Family Medicine Residency Program Directors Research Articles

Climate Change Curricula in Family Medicine Residency Programs: Program Directors' Perspectives From a CERA Survey.

Climate change is a major threat to the health of people worldwide. The health care system deals with the immediate health-related effects of climate change and, at the same time, is a major emitter of greenhouse gas. This study aimed to investigate (a) the awareness and perception of climate change among family medicine residency program directors, and (b) the state of climate change education in family medicine residency programs. The Council of Academic Family Medicine Educational Research Alliance (CERA) conducted a cross-sectional survey of family medicine program directors in the United States in April 2023. We analyzed anonymous data using descriptive and bivariate statistics. We analyzed responses from 284 family medicine residency program directors (response rate 41.1%). Of these, 56.8% indicated not having any lectures/seminars dedicated to climate change and no plans to introduce such curricula, with considerably higher rates in East South Central United States (92.8%). A majority considered principles of climate change, carbon emissions emitted by the health care system, and discussion of climate change with patients of lesser importance for residency program education. While climate change is an emerging topic affecting health and the provision of health care worldwide, our study suggests that many family medicine residency programs do not teach about it. Family medicine trainees may not always receive sufficient education about the risks posed to their patients by climate change, which could lead to them having limited knowledge and skills when discussing this topic with their patients in the future.

Holistic Review in Family Medicine Residency Programs: A CERA Study.

Interest in using holistic review for residency recruitment as a strategy to improve the diversity of the physician workforce has increased. However, no data are published on the prevalence of holistic review in the selection process for family medicine residency programs. We designed this study to assess programs' knowledge, skills, and attitudes; prevalence; barriers to implementation; and program characteristics associated with the use of holistic review. Data for this study were elicited as part of a 2023 survey conducted by the Council of Academic Family Medicine Educational Research Alliance. The nationwide, web-based survey was sent to 739 family medicine residency program directors. A total of 309 program directors completed the holistic review portion of the survey. Programs that understood and agreed with holistic review used it more in their selection process. Holistic review was more common in programs with higher rates of residents, faculty, and patients that are underrepresented in medicine. Barriers to holistic review utilization were increased number of applicants, increased resources associated with holistic review, and lack of consensus on the holistic review approach. The holistic review process is an area of growing interest to diversify the physician workforce, especially among residencies caring for underresourced communities. Further discussions on the specific scoring rubrics of family medicine residency programs that use holistic review are needed and could help programs that are facing barriers. Widespread use of holistic review to diversify the physician workforce has the potential to improve patient care access and health.

Use of Signaling in Family Medicine Residency Interviewing.

Although signals have been used in the residency application process by other specialties, family medicine residency directors have not previously participated. With applicant signal information available for the first time in the 2023-2024 application cycle, the current study describes family medicine residency program directors' intended use of signals and provides benchmarking descriptive data that may help inform best practices and future studies. A total of 691 of the 745 family medicine program directors in US family medicine residency programs accredited by the Accreditation Council for Graduate Medical Education were surveyed. We used ꭓ2 and Pearson correlation analyses to examine how program directors of family medicine residency programs intended to use signaling and their perceived impact of signaling on the residency interviewing process. Most program directors indicated that applicant signals would assist them in deciding who to invite for an interview and would be a positive factor in a holistic review process. However, program directors also noted that rotation experience or geographic ties would be more powerful inducements to interview or rank a specific candidate. Program directors did not indicate a belief that signals would decrease interview season stress or workload. Signals may play an important role in the residency application process for family medicine in 2023-2024. While signals are not anticipated to decrease application workload or stress, a signal may be an important mechanism for a specific applicant to distinguish themselves with a program.

Authors' Response to Letter About "Impostor Phenomenon Among Family Medicine Residency Program Directors: A CERA Study".

Authors' Response to Letter About "Impostor Phenomenon Among Family Medicine Residency Program Directors: A CERA Study".

Social Determinants of Health in Family Medicine Residency: A National Survey of Program Directors.

Social factors account for most health outcomes, underscoring the need to address social determinants of health (SDH) to eliminate health disparities. Our objectives are (1) to describe the scope of formal SDH curricula in family medicine residency, (2) to identify residency program characteristics associated with integrated core curriculum components to teach SDH, and (3) to identify barriers to addressing SDH in residency. We distributed a cross-sectional survey to all family medicine residency program directors (PDs) accredited by the Accreditation Council for Graduate Medical Education as identified by the Association of Family Medicine Residency Directors. Of 624 eligible program directors, 279 completed the survey (45% response rate). Overall, 41.2% of respondents reported significant formal SDH training in their program. Though a majority (93.9%) agreed that screening for social needs should be a standard of care, most (58.9%) did not use standardized screening tools. The most common barriers to addressing SDH were lack of clinical resources (eg, social workers, legal advocates), lack of community resources (eg, food banks, substance use disorder treatment), and inadequate screening instruments or integration into the electronic medical record system. Availability of referral resources was associated with PDs' increased perception of resident SDH competency. Nearly all respondents agreed that screening for social needs should be a standard part of care; however, this vision is not yet realized. To better train the next generation of physicians to identify and meaningfully address social needs, additional research is needed. This research might include mixed-methods approaches that incorporate qualitative assessments to define best practices and patient-centered outcomes related to identifying and responding to SDH.

Family Medicine Residency Program Directors' Perception of Curricular Elements Related to Autism: A CERA Study.

The family medicine (FM) approach to health care across the life span is well-suited to providing care for persons living with autism spectrum disorder (ASD). Little is known about ASD curricula in FM residency training and the characteristics of FM residency programs that prepare their residents to care for persons with this disorder. Our study questions were part of a larger omnibus survey by the Council of Academic Family Medicine Educational Research Alliance (CERA) with data collection from November 16 to December 18, 2022, from FM residency program directors (PDs). ASD curricula were investigated using 10 questions, with descriptive analyses and nonparametric comparisons between program variables and ASD curriculum. The response rate was 42.18%, with FM PDs reporting that their programs were preparing residents in the care of youth (71.53%) and adults (68.33%) with ASD, but to a lesser extent (58.89%) in facilitating transitions of care. Programs with faculty champions, access to published curricula, sufficient patients with ASD, and engagement of interprofessional faculty reported a higher proportion of resident preparedness. PDs of community-based programs were most confident in their ability to teach ASD care and transitions of care. Most FM PDs modestly agreed that they are preparing residents to provide care to patients with ASD and their families. PDs of programs with greater access to resources (ie, published curriculum, faculty champions, sufficient patients with ASD, interprofessional faculty experts) believed that their residents were more prepared. Community-based FM educators may help lead the way in providing models for care and education in this regard.

New Tools for Resident Recruiting Season: A CERA Survey of Family Medicine Residency Program Directors.

As the family medicine community continues to adapt to interview season changes secondary to the effects of the COVID-19 pandemic, discussions are underway regarding new options to improve the overall success and satisfaction of resident recruiting. Tools such as preference signaling, interview capping, and supplementary applications are options that have been investigated, and in some cases implemented, by other specialties for their recruiting seasons. Family medicine as a specialty is now actively scrutinizing the benefits and drawbacks of these tools. The fall 2021 CERA program directors' omnibus online cross-sectional survey invited family medicine program directors to provide their perceptions of these tools. Descriptive statistics and multivariate logistic regressions were conducted. Two-thirds of the 262 program director respondents (42% response rate, n=184) supported policies for preference signaling and a national interview cap; however, support was mixed for the use of supplemental applications. Because the survey results indicated a high level of support for using these innovative new tools during recruitment season, family medicine should take action to implement these programs/policies.

Impostor Phenomenon Among Family Medicine Residency Program Directors: A CERA Study.

Impostor phenomenon (IP) can be described as feelings of inadequacy that exist despite apparent success. Although IP may be related to multiple important outcomes in physicians, it has not been examined among residency program directors (PDs). The seven-item Leary Impostorism Scale (LIS) was added to the 2021 Council of Academic Family Medicine Educational Research Alliance (CERA) PD survey. In addition to standard questions, we surveyed PDs about their likelihood to leave their role, whether they started their PD role due to an unexpected transition, their beliefs concerning workplace evaluations relative to self-assessed performance, and their perceived support in completing PD responsibilities. Of the 257 PDs included in the survey (response rate approximately 41%), 28% (N=71) reported no IP. IP did not statistically differ across gender or race. LIS scores were lower among Hispanic/Latino respondents, but only 8% of our sample (N=20) identified as Hispanic/Latino. LIS scores did not significantly differ by PD likelihood to leave their position or for PDs starting their position due to a sudden transition. Respondents who felt that evaluations overestimated actual performance had higher LIS scores, as did those with lower levels of perceived support in completing administrative responsibilities and those with less time in their PD role. Most PD respondents did not report high levels of IP. Short duration of PD role, lack of programmatic support, and negative self-evaluations were correlated with higher levels of IP. Future research should examine interventions or resources to help those with IP thrive.

Features of Effective Clinical Competency Committees.

The Clinical Competency Committee (CCC) provides accountability to the general public that physicians completing a training program have achieved competence. CCC processes and features that best identify resident outcomes along a developmental spectrum are not well described. This study sought to describe CCC features associated with effective and efficient CCC performance. The study was conducted as part of the 2022 Council of Academic Family Medicine Educational Research Alliance survey of family medicine residency program directors. The survey assessed CCC methods, policies, faculty development, structure, and overall CCC time required. The outcomes were identification of residents along a spectrum of development, from failing to exceeding expectations. Ordinal logistic regressions were used to explore the relationship between CCC characteristics and CCC outcomes. The response rate was 43.3% (291 of 672). Eighty-nine percent (258 of 291) of program directors reported their CCC is successful in identifying residents not meeting expectations; 69.3% (201 of 290) agree their CCC identifies residents who are exceeding expectations. Programs with written policies for synthesizing data (OR=2.53; 95% CI 1.22-5.22; P=.012) and written policies for resident feedback (OR=19.91; 95% CI 3.72-106.44; P<.001) were more likely to report successfully identifying residents below expectations. Programs whose members spent fewer than 3 hours per 6-month interval on CCC meetings were less likely to report being able to identify failing residents (OR=0.37; 95% CI 0.19-0.72; P=.004). This survey of family medicine program directors suggests that formal policies, faculty development, and adequate time for CCC faculty are associated with an effective CCC, especially if goals beyond "identifying failure" are desired.

Dermoscopy Training in Family Medicine Residencies: A CERA Survey of Program Directors.

Diagnosing skin disorders is a core skill in family medicine residency. Accurate diagnosis of skin cancers has a significant impact on patient health. Dermoscopy improves a physician's accuracy in diagnosing skin cancers. We aimed to quantify the current state of dermoscopy use and training in family medicine residencies. We included questions on dermoscopy training in the 2021 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency program directors. The survey asked about access to a dermatoscope, the presence of faculty with experience using dermoscopy, the amount of dermoscopy didactic time, and the amount of hands-on dermoscopy training. Of 631 programs, 275 program directors (43.58% response rate) responded. Half of the responding programs (50.2%) had access to a dermatoscope, and 54.2% had a faculty member with experience using dermoscopy. However, only 6.8% of residents had 4 or more hours of didactics on dermoscopy over their entire training. Only 16.2% had 4 or more hours of hands-on dermoscopy use. Over half (58.9%) of programs planned to add more dermoscopy training. We did not find any correlations between the program's size/type/location and dermoscopy training opportunities. Despite reasonable access to a dermatoscope and the presence of at least one faculty member with dermoscopy experience, most family medicine residency programs provided limited dermoscopy training opportunities. Research is needed to better understand how to facilitate dermoscopy training in family medicine residencies.

Financial Considerations After a Fully-Virtual Interview Season: A CERA Study of Family Medicine Residency Program Directors.

The COVID-19 pandemic led to the institution of virtual interviewing for nearly all family medicine residency programs in 2020 and 2021. This paradigm shift challenged the perspectives of family medicine program directors across the United States, in part because of the financial impact on the operations of many residency programs. We sought to investigate program directors' opinions on the 2020-2021 interview season, as well whether future interview season planning would be influenced by the financial outcomes of this season. We conducted a cross-sectional survey, as part of the fall 2021 CERA Program Director omnibus online survey. Family medicine program directors were invited by email to participate. We conducted multivariate logistic regression of the likelihood of supporting a fully-virtual interviewing model. The module survey response rate was 41.7% (263/631); 91.3% of programs reported conducting a fully-virtual 2020-2021 interview season. Program directors who reported that the cost savings recouped from virtual versus in-person interviewing could be used for other residency operating costs (32.4%) were almost four times more likely to support moving to a fully-virtual interviewing model (odds ratio: 3.94, confidence interval: 1.69-9.18). When compared to a residency program's benefit from meeting and assessing applicants in person, applicants benefitting from less financial burden during a fully-virtual interview season was not seen by responding program directors as a significant reason to remain virtual. While family medicine residency program directors who recouped interview expenses during fully-virtual recruiting seasons are more likely to support ongoing, fully-virtual models, financial incentivization did not overall impact support for virtual interviewing among program directors with statistical significance.

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.

Faculty and Resident Contraceptive Opt Outs and Training Site Restrictions: A CERA Study.

Contraception is a core component of family medicine residency curriculum. Institutional environments can influence residents' access to contraceptive training and thus their ability to meet the reproductive health needs of their patients. Contraceptive training questions were included in the 2020 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency program directors. The survey asked how many faculty and residents opt out of providing contraceptive methods for moral or religious reasons, and whether training sites have institutional restrictions on contraception. We performed descriptive statistics and regression to identify program characteristics associated with having a resident or faculty opt out of providing contraceptive care. Of 626 program directors, 249 responded to the survey, and 237 answered the contraceptive questions. Percentages of program directors reporting any residents or faculty who opted out of contraceptive services are as follows: pill/patch/ring (residents 27%; faculty 17%), emergency contraception (residents 40%, faculty 33%), or intrauterine devices/implants (resident 29%; faculty 23%). Programs in the South (OR 2.78; 1.19-6.49) and those with Catholic affiliation (OR 2.35; 1.23-4.91) had higher adjusted odds of at least one opt-out faculty but were not associated with having opt-out residents. Eleven percent of programs had at least one training site with institutional restrictions on contraception. To ensure that residents have access to adequate contraceptive training, residencies should proactively seek faculty and training environments that meet residents' needs, and should make limitations on services clear to potential residents and patients.

Diversity and Facing Discrimination in Family Medicine Residencies: A CERA Survey of Program Directors.

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.

Maternity Care Tracks at US Family Medicine Residency Programs.

The number of family physicians providing maternity care continues to decline, jeopardizing access to needed care for underserved populations. Accreditation changes in 2014 provided an opportunity to create family medicine residency maternity care tracks, providing comprehensive maternity care training only for interested residents. We examined the relationship between maternity care tracks and residents' educational experiences and postgraduate practice. We included questions on maternity care tracks in an omnibus survey of family medicine residency program directors (PDs). We divided respondent programs into three categories: "Track," "No Track Needed," and "No Track." We compared these program types by their characteristics, number of resident deliveries, and number of graduates practicing maternity care. The survey response rate was 40%. Of the responding PDs, 79 (32%) represented Track programs, 55 (22%) No Track Needed programs, and 94 (38%) No Track programs. Residents in a track attended more deliveries than those not in a track (at Track programs) and those at No Track Needed and No Track programs. No Track Needed programs reported the highest proportion of graduates accepting positions providing inpatient maternity care in 2019 (21%), followed by Track programs (17%) and No Track programs (5%; P&lt;.001). Where universal robust maternity care education is not feasible, maternity care tracks are an excellent alternative to provide maternity care training and produce graduates who will practice maternity care. Programs that cannot offer adequate experience to achieve competence in inpatient maternity care may consider instituting a maternity care track.

To Post or Not to Post: Does Applicants' Social Media Affect Family Medicine Resident Recruitment?

Current literature on review of applicant social media (SoMe) content for resident recruitment is scarce. With the recent increase in the use of privacy settings, and the cost of the recruitment process, the aim of this study was to describe the practice and outcomes of review of applicant SoMe in resident recruitment and its association with program director or program characteristics. This study was part of the 2020 Council of Academic Family Medicine's Educational Research Alliance (CERA) annual survey of family medicine residency program directors (PDs) in the United States. The overall response rate for the survey was 39.8% (249/626). About 40% of PDs reported reviewing applicant SoMe content. The majority (88.9%) of programs did not inform applicants of their SoMe review practices. The most common findings of SoMe review were that the content raised no concerns (38/94; 40.4%) or was consistent with the application material (34/94; 36.2%). Forty PDs (17.0%) have ever moved an applicant up or down the rank list based on SoMe review. Review of applicant SoMe was not statistically associated with program size, program type, PD age, PD SoMe use, or program SoMe use. SoMe review has not become routine practice in family medicine resident recruitment. The outcome of SoMe review was mostly consistent with the applicant profile without any concerns and only very few changed the ranking order. This calls for more studies to explore the value of SoMe review for resident selection regarding its effect on future performance.

Why Family Medicine Program Directors Leave Their Position.

Family medicine residency program directors (PD) oversee the training of every new family physician in the United States. The median tenure of family medicine PDs is 4.5 years, and factors relating to length of tenure and reasons for departure are not well known. This exploratory study examined why family medicine PDs leave their position. We conducted in-depth interviews with family medicine PDs who recently left their director position. Semistructured and structured questions asked about their PD experience and factors contributing to stepping away from the PD role. We analyzed answers quantitatively and qualitatively. When comparing cases with longer (&gt;6 years) and shorter tenures (≤6 years), 25 PDs described differing pathways but few major differences in why they left the position. The two groups were distinguished more by their similarities than their differences. The majority left voluntarily due to a combination of factors, not a single factor. Most PDs left the position because of their desire and opportunities to move up, move over, or move on, and not because of dissatisfaction with the job. Succession plans helped with PD decisions to leave the position, knowing that the program was in good hands. Family medicine PDs left the position due to multiple factors primarily related to career pathway choices and not solely due to demands of the job. Additional research with PDs of very short tenures and long tenures may yield further details about sustaining PDs in residency education to successfully train the next generation of family physicians.

Cancer survivorship training in family medicine residency programs.

The objective of the study was to examine current family medicine residency education in cancer survivorship and barriers to cancer survivorship education in the residency curriculum. Family medicine residency program directors (n=628) were surveyed electronically between September 2019 and November 2019 through the Council of Academic Family Medicine Educational Research Alliance (CERA) annual program directory survey. Respondents (n=250) answered questions regarding eventual cancer survivorship curriculum in their residency program, including interest and barriers to implementation. Program characteristics were assessed using univariate and multivariate analyses. Only 9.2% of family medicine residency program directors reported having a cancer survivorship curriculum. Sixty-nine percent of program directors reported they would implement a cancer survivorship curriculum if one was available. The most significant barrier to implementation of a cancer survivorship curriculum was insufficient time (39.6%) followed by lack of faculty expertise (26.9%). Respondents that reported lack of faculty expertise as a barrier to implementation of cancer survivorship training were more likely be report that they would be willing to implement a cancer survivorship curriculum (p< 0.01). Despite the majority of primary care physicians providing care to cancer survivors, few family medicine residency programs have formal training in cancer survivorship care. There is interest in expanding family medicine residency training in cancer survivorship care among program directors. Gaining insight into the current educational curriculum and barriers to cancer survivorship training will lead to opportunities to improve residency training, and ultimately provide better care to cancer survivors in primary care settings.

Point-of-Care Ultrasound in Family Medicine Residencies 5-Year Update: A CERA Study.

In 2014, family medicine residency programs began to integrate point-of-care ultrasound (POCUS) into training, although very few had an established POCUS curriculum. This study aimed to evaluate the resources, barriers, and scope of POCUS training in family medicine residencies 5 years after its inception. Questions regarding current training and use of POCUS were included in the 2019 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency program directors, and results compared to similar questions on the 2014 CERA survey. POCUS is becoming a core component of family medicine training programs, with 53% of program directors reporting establishing or an established core curriculum. Only 11% of program directors have no current plans to add POCUS training to their program, compared to 41% in 2014. Despite this increase in training, the reported clinical use of POCUS remains uncommon. Only 27% of programs use six of the eight surveyed POCUS modalities more than once per year. The top three barriers to including POCUS in residency training in 2019 have not changed since 2014, and are (1) a lack of trained faculty, (2) limited access to equipment, and (3) discomfort with interpreting images without radiologist review. Training in POCUS has increased in family medicine residencies over the last 5 years, although practical use of this technology in the clinical setting may be lagging behind. Further research should explore how POCUS can improve outcomes and reduce costs in the primary care setting to better inform training for this technology.

Residency Setting Association With Resident Substance Use Disorder Training: A CERA Secondary Data Analysis.

As the opioid crisis worsens across the United States, the factors that impact physician training in management of substance use disorders become more relevant. A thorough understanding of these factors is necessary for family medicine residency programs to inform their own residency curricula. The objective of our study was to identify factors that correlate with increased residency training in addiction medicine across a broad sample of family medicine residencies. We performed secondary analysis of a national family medicine residency program director survey conducted in 2015-2016 (CERA Survey PD-8). We obtained data from the Council of Academic Family Medicine Educational Research Alliance (CERA) Data Clearinghouse. We analyzed residency clinic site designation as a patient-centered medical home (PCMH), federally-qualified health center (FQHC), or both, for their correlation with faculty member possession of DEA-X buprenorphine waiver license, as well as required residency curriculum in addiction medicine. Residency programs situated in an FQHC were more likely to have faculty members who possessed DEA-X buprenorphine waiver licenses (P=.025). Residency clinics that were both a PCMH as well as an FQHC also correlated strongly (P=.001). Furthermore, residencies with faculty who possessed a DEA-X license were significantly more likely to have a required curriculum in addiction medicine (P=.002). Our quantitative secondary analysis of CERA survey data of family medicine residency program directors revealed that resident training in addiction medicine is strongly correlated with both residency clinic setting (FQHC or FQHC/PCMH) as well as residency faculty possession of DEA-X licenses.