Didactic Hours Research Articles

Family Medicine Resident Remediation Compared Across Two CERA Studies.

From 2020 to 2022, multiple medical schools transitioned from teaching patient care directly to online electives. Family medicine program directors reported on these learners' abilities to meet the Accreditation Council of Graduate Medical Education (ACGME) core competencies during residency. The authors hypothesized an increased need for medical knowledge remediation in the 2023 Council of Academic Family Medicine Educational Research Alliance (CERA) study. Using the 2017 and 2023 CERA studies, the authors evaluated which factors were associated with residents requiring remediation, residents completing remediation, the duration of remediation, and the most remediated core competency. Compared to 2017, the percentage of residents who successfully remediated in the 2023 study increased (P=.006), while remediation duration stayed unchanged at 6 to 12 months. The top ACGME core competency needing remediation remained professionalism in both studies (2017: 38.1%; 2023: 45.1%; P=.10) with medical knowledge being second most common (2017: 30.2%; 2023: 25.2%; P=.20). We found no associations between non-U.S. medical graduate percentage, core faculty remediation training, professionalism training, or didactic hours and the number of residents undergoing remediation, the percentage of residents remediating successfully, or the most common competency remediated. Program director gender, degree, race, years of experience, underrepresented in medicine status, and remediation training were not associated with any resident remediation variables studied. Professionalism remains the top core competency requiring remediation. We found no associations between resident, program, training, or program director factors and the core competency requiring remediation, the number of residents needing remediation, or the percentage of residents who completed remediation.

Need for formalized robotic training and curriculum in obstetrics and gynecology residency: an examination of current resident outlooks and perspectives

The objectives of this study were to evaluate current robotic surgery training methodologies for ACGME-accredited obstetrics and gynecology (OB/GYN) residency programs, better understand current resident perspectives, and explore potential areas for improvement within resident education. A cross-sectional study was done of ACGME-accredited OB/GYN residents in the 2023–2024 academic year. The study was done on a national setting via web-based survey. 75 surveys were included. The study was conducted via a 33-question survey study using a mixture of multiple choice, multiple answer, and Likert scale questions. Participants noted that 98.7% of their institutions perform robotic surgery and 90.7% have access to robotic console trainers. Outside of the operating room, slightly more than half of participants (57.3%) have formalized robotics training curriculums. A variety of training modalities were noted to be utilized by residents with the most helpful being hands-on training (67.7%) followed by dual-assist console (45.6%). The least helpful was noted to be online modules (58.7%). Most residents either strongly agree (45.3%) or agree (36.0%) that standardized robotics curriculums should be implemented for all OB/GYN residency programs. The largest barriers to completion of this training were noted to be attending comfort with resident participation in the case (74.0%), personal time (58.9%), and availability or access to trainers (42.5%). A formalized and standardized robotic training curriculum should be considered for OB/GYN residents with a multi-modal model utilizing a combination of training modalities as well as dedicated didactic hours.

Program Factors Associated With Improved American Board of Surgery Examination Pass Rates.

The American Board of Surgery awards board certification after successful completion of both the Qualifying Exam and Certifying Exam. Although multiple studies have evaluated board performance at the resident level, fewer studies have evaluated board performance at the program level. Program pass rates, available through the American Board of Surgery, for 2019-2021 were compared to program information through the American Medical Association Fellowship and Residency Electronic Interactive Database Access (FREIDA). A significant positive correlation of Certifying Exam performance to residency length, resident class size, and number of total physician faculty within the program was seen. Greater average hours of didactics per week had a significant positive correlation to improved Qualifying Exam performance but not Certifying Exam. Programs with higher percentages of residents graduating from a United States MD program, compared to international or DO schools, were associated with improved performances. It also appears that more established programs performed better than younger programs <20years old. Programs in the West and Midwest performed significantly better on the Qualifying Exam than programs in the South and Northeast. Board certification serves as the capstone for surgeons after completing general surgery residency. Multiple program factors demonstrate a significant correlation to board performance.

1998. The State of Training in Infection Prevention and Control and Healthcare Epidemiology: A National Survey of Infectious Disease Fellowship Program Directors

Abstract Background Infectious disease (ID) clinicians are often identified to lead infection prevention and control (IPC)/healthcare epidemiology (HE) programs, however, there is no standardized training in fellowship for this role. The most recent survey of ID fellows in 2001 found that only 51% of graduates reported adequate training in IPC/HE. Despite this, half of respondents had IPC/HE responsibilities and received compensation from those activities. We conducted a survey of Program Directors (PD) of United States ID fellowship programs to assess current IPC/HE training. Methods An electronic survey was distributed in March and April 2023 to all ID fellowship PD identified by the Infectious Disease Society of America using Research Electronic Data Capture (REDCap). Survey questions covered training program characteristics, current required and optional IPC/HE training components, barriers to IPC/HE training, interest among fellows in IPC/HE training, and support for formalization of IPC/HE training. Results Of 166 programs, 54 (32.5%) completed the survey, representing programs in 25 states (Figure 1) and size range from 1-10 fellowship positions (mean 4). The majority (49/54, 90.7%) offered didactics in IPC/HE (mean 4.4 hours, range 1-10), of which 45/49 (94%) and 4/49 (6%) were required and elective, respectively. 52/54 (96.3%) of programs reported a formalized curriculum in IPC/HE training for all fellows and 18/54 (33.3%) of the responding programs offered a specialized track in IPC/HE. Reported training components varied (Table 1). A minority of PDs 11/55 (20%) reported considering expanding their IPC/HE training, however, 23/54 (42.6%) reported barriers (Table 2). There was widespread PD support for a formal IPC/HE certification program through a professional society (52/54, 96.3%).Figure 1:Geographic distribution of survey respondents divided by FEMA regions (1-10) of the United States and Territories (N= 54). Conclusion ID fellowship programs with dedicated IPC/HE training remain limited and the majority of training in IPC/HE is restricted to a small number of hours of didactics. Among respondents, many barriers to increasing IPC/HE training were identified. Respondents supported creation of a formal IPC/HE training program through a professional society. Disclosures Molly L. Paras, MD, Angiodynamics: Honoraria|Angiodynamics: Honoraria

Surgery clerkship shelf performance: evaluating the impact of required didactic hours on exam scores

Surgery clerkship shelf performance: evaluating the impact of required didactic hours on exam scores

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.

Integration of tobacco treatment specialist (TTS) training into dental and dental hygiene curricula.

Integration of tobacco treatment specialist (TTS) training into dental and dental hygiene curricula.

Planning for Future Is Critical to Protecting Our Profession and Americans’ Mental Health

Planning for Future Is Critical to Protecting Our Profession and Americans’ Mental Health

Efficacy of Peer-to-Peer Education for Emergency Medicine Resident Financial Literacy: Curriculum Development Study.

Early career physicians are under enormous stress from rigorous academic demands and financial insecurity due to increasingly large loan burdens and stagnant income. There are no institutionally required training programs to educate professionals on financial pitfalls or strategies for overcoming these burdens. Fiscal ignorance leaves them in a vulnerable position to be taken advantage of often, at great personal cost. Using a cross-sectional, convenience sample of emergency medicine residents at a single center, we evaluated the benefit of a six-month curriculum on financial education. Focusing on topics that were most pertinent early in medical careers, we assessed the utility of a six-lecture series totaling three hours of educationon fundamental financial literacy. Lectures were given by a single educatorwith no formal financial background in the following areas: general principles, student loans, retirement accounts, basic taxes, real estate, and insurance. Using pre-test and post-test information on 55 residents, financial literacy, as assessed by a 24-question multiple-choice survey, increased from 50% to 62% (p=<.001). Subgroup analysis was also performed within each financial category as well as by postgraduate year (PGY) of training. Raw data of individual percentages achieving specific financial milestones demonstrated an objective increase in the number of residents contributing to retirement accounts, creating an emergency fund,and establishing student loan repayment plans after the curriculum. Programs can institute sufficient financial literacy education for trainees that covers financial foundations. These programs can be taught without financial professional expertise or long hours of didactics.

Preparing Medical Students to Address Health Disparities Through Longitudinally Integrated Social Justice Curricula: A Systematic Review.

The education of health care professionals is a contributing factor to persistent health disparities. Although medical students are expected to understand racism, classism, and other social and structural drivers of health (SDH), standardization and best practices for teaching these concepts are lacking. Some medical schools are adopting social justice curricula (SJC) that prioritize health equity in teaching students to recognize SDH and preparing them to address the consequent health disparities. This systematic review sought to evaluate how these schools have integrated SJC into their core teaching; the criteria they have used to measure success and to what extent these criteria are met; and best practices in planning, implementing, and evaluating SJC. The authors searched 7 databases for English-language studies published between January 2000 and April 2020, reporting on longitudinally integrated SJC at U.S. medical schools intended for all students. Quantitative and qualitative outcomes were synthesized and summarized. Searches identified 3,137 articles, of which 11 met inclusion criteria. Results demonstrated schools use a variety of teaching methods over a wide range of didactic hours to teach SJC concepts. Surveys and objective tests indicated students in SJC are generally satisfied and demonstrated improved knowledge and skills related to understanding and mitigating SDH, although findings related to changes in attitudes were equivocal. Evaluations at graduation and in residency demonstrated students who experience SJC are more prepared than their peers to work with patients who are underserved. Best practices in SJC included addressing the hidden curriculum, considering medical mistrust, and using tools like the Racial Justice Report Card and Tool for Assessing Cultural Competence Training. These findings indicated SJC can prepare students to better address the root causes of health disparities. Future research should consider the long-term influences of these curricula on students, patients, and the community.

Abstract WP30: Zoom Or In The Room, Meeting The Stroke Education Standard

Background: Comprehensive Stroke Center nurses are required to receive 8 hours of stroke education annually; meeting this objective has been a challenge for administrators due to staffing shortages as well as the need to social distance during the COVID pandemic prompting virtual learning as a method to meet these standards. Web based courses often lack the multiplicity of diverse learning modalities needed for success. Purpose: Our objective was to provide a meaningful way to provide stroke education using the six perceptual modalities needed for adult learning which included visual, aural, printed, tactile, interactive, and kinesthetic learning. Methods: The stroke administrative team conducted a needs analysis based on nursing requests, outcome metrics, and requirements of the Joint Commission. A hybrid approach was delivered to the staff using four hours of classroom didactics, three hours of online classes, and one hour of education at hospital skills fairs, and unit meetings. Classrooms utilized social distancing, requiring multiple classes to be offered. Results: Nurses were surveyed with a 12 question Likert scale about how well they were prepared to integrate learned material into clinical practice comparing both virtual and live modalities. They were also asked about individual learning modalities. Twenty-five people responded to the survey. Only 12% of virtual learner respondents felt strongly prepared to care for stroke patients compared to 76% of classroom learners. Seventy-nine percent preferred classroom learning compared to 17% virtual, with a 4% hybrid preference. Learning preferences were multifactorial for visual, aural, printed, tactile, interactive, and kinesthetic learning being 95%, 48%, 56%, 40%, 11%, and 20% respectively. Conclusions: Virtual learning provides solutions in difficult situations, however classroom education is the preferred method of learning for healthcare professionals delivering evidenced based care for acute stroke patients. Planning committees should at least consider a hybrid approach that offer classroom time to caregivers.

Lung ultrasound training and evaluation for proficiency among physicians in a low-resource setting

BackgroundLung ultrasound (LUS) is helpful for the evaluation of patients with dyspnea in the emergency department (ED). However, it remains unclear how much training and how many LUS examinations are needed for ED physicians to obtain proficiency. The objective of this study was to determine the threshold number of LUS physicians need to perform to achieve proficiency for interpreting LUS on ED patients with dyspnea.MethodsA prospective study was performed at Patan Hospital in Nepal, evaluating proficiency of physicians novice to LUS. After eight hours of didactics and hands-on training, physicians independently performed and interpreted ultrasounds on patients presenting to the ED with dyspnea. An expert sonographer blinded to patient data and LUS interpretation reviewed images and provided an expert interpretation. Interobserver agreement was performed between the study physician and expert physician interpretation. Cumulative sum analysis was used to determine the number of scans required to attain an acceptable level of training.ResultsNineteen physicians were included in the study, submitting 330 LUS examinations with 3288 lung zones. Eighteen physicians (95%) reached proficiency. Physicians reached proficiency for interpreting LUS accurately when compared to an expert after 4.4 (SD 2.2) LUS studies for individual zone interpretation and 4.8 (SD 2.3) studies for overall interpretation, respectively.ConclusionsFollowing 1 day of training, the majority of physicians novice to LUS achieved proficiency with interpretation of lung ultrasound after less than five ultrasound examinations performed independently.

The Development and Implementation of a Hospitalist-Directed Addiction Medicine Consultation Service to Address a Treatment Gap.

Hospitalizations related to the consequences of substance use are rising yet most hospitalized patients with substance use disorder do not receive evidence-based addiction treatment. Opportunities to leverage the hospitalist workforce could close this treatment gap. To describe the development, implementation, and evaluation of a hospitalist-directed addiction consultation service (ACS) to provide in-hospital addiction treatment. Six hundred fifty-bed university hospital in Aurora, Colorado. Hospitalists completed buprenorphine waiver training, participated in a 13-part addiction lecture series, and completed a minimum of 40hours of online addiction training. Hospitalists participated in shadow shifts with an addiction-trained physician. Dedicated addiction social workers developed relationships with local addiction treatment services. Physician-related metrics included education, training, and clinical time spent in addiction practice. Patient and encounter-related metrics included a description of ACS care provision. Eleven hospitalists completed an average of 95hours of addiction-related didactics. Once addiction training was complete, hospitalists spent an average of 30days over 12months staffing a weekday ACS. Between October 2019 and November 2020, the ACS completed 1620 consultations on 1350 unique patients. Alcohol was the most common substance (n = 1279; 79%), followed by tobacco (979; 60.4%), methamphetamines/amphetamines (n = 494; 30.5%), and opioids (n = 400; 24.7%). Naltrexone was the most frequently prescribed medication (n = 350; 21.6%), followed by acamprosate (n = 93; 5.7%), and buprenorphine (n = 77, 4.8%). Trauma was a frequent discharge diagnoses (n = 1564; 96.5%). Leaving prior to treatment completion was commonly noted (n = 120, 7.4%). The ACS completed 47 in-hospital methadone enrollments. The hospitalist-directed ACS is a promising clinical initiative that could be implemented to expand hospital-based addiction treatment. Future research is needed to understand challenges to disseminating this model into other hospital settings, and to evaluate intended and unintended effects of broad implementation.

Psychiatric Education for Pediatric Emergency Medicine Fellows: Should We be Doing More?

This was a cross-sectional survey of PEM fellowship directors. The survey was submitted to the Pediatric Emergency Medicine Program Director Survey Committee via REDCap to all 83 fellowship directors. Fifty-five (66%) PEM fellowship directors completed the survey from September 2019 to December 2019. Forty-three (78%) programs provide some type of didactic teaching, although only 7 (13%) programs offer more than 5 hours of didactics over 3 years of fellowship. Six (11%) programs offer electronic resources, 13 (24%) offer simulations in psychiatry, and only 4 (7%) programs require any type of psychiatry rotation. Forty-six (84%) programs do not currently use psychiatric emergencies as a competency for evaluating PEM fellows. Program directors felt significantly more confident in faculty than graduating fellows in the management of numerous diagnoses including agitation (P < 0.001), homicidal ideation (P = 0.044), neuroleptic malignant syndrome (P = 0.006), acute dystonia (P < 0.001), and heroin overdose (P = 0.022). Ninety-six percent felt online curricula would be helpful to address this knowledge gap. Despite growing behavioral/mental health needs in the pediatric emergency department, there continues to be opportunity to improve psychiatric education during PEM fellowship. Program directors felt more confident in faculty than graduating fellows with several psychiatric diagnoses. Pediatric emergency medicine fellowship directors expressed a strong interest in online tools to assist in the education of PEM fellows.

Relationship between Didactic Attendance and Average Ophthalmic Knowledge Assessment Program Performance

Abstract Background The Accreditation Council for Graduate Medical Education's ophthalmology-specific program requirements indicate that a resident must participate in 360 hours of educational activities over the course of residency. The requirements allow a variety of options by which this educational process may occur. Furthermore, the current generation of learners has used a large array of learning tools in their careers: digital media, online resources, question banks, flipped classrooms, problem-based learning, and asynchronous lectures in addition to the traditional face-to-face didactic lectures. Objectives This article determines if the traditional face-to-face didactic lectures play a significant role in the education of ophthalmology residents, attempts to quantitate this role, and estimates the relative importance of this method. Methods Lecture hours beginning immediately after an Ophthalmic Knowledge Assessment Program (OKAP) examination and up to the subsequent exam was tabulated for 40 residents over 8 years. From 2012 through 2019 each of the residents took the OKAP exam one to three times. The average overall OKAP score for each resident was then regressed against his or her logged hours of didactics that year. This rate of average OKAP score to lecture hours was then evaluated for significant differences on the basis of postgraduate year (PGY). “STATA 13.1 IC,” was used for all statistical analysis. Conclusion Traditional synchronous didactic lectures play a statistically significant role in the education of ophthalmology residents. For each 3.5 hours of lectures per year there is a 1% increase in the average OKAP score, p = 0.0064. However, the amount of variability explained by this single factor is low, R 2 = 0.067, and other factors are presumed to play a large part in learning. PGY subgroup analysis showed significant difference in the OKAP performance to lecture hour relationship, the number of lecture hours attended, and the OKAP performance.

MON-122 Introduction of an Ambulatory Curriculum in Endocrinology Diabetes and Metabolism for Internal Medicine Trainees

Internal Medicine (IM) training programs are disproportionately weighted to inpatient learning opportunities. IM residents‘ exposure to outpatient internal medicine subspecialties, such as Endocrinology, Diabetes and Metabolism (EDM), is limited. This may contribute to gaps in medical knowledge in these content areas in spite of the frequent occurrence of EDM disorders. Further, reduced exposure during training may adversely impact interest in pursuing fellowship training in these fields, in spite of increased societal need.In July 2015 the IM residency program at the University of Pennsylvania switched to a “6 + 2” training model. In this training module, trainees are grouped into four cohorts, each of which have 6 weeks of inpatient rotations, followed by 2 weeks of an ambulatory experience. This model allowed the introduction of an organized ambulatory curriculum during the 2-week outpatient blocks, which was named the Interactive Learning Module (ILM). This creates the opportunity to deliver a standardized curriculum to all residents. Through this module we coordinate an immersive experience in five distinct outpatient themes: General Internal Medicine, Infectious Disease, EDM, Nephrology, and Rheumatology. The EDM ILM is co-led by a core faculty member and senior endocrinology fellow with interest in pursuing a career in medical education.During the EDM ILM, IM interns receive 12 hours of interactive didactics in high yield content areas including: Diabetes Workshop, Adrenal and Pituitary Diseases, Osteoporosis, Thyroid Diseases, Women’s Health, Calcium Disorders, Obesity and Endocrine Emergencies.Interns are given 3-4 opportunities to work with an EDM faculty member in the outpatient setting. Interns are also asked to read and review three publications within the field, which are discussed as a group.The EDM ILM has been consistently praised by IM interns, and feedback for the curriculum has been overwhelmingly positive. 97% of interns agreed the breadth of content was comprehensive and 94% agreed that the content was applicable to their delivery of ambulatory primary care. The quality of the teaching was rated high among 96% of interns. 89% reported improved understanding of EDM. Four years after the institution of the curriculum, we have not yet noted an increase in graduating IM residents choosing fellowship in EDM. However, all three of our IM residents who have matched into EDM fellowship over the past four years have chosen to stay at our institution.Faculty have thrived with these teaching opportunities: their consistently high evaluations have been an important criterion for academic promotion.Co-leading this course has been an important opportunity for senior EDM fellows to build expertise in medical education; three out of four participating fellows accepted academic positions with GME support.

Practical Techniques to Adapt Surgical Resident Education to the COVID-19 Era.

Practical Techniques to Adapt Surgical Resident Education to the COVID-19 Era.

Which Internal Medicine Clerkship Characteristics Are Associated With Students' Performance on the NBME Medicine Subject Exam? A Multi-Institutional Analysis.

To identify which internal medicine clerkship characteristics may relate to NBME Medicine Subject Examination scores, given the growing trend toward earlier clerkship start dates. The authors used linear mixed effects models (univariable and multivariable) to determine associations between medicine exam performance and clerkship characteristics (longitudinal status, clerkship length, academic start month, ambulatory clinical experience, presence of a study day, involvement in a combined clerkship, preclinical curriculum type, medicine exam timing). Additional covariates included number of NBME clinical subject exams used, number of didactic hours, use of a criterion score for passing the medicine exam, whether medicine exam performance was used to designate clerkship honors, and United States Medical Licensing Examination Step 1 performance. The sample included 24,542 examinees from 62 medical schools spanning 3 academic years (2011-2014). The multivariable analysis found no significant association between clerkship length and medicine exam performance (all pairwise P > .05). However, a small number of examinees beginning their academic term in January scored marginally lower than those starting in July (P < .001). Conversely, examinees scored higher on the medicine exam later in the academic year (all pairwise P < .001). Examinees from schools that used a criterion score for passing the medicine exam also scored higher than those at schools that did not (P < .05). Step 1 performance remained positively associated with medicine exam performance even after controlling for all other variables in the model (P < .001). In this sample, the authors found no association between many clerkship variables and medicine exam performance. Instead, Step 1 performance was the most powerful predictor of medicine exam performance. These findings suggest that medicine exam performance reflects the overall medical knowledge students accrue during their education rather than any specific internal medicine clerkship characteristics.

Continuing Education in Integrated Care: A Perspective From an Early Career Psychiatrist

Back to table of contents Previous article Psychiatry & Integrated CareFull AccessContinuing Education in Integrated Care: A Perspective From an Early Career PsychiatristJacynda Wheeler, D.O.Jacynda WheelerSearch for more papers by this author, D.O.Published Online:28 Feb 2020https://doi.org/10.1176/appi.pn.2020.3a27Abstract“To build a workforce equipped to provide effective mental health care in primary care and other settings, we have to think beyond traditional training programs like residencies and fellowships. In this issue’s column, we gain firsthand insight into the innovative, employment-friendly Community-Based Integrated Care Fellowship funded by the Washington state legislature that is bringing integrated care skills to psychiatrists already in practice.” —Jürgen Unützer, M.D., M.P.H.My first job out of residency included building a vision for psychiatric services across multiple settings that included a collaborative care program. A question about collaborative care during my interview with Island Hospital in Anacortes, Wash., quickly grew into a full-fledged implementation project, which was daunting as an early career psychiatrist! When an opportunity presented itself to continue training as I started my full-time job, I jumped at the chance. Education and support from expert faculty as I built a program from scratch in my first years of practice? Yes, please!I began the Community-Based Integrated Care Fellowship at the University of Washington in March 2017 as part of the first cohort, a group of psychiatric advanced practice registered nurses and psychiatrists from throughout Washington. As expected, I expanded my knowledge in primary care psychiatry and had excellent support in building our program. The real gems, however, were the unexpected learnings and growth that occurred over the fellowship year.Confidence: My confidence has increased, and I’ve been empowered by my involvement with the fellowship. Although the didactic content was critical in helping me implement my own collaborative care program, especially knowing the research base and familiarity with logistics like liability and documentation, I appreciated the genuine connections I made with a talented group of health care professionals throughout the state. Observing fellowship faculty advocate for resources and time needed to implement integrated care, I developed a level of comfort in this skill, and I have been humbled in how supportive my organization has been in response.Realistic lifelong learning: The program’s structure was a blend of online and in-person content, making it very accessible. Completing the recommended three hours of online didactics a week amid a busy outpatient practice with a toddler and another child on the way forced me to keep the work within these boundaries. I was amazed how this made me focus on relevant information and created a great foundation for lifelong learning. The 100+ CME hours was icing on the cake.Enjoyable quality improvement (QI): Through a required QI project, I became much more familiar with the QI process and how to apply it to even small changes. I found myself creating small, personal QI projects to test changes in my workflow (does a new template improve efficiency?) or even in my personal life (can a timer help toddler bedtime?). It introduced a new level of flexibility in my approach to new projects. The process of planning a change, trying something, having to adjust, and trying again feels productive and satisfying instead of overwhelming. What a gift!Concrete resources: I developed a database of knowledge and resources applicable to integrated care. Projects like creating an elevator pitch or public speaking practice have been directly relevant to my implementation project. I have saved time by pulling from things I either developed or started during the fellowship, always a win.The fellowship training in integrated care I received was excellent because it allowed me to develop my expertise, implement a quality program across multiple settings, anticipate challenges, and become more confident in my abilities both for myself and for my leadership team. All of this I was expecting. The personal growth I experienced was more of a surprise and, for me, an invaluable outcome that nurtured my first two years of practice and home life. It is something I have wholeheartedly recommended to colleagues. Through developing similar programs throughout the country or in other specialty areas, we may well be able to increase access to effective mental health care and support professional development for psychiatrists in any phase of their career with the same intervention. Win-win-win! ■More information on the Community-Based Integrated Care Fellowship is posted here.Jacynda Wheeler, D.O., is a psychiatrist and medical director of the Psychiatry and Behavioral Health Clinic at Island Hospital in Anacortes, Wash. Jürgen Unützer, M.D., M.P.H., is a professor and chair of psychiatry and behavioral sciences at the University of Washington and founder of the AIMS Center, dedicated to “advancing integrated mental health solutions.” ISSUES NewArchived

Pilot study to build capacity for family medicine with abbreviated, low-cost training programme with minimal impact on patient care for a cohort of 84 general practitioners caring for Palestinian refugees in Jordan

PurposeStudies document that primary care improves health outcomes and controls costs. In regions of the world where primary care is underdeveloped, building capacity is essential. Most capacity building programmes are...