Family Medicine Education Research Articles

Climate Change: A Crisis for Family Medicine Educators.

Climate Change: A Crisis for Family Medicine Educators.

People, Not Programs: Improving Diversity in the Family Medicine Workforce.

Patients are best served by a health care workforce that reflects the diversity of their community. Increasing diversity of family medicine requires a long-term effort to recruit more medical students from underrepresented in medicine (URiM, defined as people of Black/African American, Hispanic/Latino, Native American or Pacific Islander heritage) backgrounds into family medicine residencies. This paper examines factors that influence URiM medical students to choose family medicine residencies. Data were collected via a Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine clerkship directors. Correlations examined associations between the percent URiM faculty, percent URiM preceptors, percent clerkship cases addressing health equity, and the percent of URiM students choosing family medicine residencies. t tests determined associations between clerkship director race, preclinical electives on health equity, department faculty champion for diversity, and department diversity activities; and the percentage of URiM students choosing family medicine residencies. Survey response rate was 49%. Two factors had a positive relationship with the percentage of graduating students who were URiM choosing family medicine residencies: having a higher percentage of faculty who were URiM (r=0.33, P=.004) and having a higher percentage of preceptors who are URiM (rs=.386, P=.001). We found no such association for having cases addressing health equity, offering preclinical electives, departments with a faculty champion for diversity, clerkship director race, or a department's diversity activities. The presence of teaching faculty and community preceptors from URiM backgrounds is correlated with the rate at which students who are URiM choose family medicine. People, rather than activities, seem to influence the career choices of students from URiM backgrounds.

S1210 Catching Hepatitis C: Universal Hepatitis C Screening in a Primary Care Setting in California’s Central Valley

Introduction: An estimated 2.4 million people in the United States are living with chronic hepatitis C (HCV). Approximately 40% of HCV patients are unaware of their diagnosis. Socioeconomic status and the ongoing opioid crisis are important risk factors for HCV infection. The rates of intravenous and intranasal drug use in California’s Central Valley are among the highest in the nation and many are socioeconomically disadvantaged, creating a perfect scenario for HCV propagation. Identification and treatment of HCV is imperative to prevent morbidity and mortality as well as the spread of infection. Methods: A universal HCV screening program was implemented in the internal and family medicine teaching clinics at a large federally qualified health center in the Central Valley. The electronic medical record identifies eligible patients based on current CDC guidelines. Once identified, an automatic prompt alerts the provider and HCV labs (HCV antibody test with reflex to genotype and RNA level) are auto-populated and available to be signed at the end of the visit. Patients with active HCV infection (positive RNA level) are contacted by the designed project coordinator, who facilitates linkage to care to a primary care provider as well as to the provider experienced in treating HCV. Linkage to care is defined as, completion of the first medical appointment. Results: Universal screening was implemented on July 1, 2021. The data here was collected between July 1, 2021 and November 30, 2021. A total of 1152 patients were eligible for screening and 1084 patients completed the screening. Twenty-three patients tested positive for HCV Ab and 11 patients (9 male and 2 female) tested positive for HCV RNA. Most HCV RNA positive patients were Hispanic (36%) and African American (27%). The most common genotype was 1a (45%). Fifty-four percent of HCV RNA positive patients were linked to care. Conclusion: Prior to the implementation of universal screening, only 54% eligible patients were screened in a 12-month period. Based on preliminary data, we screened 94% eligible patients within a 5-month period. In addition, only 31% of HCV patients prior to universal screening were linked to care compared to the 54% linked to care through our initiative. Our project encouraged providers to screen patients which helped identify HCV in the community. Although data collection is ongoing, we suspect this initiative will surpass the total number of patients screened and linked to care compared to previous practices.

Changes in Career Thinking and Work Intentions Among Family Medicine Educators in Response to the COVID-19 Pandemic.

This study examined the attitudes and perceptions of family medicine educators with regards to COVID-19's impact on both career thinking and work intentions. We surveyed 949 Family Medicine educators and practicing physicians as part of the 2021 Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) survey. Changes in thinking about their nonwork lives (P < .001, OR = 2.82), changes in life priorities (P < .001, OR = 2.07), along with recent changes to the educator job that are perceived as less enjoyable (P < .001, OR = 1.31), are associated with career thinking changes. Perception of being treated fairly (P = .002, OR = 0.83), changes in thinking about nonwork lives (P = .003, OR = 1.29), changes in life priorities (P < .001, OR = 1.65), and recent less enjoyable changes to the educator job (P < .001, OR = 1.26), are associated with an intent to reduce work hours. Perception of being treated fairly (P < .001, OR = 0.81), changes in life priorities (P < .001, OR = 1.31), recent work changes that are less enjoyable (P < .001, OR = 1.38), and workload increases (P = .02, OR = 0.87), are associated with increased thoughts of doing something different in 5 years. Older participants were more likely to intent to reduce hours (P < .001, OR = 1.05) and have increased thoughts of doing something different in 5 years (P < .001, OR = 1.04). Meanwhile, women were more likely to experience career thinking changes (P = .02, OR = 1.42). Our findings suggest that the career thinking and work intentions of family medicine educators have been greatly impacted by the pandemic. There may be consequences for how they think about and approach their careers and jobs in the future. Additional research is needed to determine what these actual consequences mean. In addition, employers should carefully assess these types of changes, identify which educator subgroups they may affect the most, and act accordingly, particularly in areas like recruitment and retention.

The Impact of Self-directed Learning on the Future of Family Medicine Education.

The Impact of Self-directed Learning on the Future of Family Medicine Education.

Are Medical Students Adequately Trained to Care for Persons With Disabilities?

Insufficient provider training contributes to health care disparities for 61 million Americans with disabilities.2,4 This study examines medical students' perceptions of their disability training and the perceived effect training has on students' preparedness to care for people with disabilities (PWD) in future practice. Principles of the Core Competencies on Disability for Health Care Education5 generated 10 questions. The questions were included in a survey conducted by the Council of Academic Family Medicine Educational Research Alliance (CERA) and sent to medical student members of the American Academy of Family Physicians (AAFP). We compared responses using unadjusted χ2 tests. One hundred forty-seven surveys were returned, with 126 used for this analysis; 36% of students reported that their medical training provided them with the knowledge necessary to provide high-quality, comprehensive health care for PWD in their future practice and 97.6% agreed or strongly agreed that they needed to learn more. Six of the curricular exposures demonstrating variations of the health care needs of PWD were associated with higher percentages of medical students agreeing they are trained to perform high-quality health care for PWD in future practice. Medical students continue to report deficiencies in training, knowledge, and preparedness to care for PWD. Based on the Core Competencies framework, we have identified six curricular exposures that increase readiness to care for PWD. Therefore, we recommend the Liaison Committee on Medical Education formally integrate requirements for disability training in the standards of accreditation.7.

Disability as Diversity: Educational Opportunities for Family Medicine.

Disability is an aspect of diversity that often receives less attention in healthcare and medical education than other aspects of diversity, such as gender or race. Approximately one in four Americans has some type of disability, and individuals with disabilities have less access to healthcare, greater dissatisfaction with their healthcare, and report being in poorer health than individuals without a disability. Although many factors likely contribute to these disparities, physician perception and understanding of disability have been examined as potential pathways that influence health inequity. It is important to incorporate disability as a form of diversity in family medicine education to train physicians that provide excellent care to patients with disabilities and work toward equitable healthcare for them. In this article, we review definitions and data related to disability. We examine disparities and forms of stigmatization toward individuals with disabilities. We then present scenarios in the context of family medicine residency education that involve stigmatization of a person with a disability. Following each scenario, we identify the stigmatizing problem and its potential impact on the individual with a disability. In addition, we outline a potential intervention as an individual witnessing this scenario, and an alternative, non-stigmatizing approach to the scenario. Finally, we present proposed core competencies on disability for health care education and potential strategies to incorporate these competencies into family medicine curricula.

Use of Telemedicine in the Family Medicine Clerkship: A CERA Study.

In March 2020 with the onset of the COVID-19 pandemic, clinical rotations abruptly ceased, and telemedicine became an alternative to in-person patient care. This study investigates factors associated with long-term adoption of telemedicine during family medicine clerkships. Data were gathered from the 2021 CERA survey of family medicine clerkship directors. Participants answered questions about the use of telemedicine in the clerkship, adequacy of telemedicine resources, how well telemedicine visits helped students meet course objectives, quality of course evaluations, efficiency of students seeing patients using telemedicine, and likelihood of continuing use of telemedicine once in-person visits are reinstated. The response rate was 48.8%. While most clerkship directors did not use telemedicine prior to the COVID-19 pandemic with their own patients, most had medical students utilize telemedicine during the pandemic. Clerkship directors were more likely to continue having students use telemedicine in the clerkship if it helped them meet clerkship objectives, if telemedicine visits were efficient, and if course evaluations were positive. Adequacy of resources was not associated with likelihood of retaining telemedicine in the clerkship. Family medicine clerkship directors will likely continue to have students see patients via telemedicine, particularly if feedback is positive. Family medicine educators need to develop and evaluate new telemedicine curriculum for learner benefit, patient acceptability, and overall care quality.

Current State of Point-of-Care Ultrasound Use Within Family Medicine.

Following the publication of Point-of-Care-Ultrasound (POCUS) curriculum guidelines from the American Academy of Family Physicians in 2016, there has been a rapid expansion in POCUS curricula across family medicine departments in the US. There is growing appreciation for the potential role of POCUS in enhancing the clinical care family physicians provide to patients. The primary aim of our study was to evaluate the utilization of POCUS in outpatient clinic care across Family Medicine departments nationwide and to identify perceived or realized barriers in integrating POCUS use for clinic care. The questions were part of a larger omnibus survey of US Department of Family Medicine chairs, conducted by the Council of Academic Family Medicine Educational Research Alliance (CERA) between August 6 to August 31, 2021. 81% of departments have at least 1 POCUS-trained faculty, with 44% of departments using POCUS in some ambulatory clinical care. Currently, only 6% have established billing for the POCUS they perform. Faculty time, as well as funding, for POCUS training were seen as 2 primary barriers. The purchasing of equipment and billing for POCUS were described by FMCs as difficult. As POCUS use continues to rise in Family Medicine, it is imperative to create a more efficient and less hindered road to growth. Collaboration across departments to share best practices in training, purchasing equipment and billing for POCUS will be important to facilitate high-quality POCUS access for our patients.

Evaluating the Uptake of Antiracism Training, Policies, and Practices in Departments of Family Medicine.

Recent attention and focus on, antiracism training in health care has potential to accelerate our path to social justice and achieve health equity on a national scale. However, theoretical frameworks and empirical data have yet to emerge that explain the uptake of antiracism trainings and their efficacy. This goal of this study was to test hypotheses regarding uptake of antiracism training in Family Medicine departments using Diffusion of Innovation Theory. In 2021, we incorporated 10 survey items in the Council of Academic Family Medicine Educational Research Alliance's national omnibus survey for Department of Family Medicine Chairs (n = 104). We used DOI (Diffusion of Innovation) attributes (ie, relative advantage, compatibility, complexity, trialability, and observability) as a guiding framework to assess perceived innovation of antiracism training. We also evaluated the mode of training (eg, didactic, experiential) and whether any subsequent policy or practice-level antiracist actions occurred. We used c2 tests to examine associations between DOI attributes and antiracist actions; and logistic regression to determine odds of association. Ninety-two percent of respondents indicated antiracism training was happening in their department. Relative advantage, compatibility and observability were positively associated with antiracist actions, P < .05. Perceived relative advantage was associated with implementation of antiracist action (OR 1.94, 1.27-2.99). Complexity and trialability were not statistically significantly associated with action. Our findings provide evidence of DOIs influence on antiracism uptake in Departments of Family Medicine. We believe our findings can facilitate the future implementation of antiracism training activities and actionable antiracist policies and practices.

Bedside Teaching in Rural Family Medicine Education in Japan.

Bedside teaching is essential in family medicine education so that residents may learn about various clinical conditions and develop professional skills. In particular, bedside teaching is useful in a rural context because rural family medicine deals with a broad scope of biopsychosocial problems among older patients. Accordingly, based on an inductive thematic analysis, we propose a framework for bedside teaching in rural family medicine education, which consists of four themes: accommodation of different learners, near-peer learning, the change in engagement of medical teachers in bedside teaching, and driving interpersonal collaboration. Bedside teaching can promote interactions between different medical learners. Near-peer learning in bedside teaching compensates for the limited availability of educators and improves learners’ motivation for self-directed learning. Through bedside teaching, medical learners can observe each other and provide constructive feedback, thereby improving their relationships and learning. For effective bedside teaching, medical educators should facilitate learners and collaborate with other medical professionals. Additionally, bedside teaching should accommodate a variety of learners, facilitate near-peer and self-directed learning, educators’ involvement based on cognitive apprenticeship, along with interprofessional collaboration with nurses. Interprofessional collaboration between rural family medicine teachers, learners, and nurses may improve the quality of patient care due to the increased understanding between patients and other medical staff in hospitals.

Predictive Factors of Positive E-Learning Experience

During the COVID-19 pandemic, medical schools and residencies have utilized electronic learning (e-learning). Factors such as internet access, age, degree of introversion/extroversion, and propensity to adopt new technologies impact attitudes toward e-learning. This study investigates family medicine educators' satisfaction, effectiveness, and feasibility perceptions of e-learning, characterizes demographic factors impacting attitudes, and identifies which aspects of e-learning are important to educators. In fall 2020, a cross-sectional survey via the 2020 Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) general membership survey was conducted. Members of CAFM-affiliated associations were invited by email to participate. The response rate for the survey was 20.1% (n=862). Of the respondents, 40.4% (n=311) reported satisfaction with e-learning, 47.8% (n=368) found e-learning feasible, and 24.2% (n=186) reported e-learning met their educational goals. No differences were found in satisfaction, feasibility, or effectiveness scores according to generation, introvert/extrovert status, or technology adopter status. Interactive capabilities were the most important factor for e-learning satisfaction (55.9%) and effectiveness (62.0%). Sufficient time was the most frequently selected factor for ease of adoption. Baby Boomer respondents reported platforms not user-friendly, insufficient prior experience as the greatest obstacle more frequently than other generations, and insufficient time less frequently than other generations. Otherwise, rankings of e-learning factors were similar among groups. Satisfaction with and perceived feasibility and effectiveness of e-learning varies among family medicine educators. No differences were found in satisfaction, feasibility, or effectiveness scores according to generation, introvert/extrovert status, or technology adopter status. Respondents consistently ranked interactive capabilities most important for e-learning satisfaction and effectiveness. More research is needed to compare student and learner perspectives regarding e-learning.

Vasectomy Training in Family Medicine Residency Programs: A National Survey of Residency Program Directors.

Vasectomy is considered a permanent contraceptive method with fewer associated harms than bilateral tubal ligation. However, the number of vasectomy-trained providers may not be meeting the demand for vasectomy in the United States. We describe the vasectomy training landscape in family medicine residencies and factors related to increased procedural training. Program-specific data were collected from the Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of family medicine program directors in 2019. Program characteristics, vasectomy training (eg, time spent, procedural numbers), as well as direct and specific faculty support are described, with bivariate analyses for factors related to procedural competency, defined as more than five vasectomy procedures per resident. We received responses from 250 program directors (response rate=39.8%), with representation across all US regions, and program types. Nearly half (47.5%) offered less than 1 day of vasectomy didactics and/or procedural training; 38.9% of programs reported having a family medicine faculty champion for vasectomy. Only 16 programs (6.8%) reported that their average graduating residents performed more than five vasectomies. Programs with a faculty champion (OR 28.1, CI 3.6-216.4) or family medicine faculty as primary trainer (OR 17.6, CI 2.2-138.2) were more likely to graduate residents who had performed more than five vasectomies. Fewer than 10% of surveyed family medicine residency programs offer adequate vasectomy procedural training. Family medicine faculty who serve as primary trainers and act as faculty champions can increase vasectomy training opportunities for residents, and thereby increase the supply of vasectomy providers in the United States.

Interprofessional Collaborative Relationship-Building Model in Action in Primary Care: A Secondary Analysis.

IntroductionTeam-based care has been integrated into primary care (PC) across Canada because it improves patient safety, effectiveness, efficiency, person-centredness, and equity. However, this integration in and of itself may not lead to improved patient care without effective interpersonal relationships amongst team members. Currently, teams have few tools to guide the development of collaborative relationships. The Interprofessional Collaborative Relationship-building Model (ICRB) was developed to be a tool for understanding the stages of development of the interprofessional team's relationship-building.PurposeThis qualitative secondary data analysis illuminates a PC team's experiences of their developing interprofessional relationships with occupational therapists and physical therapists who joined the PC team.MethodEleven team member interviews of one primary care team from a family medicine teaching clinic affiliated with a training university and the health region in central Canada were analyzed using secondary data analysis. The team included family physicians (n = 4), nurses (n = 2), a social worker (n = 1), a mental health counselor (n = 1), occupational therapists (n = 2), and a physical therapist (n = 1). We used the ICRB for directed content analysis using the phased approach that includes the three main steps of data preparation, data organization and data presentation.ResultsThis team experienced the ICRB stages of Looking For Help, Fitting-In, and Growing Reciprocity thereby learning about one another to better understand what OT and PT may bring to the PC setting. However, contrary to the ICRB, co-location, was the context within which the collaborative relationship-building took place rather than a distinct developmental stage. Although team members did experience some level of Growing Reciprocity, this developing team had not yet established collaborative leadership processes. As the ICRB originally posited, communication and patient focus facilitated all stages of the relationship-building process and helped the team develop shared values and role clarity that establish how different team members contribute to improving quality care.ConclusionsThe context of co-location with a patient focus and open communication facilitated the team's development with the occupational therapists and physical therapist. Collaborative leadership is a worthy goal for future research and clinical focus as it has implications for improving overall patient quality care and team member work satisfaction.

Impact of Collaborative Inpatient Pairing Between Pharmacy Students and Family Medicine Residents on Perceptions of Interprofessional Care.

Interprofessional education (IPE) and collaborative practice increasingly inform accreditation standards for pharmacy and medical education, grounded in evidence of benefits to patients and learners. Optimizing models that meaningfully provide this type of practice remains a challenge. This study examines the impact of inpatient collaboration between pharmacy students and family medicine residents on perceptions of interprofessional care. Pharmacy students and family medicine residents were invited to participate in an IPE experience during their medicine rotation, in which student-resident pairs worked collaboratively on patient care for a block rotation. We used a Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education Instrument (SPICE-2) survey instrument and included an opportunity for open comments by participants. We performed statistical analysis using paired t tests. We observed statistically significant changes (P<.05) in four of the 10 survey items for pharmacy students and two out of 10 in family medicine residents. Narrative comments provided by both students and residents were positive regarding the IPE experience. This pilot provides preliminary evidence to support an IPE care model that integrates pharmacy students by pairing them with family medicine residents on an inpatient adult family medicine teaching service. Implementation of a paired-IPE model changed both professions' perception of their roles within the team and appreciation of training requirements. Larger studies could be done to further evaluate the outcomes of this and similar models.

Outpatient maternity care and telemedicine use perceptions in the COVID-19 pandemic: a 2020 CERA survey

ABSTRACT The COVID-19 pandemic resulted in rapid telemedicine implementation. This study aimed to identify mean differences in telehealth maternity care provided by perceived patient acceptability and clinician satisfaction, and to determine the association between acceptability, satisfaction, and perceived anticipation of long-term telehealth utilization in family medicine maternity care. Data from the 2020 Council of Academic Family Medicine Educational Research Alliance general membership survey of family medicine educators and practicing clinicians were analyzed. Respondents who reported providing maternity care in the 12 months preceding the survey were included (N = 290). Descriptive statistics were calculated. ANOVA was used to determine the mean difference in percent maternity care provided by reported clinician satisfaction and perceived patient acceptability. Logistic regression models were fit to determine associations between perceived telehealth satisfaction and acceptability with long-term use. The sample was 67 percent female, 85 percent white, mean age of 45 years (SE = .63). 51 percent reported total prenatal visits decreased since pandemic onset. Greater agreement with perceived patient telehealth acceptability (OR = 3.73 , 95 percent CI 1.09, 12.71) and clinician telehealth satisfaction (OR = 3.72 , 95 percent CI 1.40, 9.86) was significantly associated with anticipated long-term usage. Perceived patient telehealth acceptance and clinician satisfaction were significantly higher among clinicians providing more telehealth and positively associated with anticipated long-term use.

Promotion Preparation Tips for Academic Family Medicine Educators.

Promotion has historically valued the scholarship of discovery over the scholarship of teaching. The clinician-educator promotion pathway is an attractive option for academic family physicians engaged in significant teaching. However, clinician-educators are less often promoted than peers on other tracks. Family medicine educators face unique challenges in promotion due to clinical requirements and often less guidance on how to meet promotion criteria. Promotion recognizes achievements of faculty and is often tied to higher base salary. We aimed to identify promotion preparation tips for academic family medicine educators. We surveyed members of the Society of Teachers of Family Medicine (STFM) Medical Student Education Collaborative electronically on promotion preparation lessons learned in (1) curriculum vitae preparation, (2) personal statement preparation, (3) selecting external reviewers, and (4) identifying measurable achievements. This qualitative study used grounded theory and constant comparison. Fourteen individuals from 13 medical institutions responded with tips for success in promotion preparation. The tips identified actionable steps for promotion preparation of academic family medicine educators. Several main themes emerged, including the importance of timely and thorough documentation, detailed planning, and being knowledgeable about institutional-specific criteria early. The tips provided in this study support family medicine educators in preparing for promotion and can be used as a tool for mentors, chairs and faculty development.

Training Family Medicine Residents to Address the COVID-19 Pandemic: A National Survey of Program Directors.

Public health training became particularly important for family medicine (FM) residency training programs amid the COVID-19 pandemic; the Accreditation Council for Graduate Medical Education (ACGME IV.C.19) requires a structured curriculum in which residents address population health. Our primary goal was to understand if, and to what extent, public health interventions trainings were incorporated into FM residency training programs amid the COVID-19 pandemic. We hypothesized programs with more resources (eg, university affiliates) would be better able to incorporate the training compared to those without such resources (ie, nonuniversity affiliates). In 2021, we incorporated items addressing COVID-19 public health training competencies into the 2021 Council of Academic Family Medicine Educational Research Alliance national survey of FM residency program directors. The items addressed the type of training provided, mode of delivery, barriers to providing training, perceived importance of training, and support in delivering training. The overall survey response rate was 46.4% (n=287/619). All programs offered at least some training to residents. There were no statistically significant differences in training intensity between university and nonuniversity affiliates. The length of time an FM residency director spent in their position was positively associated with training intensity (r=0.1430, P=.0252). The biggest barrier to providing the trainings was the need to devote time to other curriculum requirements. FM residency programs were able to provide some public health interventions training during the pandemic. With increased support and resources, FM resident training curricula may better prepare FM residents now in anticipation of a future pandemic.

Family Medicine Musculoskeletal Medicine Education: A CERA Study.

Musculoskeletal (MSK) concerns constitute up to 40% of primary care outpatient visits. Despite Accreditation Council for Graduate Medical Education (ACGME) family medicine program requirements for musculoskeletal medicine and sports medicine training, previous studies have shown that family medicine residency graduates do not have adequate training to manage common musculoskeletal conditions. Factors for this may include deficiencies in education at both the undergraduate and graduate medical education training levels. A Council of Academic Family Medicine Educational Research Alliance survey of 287 family medicine program directors assessed the current state of the delivery of musculoskeletal medicine education. Opinions were gathered on the scope and delivery of training requirements as well as potential areas for further curricular attention. Two hundred eighty-seven program directors responded to the survey (response rate 41.53%). Most (72.60%) were in university based or affiliated programs and had a fellowship-trained primary care sports medicine physician (59.85%) curricular lead. A majority (77.4%) did not feel that PGY-1 residents enter residency with the physical exam skills needed to evaluate common musculoskeletal (MSK) conditions , and most (81.15%) did not feel that there should be changes to the current ACGME requirements. An area highlighted for further investment is faculty development in point-of-care ultrasound (39.85%). Although program directors believe that current ACGME MSK curricular requirements are likely appropriate, they do not feel residents arrive with the examination skills needed to evaluate common MSK conditions.Therefore, further attention can be given to medical student education in musculoskeletal exam skills prior to residency. Future research should develop objective measures using multiple assessors-students, residents, teaching faculty, and patients-to assess both the baseline and graduating competency in MSK medicine of our residents.

Reflection in Rural Family Medicine Education.

Reflection in medical education is vital for students’ development as professionals. The lack of medical educators in rural family medicine can impinge on the effective reflection of residents’ learning. Hence, based on qualitative research, we proposed a framework regarding reflection in rural family medicine education, indicating when, where, and how reflection is performed and progresses. The contents of reflection include clinical issues regarding knowledge and skills, professionalism in clinical decisions, and work-life balance. The settings of reflection include conference rooms, clinical wards, residents’ desks, and hospital hallways. The timing of educational reflection includes during and after patient examination and discussion with various professionals, before finishing work, and during “doorknob” times (right before going back home). Rural medical teachers need competence as clinicians and medical educators to promote learning in medical residents and sustain rural medical care. Furthermore, medical teachers must communicate and collaborate with medical residents and nurses for educational reflection to take place in rural family medicine education, especially regarding professionalism. In rural family medicine education, reflection can be performed in various clinical situations through collaboration with learners and various medical professionals, aiding the enrichment of residents’ learning and sustainability of rural medical care.