assess the value and feasibility of a longitudinal assessment option to the 10-year 1-day examination. Grounded in advances in education and

ABFM ROLLS OUT FAMILY MEDICINE CERTIFICATION LONGITUDINAL ASSESSMENT (FMCLA) AS 2019 PILOT

In response to requests from board-certified family physicians, the American Board of Family Medicine (ABFM) has announced a new pilot program for 2019 to assess the value and feasibility of a longitudinal assessment option to the 10-year 1-day examination. Grounded in advances in education and

Board Certified Family Physician Workforce: Progress in Racial and Ethnic Diversity.

Diversification of the physician workforce has been a goal of Association of American Medical Colleges for several years and could improve access to primary care for under-served populations and address health disparities. We found that family physicians' demographics have become more diverse over time, but still do not reflect the national demographic composition. Increased collaboration with undergraduate universities to expand pipeline programs may help increase the diversity of students accepted to medical schools, which in turn should help diversify the family medicine workforce.

Slow Progress and Persistent Challenges for the Underrepresented Minority Family Physician.

In the article, “Board certified family physician workforce: progress in racial and ethnic diversity,” the authors review the racial and ethnic background of physicians to document proportional growth over time as compared with 2017 United States Census data. In their analysis, they aggregated

The world could end cervical cancer if it tried: an interview with DrShobha S Krishnan.

BiographyShobha S Krishnan is the Founder and President of the Global Initiative Against HPV and Cervical Cancer (GIAHC). She is a board-certified family physician and gynecologist and has been involved in the areas of primary care and women's health for over 30 years. She has extensive experience both nationally and internationally in the field of HPV and HPV-related diseases. Her vast experience in this field has given her a unique perspective on various issues related to HPV and its disease consequences.She is the author of the national and international award-winning book, The HPV Vaccine Controversy: Sex, Cancer, God and Politics (Praeger, 2008). Her book chapter on ‘Challenges in Screening for Cervical Cancer’ was recently published in Cancer Screening in the Developing World (University Press of New England, May, 2018).She is the chair of the HPV and Cervical Cancer Task Force at the American Medical Women's Association. She is also a member on the expert's panel of the American Sexual Health Association, Medical Advisory Board of the National Cervical Cancer Coalition and on the scientific committee at the Medical Women's International Association. In addition, she has served on the sexually transmitted disease research working group at Columbia University (NY, USA) and as a surveillance physician for the Centers for Disease Control.After completing her residency training, Krishnan went into private practice for 10 years before joining Columbia University, where she worked for several years. In December 2015, she received her master's certification in Non-Profit Leadership and Management from the University of Florida (FL, USA).

Is the National Health Service Corps the Answer? (for Placing Family Doctors in Underserved Areas).

Paying for college and medical school is expensive in the United States, often leaving recent graduates with large educational loan debt.[1][1] This can influence the specialty medical students choose and where they practice. Analyzing a survey of board-certified family physicians who were 3 years

Primary care variability in patients at higher risk for colorectal cancer: evaluation of screening and preventive care practices

Objective: Sub-optimal colorectal cancer (CRC) evaluations have been attributed to both physician and patient factors. The primary objective of this study was to evaluate physician practice variation in patients with a higher risk of CRC. We wanted to identify the physician characteristics and the types of patients that were associated with missed screening opportunities; we also explored whether screening for CRC served as a proxy for better preventive care practices.Methods: A total of 213 board-certified family and internal medicine physicians participated in the study, conducted between September and December 2016. We used Clinical Performance and Value (CPV®) vignettes, simulated patients, to collect data on CRC screening. The CPV patients presented with a typical range of signs and symptoms of potential CRC. The care provided to the simulated patients was scored against explicit evidence-based criteria. The main outcome measure was rate a diagnostic CRC workup was ordered. This data quantified the clinical practice variability for CRC screening in high risk patients and other preventive and screening practices.Results: A total of 81% of participants ordered appropriate CRC workup in patients at risk for CRC, with a majority (71%) selecting diagnostic colonoscopy over FIT/FOBT. Only 6% of physicians ordering CRC workup, however, counseled patients on their higher risk for CRC. The most commonly recognized symptoms prompting testing were unexplained weight loss or inadequate screening history, while the least recognized symptoms of CRC risk were abdominal discomfort found on review of systems.Conclusion: This study shows that primary care physician screening of CRC varies widely. Those physicians who successfully screened for CRC were more likely to complete other prevention and screening practices.

Prevalence of Burnout in Board Certified Family Physicians.

Physician burnout has become a critical issue in a rapidly changing health care environment and is reported to be increasing. However, little is known about the prevalence of this problem among board-certified family physicians. Using an abbreviated burnout survey, we found a lower prevalence of this problem than has been previously reported.

Surveillance or symptom management? Insights from 5 years of caring for survivors.

44 Background: One of the most widely held definitions of cancer Survivorship is that it begins "at the time of diagnosis and for the balance of life" (NCCS). An emphasis on providing Survivorship Care Plans (SCP), pushes many Survivorship Programs toward long-term surveillance and care planning for patients who have completed treatment. The needs of survivors who are in the period between diagnosis and completion of treatment are not addressed by SCP. In 2011, our multidisciplinary oncology group hired a board-certified Family Physician to develop a Survivorship Program that would serve the needs of cancer patients at the time of diagnosis and for the balance of life. We report here on what we have learned about our survivors after the first 5 years of caring for them. Methods: Cancer patients were referred to the program by oncology specialists, community physicians, or by patient self-referral. De-identified data for each case were entered into a database including cancer type, stage, treatment, age at diagnosis and at first visit, and primary reason for referral (surveillance, symptom management, or assistance with complex medical decision making). Results: During the 5-year period, 994 patients were seen, median age 61 years (min 26, max 94). Breast cancer was the most common (86%). Patients were referred for surveillance (46%), symptom management (49%), or decision-making (5%). Patients referred for surveillance decreased from 62 to 22%. Patients referred for symptom management increased from 36 to 57%. Patients referred for decision-making increased from 2 to 21%. Patients referred for symptom management were younger (median age 60 vs 63), more likely to have stage II, III, or IV disease (53 vs 34%), and more recently diagnosed (median 1 vs 4 years) than patients referred for surveillance. Conclusions: Over the past 5 years our patients' needs have forced our program to evolve away from surveillance and prevention for early-stage, lower risk patients at the end of their treatment. We are now focused primarily on managing the adverse treatment-related symptoms for patients with higher stage disease. We have observed that patients require and desire survivorship care throughout their cancer experience, not just at the end of treatment.

International primary care snapshots: Israel and China.

For many years community medicine has been the ‘stepdaughter’ of medicine in Israel since most medical training took place in hospitals, and community medicine was perceived as second best. This has changed dramatically in the past decades. Since 1995, in accordance with Israeli national health law, all residents of the state of Israel are entitled to receive health care, provided by four health maintenance organisations (HMOs). The service is based on primary care clinics spread across the country. Today there are around 5500 GPs, of which approximately 1600 are board-certified family physicians and employed by the four HMOs. The training programme in family medicine in Israel began in 1969, and since the early 1990s, there has been a significant increase in the number of physicians specialising in family medicine. Each HMO has at least one department of family medicine responsible for the training programme. The 4-year internship in family medicine has undergone numerous changes in recent years. The portion of internship in family medicine has been extended at the expense of hospital wards, in order to shift the teaching paradigm to primary care. Board exams were modified to include standard parts enabling more uniform testing and reducing examiner dependent bias. ### Moving to the front of the stage Excellent primary care is the key to good medicine. Changes in the healthcare system led to moving services from hospitals into the community to reduce costs and improve availability, in turn leading to an increment in the exposure of community medicine in medical schools. Yet the vast majority of clinical teaching is still hospital oriented. Clerkship of family medicine became an integral, mandatory part of medical studies in all medical schools in Israel, and clerkship of exposure to community medicine have been added. The medical school, opened in 2012 at the Safed branch of Bar-Ilan University, includes about one-quarter of …

Managing Diabetes Mellitus: A Survey of Attitudes and Practices Among Family Physicians.

Due to the increasing prevalence of diabetes and the shortage of endocrinologists, family physicians have an important role in diabetes management. The purpose of this study was to examine the sources of knowledge, attitudes and practices of family physicians regarding the management of type 2 diabetes. Attendees at continuous medical education (CME) programs in Israel were requested to respond anonymously to written questions about their sources of knowledge about diabetes, the methods of diabetes management they advise their patients, their knowledge of diabetes medication treatments, and their attitudes toward people with type 2 diabetes. Questionnaires were completed by 362 family physicians (79 % response rate). Of them, 329 (91 %) reported that they usually manage their patients’ diabetes care, including that of patients with concomitant risk factors. Their most common recommendations for diabetes control were: to increase physical activity, decrease total calorie intake, consult with a dietitian and undergo weight loss counseling. Almost all physicians (97 %) reported providing lifestyle change counseling. Sixty percent reported lacking knowledge about nutritional issues. Only 58 % answered correctly regarding the effect of the anti-diabetic drug, GLP1 analog. Board certified family physicians and their residents exhibited more knowledge about diabetes practice than did non-board certified family physicians. The great majority of family physicians surveyed usually manage their patients’ diabetes themselves, and do not refer them to diabetes specialists. The implementation of strategies that will enhance the competencies and confidence of family physicians in diabetes management are important for achieving successful treatment.

Aging in rural America.

For older Americans, accessing high-quality care can be a challenge. For those in rural communities, it's even harder.