Family Medicine Graduates Research Articles

Community empowerment: multipliers of good - integrating Family and Community Medicine graduates and residents in a curricular extension project in Primary Care

Community empowerment: multipliers of good - integrating Family and Community Medicine graduates and residents in a curricular extension project in Primary Care

"Not doing it justice": Perspectives of Recent Family Medicine Graduates on Mental Health and Addictions Training in Residency.

Family physicians report feeling inadequately prepared to meet the evolving mental health care needs of the population. Little scholarship exists evaluating the effectiveness of curricula designed to teach mental health and addiction (MH&A) care to family medicine (FM) residents. As such, the purpose of this study was to explore the experiences of recent FM residency graduates in providing mental health care, and their perceptions of mental health training gaps during their residencies. A qualitative descriptive study design was conducted by 8 recent graduates of the University of Toronto's FM residency program, who participated in semi-structured video interviews. A thematic analysis approach was used to collect and analyze the data. Through thematic analysis, 3 overarching themes were developed: (1) barriers in providing mental health and addiction care, (2) curriculum renewal, and (3) the role of FPs and professional identity. Consistent with the literature, the majority of recent FM graduates expressed discomfort when managing patients with mental health and addiction concerns. Additionally, participants perceived residency program time constraints, rotational site differences, and limited exposure to marginalized populations all impacted learning and mastery of skills. The findings of this study underscore current gaps within the FM residency curriculum and highlight the need to address current curricular deficits.

Comparing Practice Intentions and Patterns of Family Physicians in Canada.

In Canada, competency-based medical education prepares family medicine (FM) graduates to provide a broad scope of practice (SoP). We compared the practice intentions of FM residents at the end of training with actual practice patterns of early career family physicians (FPs) for SoP activities reflective of comprehensive family medicine. We collected self-reported data from cross-sectional family medicine longitudinal surveys for exiting FM residents in 2015 and 2016 and from a separate cohort of FPs who were 3 years into practice in 2018 and 2019 from 15 programs. We measured outcomes from exiting FM residents intending to participate in SoP activities and FPs participating in 15 SoP domains of family medicine. A total of 1,409 exiting FM residents (58.2% response rate) and 523 early career FPs (21% response rate) responded to the surveys. A high correlation existed between the percentage of exiting residents who intended to participate in each SoP activity and the percentage of FPs who participated in those activities (r2=0.95). However, we found statistically significant declines in the percentage of FPs reporting involvement in the SoP activities compared to their reported practice intentions for 14 of the 15 domains. We saw the greatest declines in providing care in long-term care facilities, rural communities, emergency departments, intrapartum care, and care for Indigenous populations (P<.001). While SoP patterns are highly correlated with practice intentions, early-career FPs are less likely to provide care as intended for all SoP activities. Further research is needed on the factors influencing practice patterns in specific areas to determine how FP graduates can be supported to provide comprehensive care.

Longitudinal Study of Family Medicine Residents' Clinical Teaching After Participation in the Residents-as-Teachers Program.

Residents-as-teachers (RAT) programs provide opportunities for residents to gain teaching skills. Published studies have assessed RAT programs largely at a single point in time rather than longitudinally. To address this gap, we examined (a) longitudinal trends in RAT participants' interest, comfort, confidence, skill, and familiarity with aspects of clinical teaching; and (b) subsequent involvement in clinical teaching. We conducted a longitudinal survey of one cohort of family medicine residents (N=56) who participated in the RAT program during residency. We collected data before and after the RAT program and at one and three years into practice (2016-2020). We measured outcomes including interest, comfort, confidence, skill, familiarity with aspects of clinical teaching and involvement in clinical teaching. We performed longitudinal analysis using repeated measures analysis of variance. Response rates at four data collections were 63% (n=35), 66% (n=37), 55% (n=31), and 34% (n=19), respectively. We observed consistent trends in interest, comfort, confidence, skill, and familiarity with aspects of clinical teaching; mean scores increased from before to after the RAT program and subsequently decreased in the early years in practice. At 1 and 3 years in practice, 71% and 74% of respondents, respectively, reported being involved in teaching, primarily teaching medical students. The RAT program appears to be a positive contributing influence on family medicine graduates' perceived preparedness to teach and their involvement in teaching after graduation from residency. A relatively high proportion of residents are involved in teaching in the early years in practice.

Starting out rural: a qualitative study of the experiences of family physician graduates transitioning to practice in rural Ontario.

New family medicine graduates are a promising group to recruit to underserved rural areas. This study aimed to understand the experiences of this group as they transitioned to practice in rural Ontario. We used a hermeneutic phenomenology approach. Purposive sampling was used to recruit participants who graduated from a Canadian family medicine residency program and worked in a rural community in Ontario (Rurality Index for Ontario score ≥ 40) for at least 1 year within the past 5 years. Participants completed an online demographic survey followed by a virtual semistructured interview (May-August 2022). Interviews were video recorded and transcribed. Two researchers reviewed transcripts for codes, and then codes were reviewed in an iterative process to create themes. Transcripts, codes and themes were reviewed by an independent researcher, and final themes were shared with participants to ensure reliability. We included 18 family physicians in the study. We identified 8 themes and 18 subthemes. The themes identified as important to the experience of new graduates were as follows: choosing rural practice, preparedness for practice, navigating work-life balance, navigating transition to practice, challenges during transition to practice, successes during transition to practice, locuming and emergency medicine as part of rural generalist practice. Most physicians interviewed felt prepared for rural practice and enjoyed their work; however, they faced unique challenges associated with being an early-career physician in rural practice. This study identifies opportunities for improvements, which can guide medical educators, rural communities and their recruiters, new graduates and policy-makers.

Defining the capabilities and competencies of high-performing family physicians: a mixed methods study

IntroductionHigh-performing primary care is recognised as the foundation of an effective and efficient healthcare system. Many medical graduates report they are not prepared for independent practice. To date, no research...

Perceptions of portfolio assessment in family medicine graduates: a qualitative interview study

BackgroundThe use of the portfolio methodology in medical education can serve as a tool for learning, assessment, and reflection on practice. This study concentrates on perceptions of the portfolio assessment methodology among participants in the Saudi Diploma of Family Medicine program.MethodsIn this qualitative interview study, data were collected and analysed using a grounded theory approach.ResultsNine codes emerged: (1) Importance of understanding the definition, objectives, and process of portfolio assessment, (2) Impact of different understandings on the part of various trainers, (3) Role of the type of assessment, (4) Workload and stress of portfolio assessment, (5) Effectiveness of the portfolio contents, (6) Role of the mentor’s feedback, (7) Role in the learning process, (8) Role in practice, (9) Suggestions for portfolio improvement. Open codes were then regrouped into three axial codes: context, strategy, and outcome of portfolio assessment.ConclusionThis study explored a general explanation of portfolio assessment shaped by the postgraduate students. It identifies the importance of portfolio understanding in student acceptability of the portfolio assessment methodology. Thus, proper implementation is vital for the success of assessing the student by the portfolio methodology. The students perceived reflection as the most valuable part of the process, which facilitated their learning, confidence, and self-assessment. Mentor feedback is a good strategy for coping with portfolio challenges. Our findings provide some evidence of positive outcomes of portfolio assessment in practice and professional development.

Focused practice in family medicine

To determine factors associated with having a focused practice among a sample of family medicine graduates in Canada and to assess the characteristics of FPs with focused practices and the range of services provided by these FPs in relation to the full scope of office-based care. Secondary analyses of cross-sectional data from the 2013-2014 Western Family Medicine Resident Follow-Up Survey. Western University in London, Ont. Western University family medicine residency graduates who completed the program between 1985 and 2012. Physician and practice characteristics and the clinical services that survey participants provide. Completion of postgraduate third-year (PGY3) training was associated with having a focused practice. Focused practice FPs were more likely to be remunerated by fee-for-service, alternative payment plans, or alternative funding plans compared with non-focused practice FPs, who were more likely to participate in group payment models. Focused practice FPs appeared to be a heterogeneous group who were distinguished by being either an office-based focused practice FP (OBFFP) or a non-office-based focused practice FP (NOBFFP). Office-based focused practice FPs were less likely than NOBFFPs to have completed PGY3 training and more likely to work under a fee-for-service or group payment model. Further, the OBFFP group offered a greater variety of primary care services than the NOBFFP group, but offered less variety than non-focused practice FPs. Completion of PGY3 training and payment through certain remuneration models were both associated with focused practice. Important differences exist between OBFFPs and NOBFFPs. The overall service provision of focused practice FPs was centred on specialized areas, especially among those practising in non-office-based settings. Novel findings from this study provide insights for family medicine education, work force planning, and policy making in the Canadian health system.

Evaluating the Teaching Health Center Graduate Medical Education Model at 10 Years: Practice-Based Outcomes and Opportunities.

Since 2011, the Teaching Health Center Graduate Medical Education (THC GME) program has sought to expand access to care by training residents in safety net settings. To examine impact on physician scope, location, and patient population served using a unique data set. Using 2017-2020 data from the American Board of Family Medicine National Graduate Survey, we compared demographics, practice location, populations served, and scope of practice between graduates of THC GME programs and graduates of other family medicine programs. Our sample comprised 8608 (out of 13 465) eligible family medicine graduates 3 years after completion of residency training, for a response rate of 63.9%. THC graduates were significantly more likely than other graduates to practice in a rural location (17.9% to 11.8%), within 5 miles of their residency program (18.9% to 12.9%), and to care for medically underserved populations (35.2% to 18.6%). Their scope of practice was wider than other graduates and more likely to comprise services like buprenorphine prescribing, behavioral health care, and outpatient gynecological procedures. Regression results suggest that THC training is independently correlated with a broader scope of practice. Graduates of THC programs were significantly more likely than graduates of other programs to practice close to their training sites and in rural areas, and to care for underserved patients while maintaining a broader scope of practice than other graduates.

Methodological Reflections of a Student- and Community-based Partnership on Operationalizing a Community-based Participatory Research Model: Recommendations for Building, Securing, and Sustaining Partnerships.

Community-based participatory research (CBPR) is an approach that values community expertise and ownership in creating knowledge. This approach's success is challenged by inherent cultural imbalances, making it difficult to sustain partnerships and build from what has been learned from a project as it develops. As student researchers and community members, we reflected on the challenges in CBPR and gave guidance to future novice researchers pursuing CBPR. From the application of an initial CBPR model as a framework to our partnership, we propose empirical avenues to continuously adapt the CBPR approach. A CBPR partnership between McGill's Family Medicine Graduate Student Society and Share the Warmth, a community-based organization aiming to fight poverty and hunger, was formed to collaboratively assess a music program offered in a socioeconomically disadvantaged community. The partnership process was based on a model that we conceptualized in three phases of our framework: building, securing, and sustaining. We reflect on the facilitators and challenges of this project and propose solutions to overcome identified barriers within the context of our partnership. We highlight the importance of integrating student partners in the community, reevaluating formal research agreements, and coordinating the transition of new partners in this adaptive CBPR model. We argue that this systematic and reflexive process has made the model especially useful as a framework for student and community partnerships. We propose adaptive components to the CBPR model. Our recommendations could help other partnerships cultivate CBPR to be more applicable in community health research.

Exploring resident perspectives on family medicine enhanced skills training.

Third-year enhanced skills programs, also known as family medicine (FM) PGY3 programs, have always been an area of debate. Their exponential growth does not stem from a strong body of academic evidence or public health needs assessment. This qualitative descriptive study explores the current perspectives of second-year FM residents at the University of Ottawa on extended training programs through semi-structured interviews. Of the fifteen participants, eight were applying to PGY3 FM programs, six were not and one was unsure. Themes generated included: developing generalist niches within primary care, increasing confidence of FM graduates, allowing generalists to fill in healthcare gaps to meet community needs, meeting the pressures of workplace competition and employability requirements, and creating alternate paths to five-year specialties. 80% would extend their core FM training, with self-design and options of shorter time frames as preconditions. FM residents are interested in furthering their training, whether through extending core residency period or via enhanced skills programs. The demand for these programs will continue rising. Capitalizing on residents' interests to catapult the profession forward and optimize the quality of healthcare should be the priority for licensing bodies and medical educators.

Insights for Teaching During a Pandemic: Lessons From a Pre-COVID-19 International Synchronous Hybrid Learning Experience.

Medical educators and researchers have increasingly sought to embed online educational modalities into graduate medical education, albeit with limited empirical evidence of how trainees perceive the value and experience of online learning in this context. The purpose of this study was to explore the experiences of hybrid learning in a graduate research methods course in a family medicine and primary care research graduate program. This qualitative description study recruited 28 graduate students during the fall 2016 academic term. Data sources included qualitative group discussions and a 76-item online survey collected between March and September 2017. We used thematic analysis and descriptive statistics to analyze each data set. Nine students took part in three group discussions, and completed an online survey. While students reported positive learning experiences overall, those attending virtually struggled with the synchronous elements of the hybrid model. Virtual students reported developing research skills not offered through courses at their home institution, and students attending the course in person benefited from the diverse perspectives of distance learners. All stressed the need to foster a sense of community. Quality delivery of online graduate education in family medicine research requires optimizing social exchanges among virtual and in-person learners, ensuring equitable engagement among all students, and leveraging the unique tools afforded by online platforms to create a shared sense of a learning community.

Simulation-Based Medical Education in Family Medicine Residencies: A CERA Study.

To better understand the current use of simulation and barriers to its use in family medicine resident education, we surveyed US family medicine residency (FMR) program directors (PDs) about opinions and use of simulation-based medical education (SBME) in their programs. A number of specialties have incorporated or required simulation-based educational techniques in residency education over the past 10 years, but little is known about the current use of SBME in family medicine graduate medical education. We also evaluated associations between program characteristics and the use of SBME in FMR education. Questions were included on the 2019 Council of Academic Family Medicine Education Research Alliance (CERA) survey of US FMR PDs. The survey included questions regarding current use of SBME along with questions to identify barriers to its use in family medicine programs. Thirty-nine percent (n=250) of PDs completed the survey; 84.5% reported using simulation. PDs reporting they did not use simulation were less likely to view simulation as valuable for education or assessment. Unexpectedly, residency program size was not associated with simulation use or access to a dedicated location for SBME. Use of SBME in family medicine resident education has increased since 2011. PDs value simulation for education and remediation, and most programs have introduced some degree of simulation despite barriers. The results of this study can inform resources to support the continued integration of SBME into family medicine resident education.

Residency Experience Treating Patients With Buprenorphine Boosts Prescribing in Practice

Residency Experience Treating Patients With Buprenorphine Boosts Prescribing in Practice

HIV Care by Early-Career Family Physicians.

Antiretroviral treatment has transformed human immunodeficiency virus (HIV) infection into a chronic disease. Prior research demonstrated a discrepancy between preparation to provide HIV care and current provision among recent residency graduates. Our study aimed to describe characteristics related to preparedness and provision of HIV care, and to identify the associations between physician and practice characteristics with current provision of HIV care among those prepared. We obtained data from the 2016 through 2019 American Board of Family Medicine (ABFM) National Family Medicine Graduate Survey. Our main outcome was self-reported provision of HIV care. Bivariate statistics compared differences in personal and practice characteristics with self-reported preparation for HIV care, then among those prepared, provision of HIV care. We used logistic regression to determine associations between HIV care, among those prepared, with practice and personal characteristics. The response rate was 68.7% and our final sample size was 6,740 respondents. Only 25% of respondents reported preparedness in residency, and 44% of them reported current provision. Among those prepared, female gender (OR=0.604; 95% CI, 0.494-0.739) was associated with lower odds of practicing HIV care. Those working in high HIV prevalence areas (OR=1.718; 95% CI, 1.259-2.344) and in Northeast census region (OR=1.557; 95% CI, 1.137-2.132) had higher odds of providing HIV care. Fewer than half of those prepared in residency reported currently providing HIV care. Working in a high HIV prevalence area was associated with higher odds of providing HIV care, which suggests early-career family physicians are responding to community needs.

The contribution of family medicine to the health system in Somaliland

Somaliland’s first specialty training programme for physicians was a master’s degree in Family Medicine that began at Amoud University in 2012. A survey of the 24 Family Medicine graduates working in Somaliland demonstrates their clinical and leadership impact on the health system and their contribution to higher education. The specialists directly contribute to the health and education priorities of the government of Somaliland.

Intimidation, harassment, and discrimination during family medicine residency training: a mixed methods study

BackgroundThe importance of wellbeing of family medicine residents is recognized in accreditation requirements which call for a supportive and respectful learning environment; however, concerns exist about learner mistreatment in the medical environment. The purpose of this study was to to describe family medicine graduates’ perceived experience with intimidation, harassment and discrimination (IHD) during residency training.MethodsA mixed-methods study was conducted on a cohort of family medicine graduates who completed residency training during 2006–2011. Phase 1, the quantitative component, consisted of a retrospective survey of 651 graduates. Phase 2, the qualitative component, was comprised of 11 qualitative interviews. Both the survey and the interviews addressed graduates’ experience with IHD with respect to frequency and type, setting, perpetrator, perceived basis for IHD, and the effect of the IHD.ResultsThe response rate to the survey was 47.2%, with 44.7% of respondents indicating that they experienced some form of mistreatment/IHD during residency training, and 69.9% noting that it occurred more than once. The primary sources of IHD were specialist physicians (75.7%), hospital nurses (47.8%), and family physicians (33.8%). Inappropriate verbal comments were the most frequent type of IHD (86.8%). Graduates perceived the basis of the IHD to be abuse of power (69.1%), personality conflict (36.8%), and family medicine as a career choice (30.1%), which interview participants also described. A significantly greater proportion IMGs than CMGs perceived the basis of IHD to be culture/ethnicity (47.2% vs 10.5%, respectively). The vast majority (77.3%) of graduates reported that the IHD experience had a negative effect on them, consisting of decreased self-esteem and confidence, increased anxiety, and sleep problems. As trainees, they felt angry, threatened, demoralized, discouraged, manipulated, and powerless. Some developed depression or burnout, took medication, or underwent counselling.ConclusionsIHD continued to be prevalent during family medicine residency training, with it occurring most frequently in the hospital setting and specialty rotations. Educational institutions must work with hospital administrators to address issues of mistreatment in the workplace. Residency training programs and the medical establishment need to be cognizant that the effects of IHD are far-reaching and must continuously work to eradicate it.

Six Years' Experience Using Specialty National Residency Index: An Early Dashboard to Document Change Over Time.

A decade ago, the Association of Family Medicine Residency Directors developed the Residency Performance Index (RPI) as a novel dashboard of metrics to support residency programs' quality improvement efforts. Although the RPI has since been discontinued, we sought to identify lessons learned from an analysis of 6 years of data collected while the RPI was in use to inform future quality and accreditation efforts implemented at the national level. The RPI collected data from 2012-2017 for nearly 250 distinct family medicine residency programs, identifying strengths and areas for improvement. Eighty-two programs provided data for 3 or more years of measures allowing analysis of improvement trends. For participating programs, aggregate data over 6 years indicated the majority had stable leadership and accreditation. Total family medicine center (FMC) visits by graduates and resident visit demographics were robust. Graduate scope of practice was consistent with nationally publicized trends. Programs hit most aspirational targets more than 40% of the time. However, analysis for those programs with 3 or more years of data revealed that the tool did not result in significant changes for most metrics. Linear regression analysis showed improvements in total patient visits, visits under 10 years of age, and certain procedural competencies for those programs with 3 or more years of data. The RPI was the first and only nationally utilized family medicine graduate medical education quality improvement tool. Individual programs did not show substantial change in quantifiable metrics over time despite limited evidence of select programmatic improvements. Nationally, aggregated data provided insight into scope of practice and other areas of interest in residency training. Further efforts in provision of residency improvement tools are important to support programs given the increasing complexity and high stakes of family medicine residency education.

Expected Outcomes from Family Medicine Specialized Graduates in Iranian Health System from the Viewpoints of Stakeholders: A Qualitative Study

Background and Objectives: The purpose of training and applying family physicians in the health system is to optimize rating the services and referral system. The purpose of this study was to explanation of the expected outcomes of family medicine graduates from the viewpoints of professors, assistants and senior managers of the health system and its comparison with the defined consequences in the curriculum of this major at Tabriz University of Medical Sciences. Material and Methods: This is a qualitative study with the content analysis approach. Sampling method is non-random and purposive. Three focus group discussions and six semi-structured interviews conducted with 31 participants, including three groups of professors, assistants and senior managers of the health system by FGD method and also including 25 participants and 6 individuals were used for individual interview. Interviews continued until data saturation. Content analysis method used for data analysis. Results: After conceptualizing, extracting and coding themes into 56 themes, the findings were categorized into three general themes: Occupational status (such as: Conscientious physician, policy maker, supervisor or provider), job duties (Education, research, management, consulting and visit) and employment outcomes (such as: Cost reduction, unnecessary refer and population health promotion). Conclusion: The use of specialist family physicians in positions such as the physician in charge of the health complex and service provision in comprehensive health centers can have outcomes such as appropriating referrals, reducing costs and preventing overuse, and reducing the workload of levels 2 and 3.

The effect of Balint training on the psychological skills of residents beyond family medicine residency

Background: Engaging with the psychological well-being of patients is central to patient care. The empathy and psychological skills of practitioners may be enhanced by Balint training during the residency years. However, there is scarce evidence concerning the outcomes of Balint training beyond graduation. Objective: The aim of the study was to compare the psychological skills of practising family medicine graduates who had received Balint training during their residency compared to the skills of those who did not. Design: Cross-sectional, mixed-methods study. Setting: Family medicine graduates at the American University of Beirut. Methods: A telephone-based interview or an online-based questionnaire was used to survey family medicine graduates between 2007 and 2018. Those who graduated between 2012 and 2018 had received Balint training, whereas the remainder had not. Psychological skills and abilities were measured using an 11-item Psychological Medicine Inventory (PMI) questionnaire. Results: Thirty-seven family medicine graduates participated in the study, with a response rate of 69.8%. There was no difference in the PMI item scores between those who received Balint training as compared to those who did not. In response to an open-ended question, participants emphasised the importance of Balint seminars in improving their communication abilities, dealing with ‘difficult’ patients, finding blind spots and developing the doctor–patient relationship. Exploratory factor analysis revealed three components that explained 80.6% of the total variance. None of these components was associated with Balint training. Conclusion: Although PMI scores did not differ between those who received Balint and those who did not, Balint training may improve family medicine graduates’ confidence to engage with the psychological problems of patients beyond residency based on the statements made by the practising graduates.