Family Medicine Training Research Articles

Impact on the Physician - A Signature Reflection Dealing with Death

Home visits on patients require checks for the request, the illness, the date last seen, current medications, and who the carer is. Globally, especially in the Middle East, cultural awareness and sensitivity are paramount, particularly in palliative care. Family physicians care for terminally ill patients. Often in the last stages, fatigued, dyspneic, anemic, cachectic, relatively anorexic, a patient’s mind may still be needle-sharp. Sincere empathy should never be standardized. Questions should be answered truthfully. No two caring moments are the same, making each interaction unique. In palliative care, the quality of physician conversations can assume wide empathetic dimensions. Training in family medicine, while thorough, usually provides lighter exposure to cancer patients. The first serious cancer death experience can be stressful for the carer. However, responsibility for palliative care is a reality. There is no respite. In family practice, deaths from cancer are common. Some bête-noirs include multiple myeloma, ovarian, lung, and breast cancer. Intrinsic patient conversations occur after each diagnosis, at the beginning, in between, and in palliation. What vital information needs relaying by the physician? How much is shared with spouses or family relatives, with consent? What impact does that make on both the patient and physician? Patient self-awareness being near death in terminal illness is common. It is still unsettling. A physician of care considers the choice of a dying patient choosing to stay home. The gain is avoiding moving to a hospital or a hospice in unfamiliar settings. More poignantly, it enables loving care from one’s lifetime partner and family at home. After death, an exchange of warm words with facial expressions evokes everyone’s emotions. Personal feelings resonate in care, empathy, hope, truth, trust, and professional respect for one another. The end feels more like losing a friend. Such patients are not forgotten; physicians learn from them. The dead do not suffer pain, only those left behind. Is healing ever complete when looking after sick patients for the practicing physician grappling with professional and personal emotions? How long does that take? Do multiple deaths cumulate the impact? Recovery is part of being resilient, critical in the profession, and feeling vocational compassion satisfaction in work. What if one does not always cope adequately? Is compassion fatigue a danger? Who tends for the wounded carer? When is physician resilience needed most? What keeps physicians motivated? How do they care for themselves and stay well-balanced? Reflections on practice experiences keep life in perspective. Dying patients, subconsciously, are often our best teachers.

The effects of intermittent fasting on nighttime blood pressure levels

Hypertension, a preventable disease with a high prevalence, is frequently seen in obese patients with cardiovascular risk factors. Our study aimed to investigate the effect of an intermittent fasting regimen on nighttime blood pressure levels. Patients who applied to Karabuk University Faculty of Medicine Training and Research Hospital Cardiology and Family Medicine Polyclinic between January and March 2021 and were followed up for 24 hours on an outpatient basis were included in this self-controlled interventional study. Patients underwent a second 24-hour Holter blood pressure follow-up after one month of diet, and the results were compared. The study was conducted with 30 subjects who adhered to a one-month intermittent fasting regimen. 63.3% of the patients were male, and the mean age was 54.60 ± 9.71 years. One month later, 13 patients whose nighttime blood pressure improved were assigned to Group 1 and 17 patients to Group 2. There was no important variance between the groups in terms of gender, age, height, waist circumference and BMI (p=0.609, p=0.105 and p=0.087, in order of). Mean VA and BSA were considerably lower in Group 2 (p=0.027 and p=0.045, in order of). HT duration was longer in Group 1 (p=0.001). There was no important variance between the groups in terms of smoking, alcohol use, average daily sleep time, salt intake awareness and exercise habits. The rate of snacking habits in Group 2 was statistically considerably higher (p=0.033). Intermittent fasting may be beneficial in preventing nocturnal hypertension.

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.

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.

Assessing knowledge, acts of discrimination, stigmatizing attitudes and its associated factors towards people living with HIV (PLHIV) among Family Medicine trainees in Malaysia.

Human immunodeficiency virus (HlV)-related stigmatisation and discrimination adversely affect health outcomes in terms of timely diagnosis, treatment and care. Despite global efforts, they remain common among healthcare workers worldwide. In Malaysia, family medicine specialists are entrusted with the care of HIV patients at the primary care level. This study aimed to assess HIV-related knowledge, acts of discrimination, stigmatising attitudes and their associated factors among family medicine trainees in Malaysia. This cross-sectional study was conducted among 397 family medicine trainees in Malaysia using a validated, self-administered questionnaire that assessed the participants' sociodemographic information, HIV/AIDS knowledge, stigmatising attitudes (attitudes of blame, attitudes towards imposed measures, comfort in dealing with HIV patients) and acts of discrimination. The most common stigmatisation was "attitudes of blame" (mean [SD] score: 3.0 (0.74); range score:1-5), and the most frequent discriminatory act was breaching patient confidentiality (54.9%). Around 82.1% had good knowledge of HIV/AIDS. Married participants and participants who had 7 years or less in service were more stigmatising in "attitudes of imposed measures" towards people living with HIV (p=0.006). Family medicine trainees exhibited stigmatisation and discrimination towards HIV patients despite having good HIV knowledge. Hence, appropriate and concerted health education should be given to all family medicine trainees to eliminate stigmatisation and discrimination.

Bridging the Gap Between Competencies and Uncertainties in Postgraduate Training in Family Medicine: Results and Psychometric Properties of a Self-Assessment Questionnaire.

PurposeOne of the reasons for postgraduate trainees not to choose working in a rural area is uncertainty related to the lack of competencies. The aim of this study was to investigate the concept of uncertainty by measuring competencies and to examine the psychometric properties of an instrument that measures competencies related to uncertainty in the self-assessment of postgraduate trainees in family medicine.Patients and MethodsA questionnaire was created based on pre-existing instruments. It was distributed to participants of postgraduate training seminars in the federal states of Baden-Württemberg and Schleswig-Holstein, Germany in 2016. Descriptive statistics and a partial correlation analysis were calculated for measuring the degree of association between year of postgraduate training and items’ responses. Psychometric properties were assessed by calculating descriptive item analysis, factor analysis and internal consistency.ResultsThe response rate was 85% (105/124). More than one-fifth of the participants stated to show only seldom or sometimes the following skills: ability to balance work and life (N=25, 24%), letting a mild disorder run its own way (N=24, 23%) and ability to conduct interventions that decreased aggression from the patient (N=22, 21%). More than half of the participants felt (very) insecure in performing routine child check-ups, the application of a below elbow backslab and the partial removal of a toenail. Nine out of 21 items showed positive statistically significant correlation between level of competence and progress in training. Factor analysis led to a final instrument with 12 items (Cronbach’s α=0.736) and a three-factor-structure: “doctor well-being and resilience”, “communication” and “skills”.ConclusionIn order to reduce uncertainty with all its consequences, a focus on teaching of competencies regarding the physicians’ well-being and resilience, communication and skills has to be continued in postgraduate training.

Osteopathic manipulative treatment use among family medicine residents in a teaching clinic.

Osteopathic Principles and Practice (OPP), including osteopathic manipulative treatment (OMT) is the core foundation of the education provided by osteopathic medical schools. Multiple studies performed over the past 25years have demonstrated that a dwindling number of osteopathic physicians utilize OMT in their practice, despite 95% of osteopathic family physicians perceiving OMT as an effective treatment modality. The objective of this study is to quantify how often OMT is being performed by residents in an osteopathically recognized family medicine training clinic and to identify the perceived barriers to performing OMT. Fifteen family medicine residents were given access to an anonymous written survey for three 2week periods. The survey allowed them to input the total number of patient encounters for their half clinic day, the encounters in which OMT was perceived to be appropriate, the encounters in which OMT was performed, and the reasoning for encounters in which OMT was not performed. Surveys were collected anonymously, and data were input into a datasheet in which results were calculated. A total of 101 survey responses were collected for a total of 304 patient encounters. OMT was performed in 5/304 (1.6%) encounters, yet it was perceived to be appropriate in 60/304 (19.7%) encounters. The primary documented reason that OMT was deferred was due to time constraints (42/50 responses, or 70.0% of the encounters in which OMT was deemed appropriate). This study highlights time as the main reason OMT is deferred by residents in a teaching clinic. This provides insight into potential interventions in a training clinic to increase the use of OMT by family medicine residents.

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.

Outpatient regulation in Primary Care in the municipality of Rio de Janeiro, Brazil, based on the local regulatory doctors.

The scope of the article was to characterize the process of regulation of care in Primary Health Care units in the city of Rio de Janeiro, with an emphasis on the outpatient dimension. A cross-sectional study was carried out in 2019, by means of a survey, with the participation of 114 local regulatory physicians. With respect to the profile of local regulators, there is a high percentage with training in Family and Community Medicine and the length of service of these professionals in the units is relatively satisfactory. For 52.6%, the infrastructure for regulation is adequate, but connectivity frequently presents problems. In the regulation system, the mechanisms and schedules for making vacancies available and accessing them elicit competition between the regulators of the units, with work overload and associated access inequities. There was major involvement of local regulators in activities of evaluation and management of waiting times. The majority reported that there was little or no interaction with specialized care. Although the decentralized regulation process still has some shortcomings, the study points to the feasibility and contribution of more intense participation of Primary Care in the regulation of access.

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.

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

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

Natural Language Processing to Identify Digital Learning Tools in Postgraduate Family Medicine: Protocol for a Scoping Review

BackgroundThe COVID-19 pandemic has highlighted the growing need for digital learning tools in postgraduate family medicine training. Family medicine departments must understand and recognize the use and effectiveness of digital tools in order to integrate them into curricula and develop effective learning tools that fill gaps and meet the learning needs of trainees.ObjectiveThis scoping review will aim to explore and organize the breadth of knowledge regarding digital learning tools in family medicine training.MethodsThis scoping review follows the 6 stages of the methodological framework outlined first by Arksey and O’Malley, then refined by Levac et al, including a search of published academic literature in 6 databases (MEDLINE, ERIC, Education Source, Embase, Scopus, and Web of Science) and gray literature. Following title and abstract and full text screening, characteristics and main findings of the included studies and resources will be tabulated and summarized. Thematic analysis and natural language processing (NLP) will be conducted in parallel using a 9-step approach to identify common themes and synthesize the literature. Additionally, NLP will be employed for bibliometric and scientometric analysis of the identified literature.ResultsThe search strategy has been developed and launched. As of October 2021, we have completed stages 1, 2, and 3 of the scoping review. We identified 132 studies for inclusion through the academic literature search and 127 relevant studies in the gray literature search. Further refinement of the eligibility criteria and data extraction has been ongoing since September 2021.ConclusionsIn this scoping review, we will identify and consolidate information and evidence related to the use and effectiveness of existing digital learning tools in postgraduate family medicine training. Our findings will improve the understanding of the current landscape of digital learning tools, which will be of great value to educators and trainees interested in using existing tools, innovators looking to design digital learning tools that meet current needs, and researchers involved in the study of digital tools.Trial RegistrationOSF Registries osf.io/wju4k; https://osf.io/wju4kInternational Registered Report Identifier (IRRID)DERR1-10.2196/34575

Development and validation of the scale for measuring biopsychosocial approach of family physicians to their patients.

ObjectiveWhile other models focus more on disease and pathophysiology, the biopsychosocial approach emphasises the importance of human health and disease in their fullest contexts. If we are to gain an insight into physical and psychological health needs, and address them quickly and adequately, it is important that we recognise them already at the family practice stage. An approach that assesses needs at patient level could also be seen as patient-centred care, which is one of the key elements of high-quality care. To the best of our knowledge, no scale for measuring the biopsychosocial approach of family physicians has yet been developed.DesignThe aim of this study was to develop and validate a scale that measures the biopsychosocial approach of family physicians to their patients through the Delphi and validation process.SettingThe scale was developed through the Delphi study and validated by means of significant statistical methods. Pearson’s correlation coefficient, Cronbach’s alpha, the intracorrelation coefficient, the Spearman-Brown coefficient and exploratory factor analysis were applied.ParticipantsFive family physicians took part in a brainstorming process and 24 family medicine experts took part in the Delphi study. For the first part of the validation process, there were 31 family medicine trainees in the first group and 32 in the second group. For the last part of the validation process, 164 family physicians completed the scale.ResultThrough the Delphi study, 39 final items covering three areas within the biopsychosocial approach were identified. Construct validity was high, with positive linear correlation and good face validity. The intraclass correlation coefficient for test–retest reliability was 0.862. The Spearman-Brown coefficient was the highest (0.931) on an even and odd division. Factor rotation showed that three factors on 35 items explained 39.5% of variances. The final internal consistency on 35 items was 0.911.ConclusionThe developed scale measures the biopsychosocial dimension of family physicians’ work with high Cronbach’s alpha measures and good validity.

Supporting Community-Based Family Medicine Residency Training Programs in North Carolina and their Potential Impact on Healthy NC 2030.

North Carolina is a leader in family medicine, but a growing health care chasm exists between the state's urban centers and rural areas. Training family medicine residents in rural communities can address disparities in health care access and improve rural population health metrics for all subsets of the population, goals that align well with renewed state and national strategies.

Need of the Hour: Family Medicine in India.

Family medicine practitioners can manage a wide range of health problems, either directly or through referral to other specialists, thereby optimizing the cost-effectiveness of the healthcare system. For most health problems, family medicine practitioners serve as an entry point for individualized healthcare. Providing comprehensive care for most specialties for all ages is the hallmark of family medicine. It is recognized as a distinct specialty in many developed countries, and training is provided through organized residency programs. Family medicine has been incorporated in the foundation course of Bachelor of Medicine, Bachelor of Surgery (MBBS) and is planned to be adopted in all medical institutes in India; however, the MBBS syllabus includes no mention of it. In medical schools in India, fully functioning family medicine departments should be established on an urgent scale. It is necessary to take the required measures to introduce the subject into the undergraduate MBBS program and to generalize it across India. It is recommended that the number of medical schools offering postgraduate residency training in family medicine be increased to meet current community health needs.

Preparing residents to practice integrated behavioral health care: Multi-site feasibility study of a competency-based curriculum.

Workforce development is essential for the dissemination of team-based integrated behavioral healthcare. There is limited literature on training family medicine residents to function within an integrated behavioral health (IBH) system. The purpose of this pilot study was to assess the feasibility and value of an IBH competency-based curriculum for family medicine residents across multiple programs. Residency programs were recruited using professional listservs and networks to test a competency-based, multi-modal curriculum for preparing residents to practice IBH in primary care. Faculty instructors who led the workshop were invited to complete semi-structured interviews to examine the feasibility and appropriateness of the curriculum. Interview data were analyzed using thematic analysis to identify, analyze, and report patterns. Residents completed a survey of perceived IBH skill and knowledge before and after training. A paired-sample t-test was used to determine significant differences pre- and post-training. All five instructors completed interviews. Results suggest IBH training is valuable. Instructors gave specific feedback on online modules, implementation flexibility, and adjusting faculty development to differing levels of experience. Nineteen of forty residents (48%) completed anonymous pre-, post-, and retrospective-training surveys. Residents reported an increase in competence after training. The results of this pilot suggest that IBH training implementation is feasible, desirable, timely, and may improve resident ability to work on an IBH team. Training should accommodate variations in program structure and faculty expertise.

Effectiveness of a web-based, electronic medical records-integrated patient agenda tool to improve doctor-patient communication in primary care consultations: A pragmatic cluster-randomized controlled trial study

BackgroundDoctors may struggle to identify patient agendas during busy primary care consultations. Therefore, an online patient agenda tool (the Values in Shared Interactions Tool- VISIT) was developed which allowed patients to enter their agenda items pre-consultation for doctors to view on their electronic medical records (EMR). This study aimed to measure the impact of this EMR-integrated website on patient satisfaction, number of agenda items discussed and consultation time. MethodsAn unblinded cluster-randomized controlled trial was conducted in a university-based primary care clinic between June-October 2019. Twenty-five family medicine trainees were randomized into using the VISIT tool (intervention) and usual care (control). Descriptive analysis showed significant differences between arms for age, occupation and mobile device proficiency scores. These were entered as covariates in trial analyses. Primary outcome was mean self-reported patient satisfaction score using the Healthcare Provider-Patient Communication (HCPPC) questionnaire, secondary outcomes were mean agenda items per consultation and mean consultation time. ResultsThe intervention arm had 12 doctors and 109 patients; the control arm had 13 doctors and 137 patients. Participation rates were 25.5% for intervention vs 53.6% for control. There was no difference between arms for patient satisfaction scores (133.3, 95% CI: 130.67–135.88 intervention vs 134.0, 95% CI: 131.76–136.29 control, P =.680) and consultation duration (15.83 min, 95% CI: 13.66–17.99 intervention vs 15.45 min, 95% CI: 13.57–17.34 control, P =.805). Mean number of agenda items discussed was higher in the intervention arm (2.25 items, 95% CI: 2.06–2.44 intervention vs 1.94 items, CI 95%: 1.78–2.11, P =.024). ConclusionsIntegrating patient agendas into the EMR did not affect patient satisfaction compared to usual care but was associated with a slightly increased number of agenda items without an increase in consultation time. This shows it may be useful for a busy primary care setting with multiple comorbidities and short consultation times.

Incorporating Telehealth Into Family Medicine Training: An Emerging Need

Incorporating Telehealth Into Family Medicine Training: An Emerging Need