Family Medicine Training Programs Research Articles

Evidence of learning in workplace-based assessments in a Family Medicine Training Programme.

Learning portfolios (LPs) provide evidence of workplace-based assessments (WPBAs) in clinical settings. The educational impact of LPs has been explored in high-income countries, but the use of portfolios and the types of assessments used for and of learning have not been adequately researched in sub-Saharan Africa. This study investigated the evidence of learning in registrars' LPs and the influence of the training district and year of training on assessments. A cross-sectional study evaluated 18 Family Medicine registrars' portfolios from study years 1-3 across five decentralised training sites affiliated with the University of the Witwatersrand. Descriptive statistics were calculated for the portfolio and quarterly assessment (QA) scores and self-reported clinical skills competence levels. The competence levels obtained from the portfolios and university records served as proxy measures for registrars' knowledge and skills. The total LP median scores ranged from 59.9 to 81.0, and QAs median scores from 61.4 to 67.3 across training years. The total LP median scores ranged from 62.1 to 83.5 and 62.0 to 67.5, respectively in QAs across training districts. Registrars' competence levels across skill sets did not meet the required standards. Higher skills competence levels were reported in the women's health, child health, emergency care, clinical administration and teaching and learning domains. The training district and training year influence workplace-based assessment (WPBA) effectiveness. Ongoing faculty development and registrar support are essential for WPBA.Contribution:This study contributes to the ongoing discussion of how to utilise WPBA in resource-constrained sub-Saharan settings.

Registrars' experience with research in family medicine training programmes in South Africa.

Completion of a research assignment is a requirement for specialist training in South Africa. Difficulty with completion delays graduation and the supply of family physicians. The aim of this study was to explore the experience of registrars with their research in postgraduate family medicine training programmes. An explorative descriptive qualitative study. Extreme case purposive sampling selected registrars who had and had not completed their research on time, from all nine training programmes. Saturation was achieved after 12 semi-structured interviews. The framework method was used for data analysis, assisted by ATLAS.ti software. The assumption of prior learning by teachers and supervisors contributed to a sense of being overwhelmed and stressed. Teaching modules should be more standardised and focussed on the practical tasks and skills, rather than didactic theory. Lengthy provincial and ethics processes, and lack of institutional support, such as scholarly services and financial support, caused delays. The expertise of the supervisor was important, and the registrar-supervisor relationship should be constructive, collaborative and responsive. The individual research experience was dependent on choosing a feasible project and having dedicated time. The balancing of personal, professional and academic responsibilities was challenging. Training programmes should revise the teaching of research and improve institutional processes. Supervisors need to become more responsive, with adequate expertise. Provincial support is needed for streamlined approval and dedicated research time.Contribution:The study highlights ways in which teaching, and completion of research can be improved, to increase the supply of family physicians to the country.

Family Medicine Resident Experience Toward Workplace-Based Assessment Form in Improving Clinical Teaching: An Exploratory Qualitative Study.

Workplace-Based Assessment (WPBA) has been widely utilized for assessing performance in training sites for both formative and summative purposes. Currently, with the recently updated duration of the family medicine (FM) training program in Saudi Arabia from four years to three years, the possible impact of such a change on assessment would need to be investigated.This objective was to explore the experiences of FM residents regarding the usage of WPBA as an assessment tool for improving clinical teaching at King Abdulaziz Hospital (KAH), Al Ahsa, Saudi Arabia. The study involves an exploratory qualitative phenomenological approach targeting family medicine resident in KAH was used. Purposive sampling techniques were used. In this descriptive study, data was collected through the utilization of 1:1 semi-structured interviews guided by directive prompts. All recorded interviews were transcribed verbatim. An inductive analytical approach was applied for thematic analysis of transcripts. Fifteen participants were individually interviewed until data saturation was reached. The themes that emerged were organized into the categories of underlying principles of WPBA, the impact of the learning environment, associated opportunities and challenges, and making WPBA more effective. Participants expressed that the orientation provided by the program was insufficient, although the core principles were clear to them. They valued the senior peers' support and encouragement for the creation of a positive learning environment. However, time limit, workload, and a lack of optimum ideal implementation reduced the educational value and effectiveness of WPBA among senior residents. The study examined residents' experiences with WPBA and concluded that low levels of satisfaction were attributed to implementation-related problems. Improvements should be made primarily in two areas: better use of available resources and more systematic prior planning. Revision and assignment of the selection process were suggested, in addition to the implementation of the new curriculum. The research will assist stakeholders in selecting and carrying out evaluation techniques that will enhance residents' abilities.

Integrated Behavioral Health Implementation and Training in Primary Care: A Practice-Based Research Network Study.

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

Workplace-based learning opportunities in a South African family medicine training programme.

Workplace-based learning (WBL) provides authentic learning opportunities to develop fit-for-practice healthcare workers. Different types of WBL opportunities have been described in high-income countries, but the opportunities in the district health systems of sub-Saharan Africa have not been characterised. This study explored family physicians' (FPs) and registrars' perceptions of WBL opportunities in a decentralised postgraduate family medicine registrar training programme. The study was conducted at five decentralised training sites across two provinces affiliated with the University of the Witwatersrand in South Africa. This instrumental case study involved semi-structured qualitative interviews with 11 FPs and 11 registrars purposively sampled across the training sites. The verbatim transcripts were thematically analysed using Braun and Clark's six-step approach. Workplace-based learning opportunities were grouped into four themes: Learning from interpersonal interactions, learning from district activities, self-directed learning and contextual influences on learning opportunities. Registrars learnt from patients, peers, FPs and other professionals. Feedback, self-reflection, portfolio use, involvement in various district events, such as student and staff teaching, and continuous medical education augmented learning. Contextual influences originated from health facilities, resource availability, district management and university support, excessive workload and a need for standardised district learning opportunities. Registrars are exposed to several types of WBL opportunities in district health systems. Effective engagement with available opportunities and addressing contextual challenges could enhance registrar learning.Contribution: Maximising learning opportunities to promote registrars' acquisition of required skills and competencies to efficiently address community needs in a middle-income country such as South Africa.

Family medicine residents’ perspectives on different teaching modalities used throughout their training

ABSTRACT Background: New teaching modalities have emerged throughout the years to help enhance residency training programs. Studies have shown that when establishing a new teaching modality, it is crucial to consider the trainee’s perception and feedback as trainee-centered teaching techniques aim to enhance the students’ motivations and problem-solving skills. The aim of this study is to discover residents’ perceptions of different teaching modalities used through their training programs and to recognize which teaching modality is preferable to residents among the family medicine residents in Riyadh, Saudi Arabia. Methodology: A cross-sectional study was conducted between April 2021 and April 2022 that included all family medicine residents in the Saudi Board Family Medicine Training Program at Prince Sultan Military Medical City (PSMMC) in Riyadh, Kingdom of Saudi Arabia. An online questionnaire included two main parts. The first part collected demographic information. The second part concerned residents’ opinions regarding different teaching modalities used throughout their training and factors leading to better learning outcomes. Results: The survey was completed by 60 family medicine residents. Half of the respondents perceived weekly academic day activities [WADA] as the most important teaching style (53.3%), followed by self-directed learning [SDL] (40%), while learning management system [LMS] was not ranked as the top choice by any of the respondents. Conclusion: These findings can be applied to the improvement of family medicine training programs. Understanding the perceptions of different teaching modalities can help enhance training programs to help future family medicine practitioners.

The emergence of family medicine in India-A qualitative descriptive study.

Countries globally are introducing family medicine to strengthen primary health care; however, for many, that process has been slow. Understanding the implementation of family medicine in a national context is complex but critical to uncovering what worked, the challenges faced, and how the process can be improved. This study explores how family medicine was implemented in India and how early cohort family physicians supported the field's emergence. In this qualitative descriptive study, we interviewed twenty family physicians who were among the first in India and recognized as pioneers. We used Rogers's Diffusion of Innovation Theory to describe and understand the roles of family physicians, as innovators and early adopters, in the process of implementation. Greenhalgh's Model of Diffusion in Service Organizations is applied to identify barriers and enablers to family medicine implementation. This research identifies multiple mechanisms by which pioneering family physicians supported the implementation of family medicine in India. They were innovators who developed the first family medicine training programs. They were early adopters willing to enter a new field and support spread as educators and mentors for future cohorts of family physicians. They were champions who developed professional organizations to bring together family physicians to learn from one another. They were advocates who pushed the medical community, governments, and policymakers to recognize family medicine's role in healthcare. Facilitators for implementation included the supportive environment of academic institutions and the development of family medicine professional organizations. Barriers to implementation included the lack of government support and awareness of the field by society, and tension with subspecialties. In India, the implementation of family medicine has primarily occurred through pioneering family physicians and supportive educational institutions. For family medicine to continue to grow and have the intended impacts on primary care, government and policymaker support are needed.

Snapshot of family medicine around the world: Introducing the global family medicine website.

To develop an interactive, living map of family medicine training and practice; and to appreciate the role of family medicine within, and its effect on, health systems across the world. A subgroup of the College of Family Physicians of Canada's Besrour Centre for Global Family Medicine developed connections with selected international colleagues with expertise in international family medicine practice and teaching, health systems, and capacity building to map family medicine globally. In 2022, this group received support from the Foundation for Advancing Family Medicine's Trailblazers initiative to advance this work. In 2018 groups of Wilfrid Laurier University (Waterloo, Ont) students conducted broad searches of relevant articles about family medicine in different regions and countries around the world; they conducted focused interviews and then synthesized and verified information, developing a database of family medicine training and practice around the world. Outcome measures were age of family medicine training programs and duration and type of family medicine postgraduate training. To approach the question of how delivery of the family medicine model of primary care can affect health system performance, relevant data on family medicine were collated-the presence, nature, duration, and type of training and role within health care systems. The website https://www.globalfamilymedicine.org now has up-to-date country-level data on family medicine practice around the world. This publicly available information will allow such data to be correlated together with health system outputs and outcomes and will be updated as necessary through a wiki-type process. While Canada and the United States only have residency training, countries such as India have master's or fellowship programs, in part accounting for the complexity of the discipline. The maps also identify where family medicine training does not yet exist. Mapping family medicine around the world will allow researchers, policy makers, and health care workers to have an accurate picture of family medicine and its impact using relevant, up-to-date information. The group's next aim is to develop data on parameters by which performance in various domains can be measured across settings and to display these in an accessible form.

Knowledge, Attitude, and Practice Regarding Fibromyalgia Among Primary Care Physicians in Tabuk, Saudi Arabia.

Adequately informed family physicians have the greatest potential to correctly identify the diagnosis of fibromyalgia (FM) and develop an initial treatment plan. Therefore, it is substantial to determine the levels of weakness and inaccuracy among primary care physicians regarding FM diagnostic criteria and management strategies. This study aimed to assess the knowledge, attitude, and practices regarding FM among primary care physicians in Tabuk, Saudi Arabia. This cross-sectional study included family physicians who were board-certified or registered in the family medicine training program and working at the government family healthcare centers in Tabuk. A pre-designed, structured questionnaire was distributed either in written form or as an online survey. This study included 52 primary healthcare physicians. Twenty-two (42.3%) participants incorrectly recorded localized pain as a diagnostic symptom, and 45 (86.5%) incorrectly recorded nonsteroidal anti-inflammatory drugs (NSAIDs), prednisolone, and/or opioids as drugs that are used for treating FM. Only 59.6% were confident in recognizing the symptoms of FM, and 55.8% were confident in differentiating FM from other similar diseases. The primary healthcare physicians working in the government's primary healthcare centers in Tabuk City, Saudi Arabia, have low levels of knowledge about diagnostic criteria and treatment strategies for FM. These findings highlight the need for continuous professional development involving family physicians in the primary healthcare setting with suitable continuous medical education (CME) programs concerning FM.

KNOWLEDGE, ATTITUDE AND PRACTICE REGARDING FIBROMYALGIA AMONG PRIMARY CARE PHYSICIANS IN TABUK, SAUDI ARABIA

Background: Adequately informed family physicians have the greatest potential to correctly identify the diagnosis of fibromyalgia (FM) and develop an initial treatment plan. Therefore, it is substantial to determine the levels of weakness and inaccuracies of primary care physicians regarding FM diagnostic criteria and management strategies. Aim: This study aimed to assess the knowledge, attitude, and practices regarding FM among primary care physicians in Tabuk, Saudi Arabia. Methods:This cross-sectional study included family physicians who were board-certified or registered in the family medicine training program and working at the government family health care centers in Tabuk. A pre-designed, structured questionnaire was distributed either in a written form or as an online survey. Results: This study included 52 primary healthcare physicians. Twenty-two (42.3%) participants incorrectly recorded localized pain as a diagnostic symptom, and 45 (86.5%) incorrectly recorded nonsteroidal anti-inflammatory drugs, prednisolone, and/or opioids as drugs that are used for treating FM. Only 59.6% were confident recognizing symptoms of FM and 55.8% were confident differentiating FM from other similar diseases. Conclusions: The primary healthcare physicians working in the governments primary healthcare centers in Tabuk city, Saudi Arabia have low levels of knowledge about diagnostic criteria and treatment strategies of FM. These findings highlight the need for continuous professional development involving family physicians in the primary health care setting with suitable continuous medical education programs concerning FM.

Assessment of family medicine residents' attitude toward patient safety in Riyadh city, Kingdom of Saudi Arabia

Objective: To assess the attitude of family medicine residents toward patient safety in Riyadh city, Kingdom of Saudi Arabia, and to evaluate the role of the family medicine training program in the enhancement of the understating of patient safety. Methods: A cross-sectional survey was conducted among family medicine residents in Riyadh city. A validated questionnaire, including the Attitudes to Patient Safety Questionnaire III, was developed for the purpose of assessing the attitude. Data were collected through a self-administrative technique. Results: The participants' overall attitude toward patient safety was positive. Generally, there were no significant effects of gender, institute of training, and level of training on residents' attitudes toward patient safety. A large proportion of the residents (68%) were not satisfied with their competencies in patient safety. Conclusion: Family medicine residents in Riyadh city had a positive attitude toward patient safety. More training activities focusing on patient safety issues to improve residents' knowledge and satisfaction are required.

Evaluation of learning environment of different family medicine programs, Jeddah-KSA, 2021.

A supportive educational climate in which learners are educated and monitored is a significant determinant of the medical trainees' performance and progress and eventually contributes to better patient care. Therefore, residents' training programs need to be assessed and incorporated according to the views and expectations of the candidates. The objectives of this research are to compare and evaluate the learning environment of Family Medicine (FM) programs in Jeddah and make practical recommendations for improvement of the learning environment. A descriptive causal-comparative study was designed at FM programs in Jeddah, Saudi Arabia during January, and February 2021, including all residents from R1 to R4. A Postgraduate Hospital Educational Environment Measure (PHEEM) questionnaire was used in this study. The overall score and the three domains were calculated. Two hundred and eighty-three questionnaires were distributed, and 262 were completed and collected, making a response rate of 92.6%. Females represented were 150 (57.3%), and males were 112 (42.7%). The study shows that 78 (29.8%) of the residents reported that the learning environment was excellent, and 154 (58.8%) described it as a more positive than the negative environment, whereas 29 (11.1%) described it as having a lot of problems. Out of 160 maximum scores, the highest total score (127) was observed among residents at the National Guard program, whereas the lowest score (108) was in the FM joint program, P < 0.001. Evaluation of the training programs is an essential component of quality assurance procedures. The satisfaction of the FM residents at different programs in Jeddah, Saudi Arabia, is better than reported previously, but however, further improvement is warranted. Juniors and residents of the National Guard program were more satisfied than their peers. We recommend low score items should have special consideration from high authorities and ongoing evaluation of the FM training program for further improvement of the learning environment.

Building the foundation for universal healthcare: Academic family medicine's ability to train family medicine practitioners to meet the needs of their community across the globe.

BackgroundThe Declaration of Astana marked a revived global interest in investing in primary care as a means to achieve universal healthcare. Family medicine clinicians are uniquely trained to provide high-quality, comprehensive primary care throughout the lifespan. Yet little focus has been placed on understanding the needs of family medicine training programs.AimThis study aims to assess broad patterns of strengths and resource challenges faced by academic programs that train family medicine clinicians.MethodsAn anonymous online survey was sent to family medicine faculty using World Organization of Family Doctors (WONCA) listservs.ResultsTwenty-nine representatives of academic family medicine programs from around the globe answered the survey. Respondents cited funding for the program and/or individual trainees as one of either their greatest resources or greatest limitations. Frequently available resources included quality and quantity of faculty and reliable clinical training sites. Frequently noted limitations included recruitment capacity and social capital. Over half of respondents reported their program had at some point faced a disruption or gap in its ability to recruit or train, most often because of loss of government recognition. Reflecting on these patterns, respondents expressed strong interest in partnerships focusing on faculty development and research collaboration.Lessons learntThis study provides a better understanding of the challenges family medicine training programs face and how to contribute to their sustainability and growth, particularly in terms of areas for investment, opportunities for government policy and action and areas of collaboration.Keywordsfamily medicine; primary care; medical education; global health; community medicine.

Family Medicine Residencies: How Rural Training Exposure in GME Is Associated With Subsequent Rural Practice.

Rural US populations face a chronic shortage of physicians and an increasing gap in life expectancy compared to urban US populations, creating a need to understand how to increase residency graduates' desire to practice in such areas. This study quantifies associations between the amount of rural training during family medicine (FM) residencies and subsequent rural work. American Medical Association (AMA) Masterfile, AMA graduate medical education (GME) supplement, American Board of Family Medicine certification, Accreditation Council for Graduate Medical Education (ACGME), and Centers for Medicare and Medicaid Services hospital costs data were merged and analyzed. Multiple logistic regression measured associations between rural training and rural or urban practice in 2018 by all 12 162 clinically active physicians who completed a US FM residency accredited by the ACGME between 2008 and 2012. Analyses adjusted for key potential confounders (age, sex, program size, region, and medical school location and type) and clustering by resident program. Most (91%, 11 011 of 12 162) residents had no rural training. A minority (14%, 1721 of 12 162) practiced in a rural location in 2018. Residents with no rural training comprised 80% (1373 of 1721) of those in rural practice in 2018. Spending more than half of residency training months in rural areas was associated with substantially increased odds of rural practice (OR 5.3-6.3). Only 4% (424 of 12 162) of residents spent more than half their training in rural locations, and only 5% (26 of 436) of FM training programs had residents training mostly in rural settings or community-based clinics. There is a linear gradient between increasing levels of rural exposure in FM GME and subsequent rural work.

Development, Implementation, and Meta-Evaluation of a National Approach to Programmatic Assessment in Canadian Family Medicine Residency Training.

The growing international adoption of competency-based medical education has created a desire for descriptions of innovative assessment approaches that generate appropriate and sufficient information to allow for informed, defensible decisions about learner progress. In this article, the authors provide an overview of the development and implementation of the approach to programmatic assessment in postgraduate family medicine training programs in Canada, called Continuous Reflective Assessment for Training (CRAFT). CRAFT is a principles-guided, high-level approach to workplace-based assessment that was intentionally designed to be adaptable to local contexts, including size of program, resources available, and structural enablers and barriers. CRAFT has been implemented in all 17 Canadian family medicine residency programs, with each program taking advantage of the high-level nature of the CRAFT guidelines to create bespoke assessment processes and tools appropriate for their local contexts. Similarities and differences in CRAFT implementation between 5 different family medicine residency training programs, representing both English- and French-language programs from both Western and Eastern Canada, are described. Despite the intentional flexibility of the CRAFT guidelines, notable similarities in assessment processes and procedures across the 5 programs were seen. A meta-evaluation of findings from programs that have published evaluation information supports the value of CRAFT as an effective approach to programmatic assessment. While CRAFT is currently in place in family medicine residency programs in Canada, given its adaptability to different contexts as well as promising evaluation data, the CRAFT approach shows promise for application in other training environments.

Resident perception on the impact of point-of-care ultrasound in clinical care at a family medicine training program in Zambia

BackgroundPatient access to necessary medical imaging in low- and middle-income countries (LMICs) remains a major obstacle, complicating clinician decision-making and compromising patient outcomes.MethodsWe implemented a longitudinal point-of-care ultrasound (POCUS) training program at a new Family Medicine residency in Zambia and subsequently evaluated residents’ perceptions on the impact of POCUS in patient care. Data were documented by the scanning resident via a post-scan survey, which assessed if/how the scan assisted in medical management, and if/how the scan changed that management. The primary endpoint was frequency of scans assisting and changing management. Data were summarized using descriptive statistics.ResultsOver the 1-year study period, 366 patient encounters occurred in which POCUS was utilized, resulting in a total of 542 unique POCUS scans. POCUS assisted in decision-making in 95.6% (350/366) of patient encounters, most commonly by helping to determine a diagnosis. POCUS changed management in 65.8% (235/357) of patient encounters, most commonly leading to a medication change.ConclusionsZambian resident physicians perceived POCUS to be very helpful in their clinical decision-making. These data support the need to advance POCUS education at the residency level throughout LMICs, which may be an ideal strategy to promote widespread utilization of POCUS in low-resource settings globally.

Exploration of Remote Didactics at Rural Family Medicine Training Programs.

Distance learning is a feasible and effective method of delivering education, especially in rural settings. Few studies focus on remote learning in graduate medical education. This study explores remote didactic practices of rural family medicine programs in the United States. We conducted an electronic survey of rural family medicine residency site directors across the United States. We completed sample analyses through descriptive statistics with an emphasis on descriptions of current didactic practices, facilitators, and challenges to implementation. The overall response rate was 38% (47/124) for all participants from rural residency programs, representing 28 states. About 24% of rural training track (RTT) participants reported no shared remote didactics between urban and rural sites. More than half of RTT participants (52%) reported remote virtual didactics were either not shared between urban and rural site or were shared less than 50% of the time. Top challenges to implementing remote shared didactics were lack of appropriate technology (31%) and lack of training for faculty and residents in delivery of remote didactics (31%). Top facilitators included having technology for the remote connection (54%), a faculty champion (42%), and designated time to develop the curriculum (38%). There is potential for improving shared remote didactic sessions between rural and urban sites for family medicine RTTs, which may enhance efficiency of curriculum development across sites and maximize opportunities for bidirectional learning between urban and rural sites.

Diversity, Equity, and Inclusion Milestones: Creation of a Tool to Evaluate Graduate Medical Education Programs.

As the Accreditation Council for Graduate Medical Education (ACGME) began to ask programs to report their efforts surrounding diversity, equity, and inclusion (DEI), program directors felt ill prepared to evaluate their programs and measure change. To develop a tool that would allow graduate medical education (GME) programs to evaluate the current state of DEI within their residencies, identify areas of need, and track progress; to evaluate feasibility of using this assessment method within family medicine training programs; and to analyze and report pilot data from implementation of these milestones within family medicine residency programs. The Association of Family Medicine Residency Directors (AFMRD) Diversity and Health Equity (DHE) Task Force developed a tool for program DEI evaluation modeled after the ACGME Milestones. These milestones focus on DEI assessment in 5 key domains: Institution, Curriculum, Evaluation, Resident Personnel, and Faculty Personnel. After finalizing a draft, a pilot implementation of the milestones was conducted by a convenience sample of 10 AFMRD DHE Task Force members for their own programs. Scores varied widely across surveyed programs for all milestones. Highest average scores were seen for the Curriculum milestone (2.65) and the lowest for the Faculty Personnel milestone (2.0). Milestone assessments were completed within 10 to 40 minutes using various methods. The AFMRD DEI Milestones were developed for program assessment, goal setting, and tracking of progress related to DEI within residency programs. The pilot implementation showed these milestones were easily used by family medicine faculty members in diverse settings.

Lack of Neuromodulation Knowledge Among Rural Family Medicine Residents: A Call for Implementation Research.

ObjectiveSpinal cord stimulation is a proven, evidence-based therapy for persistent spinal pain syndrome. While some patients with this disease are managed by chronic pain physicians, many are managed in primary care offices. Despite mounting evidence, dissemination of this research outside of neuromodulation related fields and implementation of this treatment in common practice has not yet occurred. We hypothesize that family medicine residents in rural training programs will have little knowledge of neuromodulation despite it being an evidence-based and common treatment of post-laminectomy syndrome.Materials and MethodsOnline surveys were sent to family medicine residents in six rural family medicine training programs at the University of Arkansas for Medical Sciences Regional Programs to characterize knowledge of neuromodulation as a treatment for post-laminectomy syndrome.ResultsForty-one percent of responding rural, Arkansas family medicine residents reported treating post-laminectomy syndrome during their training, yet only 10% have referred a patient for neuromodulation consultation. Residents rated their knowledge of neuromodulation/spinal cord stimulation at 19 on a scale of 0 (no knowledge) to 100 (extensive knowledge).ConclusionDespite proof that neuromodulation is an evidence-based treatment for post-laminectomy/failed back syndrome, rural family medicine residents have limited knowledge about the therapy and many do not consider a referral for neuromodulation. Further research to ascertain effective implementation strategies to increase the uptake of neuromodulation for patients with post-laminectomy syndrome is desperately needed.

Questionnaire for Community Medicine Training in Family Medicine Training Program and Rural Health Center Training Program

&lt;p&gt;目的：根據衛生福利部調查醫療區域醫師人力密度，部份次醫療區域醫師人力仍低於世界衛生組織所定最低醫療基本需求之每萬人口醫師數10位，因此衛生福利部提出優化偏鄉醫療精進計畫，其中教育方面規範家庭醫學科於專科訓練期間得前往偏遠地區衛生所進行輪訓。為完善規劃偏遠衛生所輪訓試辦之事宜，因此進行本研究。&lt;/p&gt; &lt;p&gt;方法：於2020年6月對全台68所符合家庭醫學科訓練資格醫院之部科主任或家庭醫學專科醫師訓練計畫主持人行問卷調查，後續召集有參加試辦計畫意願之醫療院所進行會談與二次調查。&lt;/p&gt; &lt;p&gt;結果：問卷回收率100%。全台約60.3%之教學訓練醫院有大於一個月以上的衛生所訓練計畫，且大部分的訓練醫院同意衛生所是具備教學功能之院外基層醫療訓練場所。然而安排偏遠地區衛生所訓練的主要障礙是工作分配困難與和不符合醫院組織的方向與需求，此外工作場所安全、學習和工作間的平衡也是一大考量。儘管如此，多數醫院仍認為偏遠地區衛生所之訓練能有助住院醫師的責任感訓練及不同制度下之工作與溝通訓練。&lt;/p&gt; &lt;p&gt;結論：此計畫執行立意良善，然衛福部需考慮增加家庭醫學科總訓練容額、補助交通經費、補助相關保險、偏遠執業風險及教學訓練之平衡。以期於住院醫師訓練、醫療院所家庭醫學科成長及國家偏遠醫療精進之間達成多贏局面。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Purpose: According to a MOHW (the Ministry of Health and Welfare) survey, several sub-regions (mainly rural and remote areas) in Taiwan fail to meet the WHO minimum requirement for health workforce (ten physicians per ten thousands residents). The MOHW had accordingly developed and implemented a program requiring all family medicine doctors-in-training to spend a part of their residency at rural health centers (RHCs). To promote the quality and efficacy of the training program and the safety of the training environment, the following research was conducted.&lt;/p&gt; &lt;p&gt;Methods: A questionnaire was issued in June 2020 to the branch chiefs and training program organizers of the 68 hospitals qualified for family medicine training in Taiwan. A symposium was subsequently held and a survey conducted to learn and analyze the responses of all the participating hospitals and public health centers.&lt;/p&gt; &lt;p&gt;Results: The response rate of the questionnaire was 100%. Around 63% of the responding hospitals had a RHC training program more than one month long, and most of the hospitals found public health center a good training venue. A major difficulty was that sending residents specializing in family medicine to RHCs seldom met the needs and goals of those hospitals. In addition, safety of the working environment and balance between learning and working were identified as issues demanding further consideration. Nevertheless, most participating hospitals believed that training at RHCs did help promote residents&amp;rsquo; sense of responsibility, as well as their ability to work under different systems.&lt;/p&gt; &lt;p&gt;Discussion: The program has great humanitarian potential. However, the MOHW may need to consider increasing the allowed number of trainees in family medicine each year, subsidizing trainee&amp;rsquo;s travel and insurance expenses, and assessing and addressing the risks of practicing in remote and rural areas so both the quality and efficacy of the training program can be improved to create win-win outcomes for all parties involved.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;