Family Medicine Research Articles

Sarcopenia and Associated Factors in Adults Aged 40 and Above: A Study Conducted in Primary Healthcare.

Sarcopenia, characterized by progressive skeletal muscle loss, has emerged as a significant public health concern, with a global prevalence of 10-27%. While traditionally studied in geriatric populations, recent evidence indicates its impact on individuals aged 40 and above, with early manifestations of muscle decline. Primary care settings play a pivotal role in the early identification and management of sarcopenia, facilitating timely diagnosis and intervention. This study aims to evaluate the prevalence of sarcopenia and its associated factors among individuals aged 40 and above attending a family medicine outpatient clinic. A cross-sectional study was conducted in a family medicine outpatient clinic, including participants aged 40 and above. Participants underwent handgrip strength measurements, calf circumference measurements, and a 4-m walking test. Based on the criteria of the European Working Group on Sarcopenia in Older People 2 (EGSWOP2), individuals with sarcopenia and those at risk of sarcopenia were identified. The Mini Nutritional Assessment (MNA) was used to assess nutritional status. Sociodemographic characteristics, comorbidities, and laboratory values were recorded. A comparison was made between individuals with normal muscle strength and those at risk of sarcopenia. Among 213 individuals, 33 (15.4%) were at risk of sarcopenia (probable sarcopenia), and 12 (5.6%) were diagnosed with sarcopenia. There was a negative correlation observed between age and muscle strength (r=-0,339, p<0,001), and positive correlation was found between muscle strength and MNA score (r=0.301, p<0.001). Individuals with higher education and income levels exhibited higher muscle strength. Participants at risk of sarcopenia had higher prevalence rates of comorbidities such as diabetes mellitus (DM), chronic kidney disease, and cardiovascular disease (p=0.20, p<0.01, p=0.015, respectively). Our study highlights the prevalence and associated factors of sarcopenia in individuals aged 40 and above emphasizing the need for screening and intervention strategies in primary care settings. The study findings support the role of primary care in addressing sarcopenia and improving patient outcomes.

Kaua'i Rural and Public Health Selective: A Family Medicine Residency First.

Governmental public health professionals and community physicians often have limited understanding of each other's roles and responsibilities. To increase the connection between public health and primary care as well as to incorporate rural health care in graduate medical education training, a new "Kaua'i Rural and Public Health Selective" brings Family Medicine resident physicians (Residents) into the local health department on Kaua'i. This first-time collaboration between the Kaua'i District Health Office (KDHO) and University of Hawai'i John A. Burns School of Medicine (JABSOM) Family Medicine Residency Program advances Residents' understanding of public health and has been well-received by Residents and by department of health staff. Future plans include evaluation and continued incorporation of public health experiences into the core curriculum of a rural Family Medicine residency training program based on Kaua'i.

Family Physicians’ Awareness of the Burden of Oral Corticosteroids in Asthma Patients

Objective. The objective of this study was to identify when family physicians decide to prescribe oral corticosteroids (OCS) to treat asthma, to establish the factors affecting their decision, and how familiar family physicians are with the side effects of OCS. Materials and Methods. A cross-sectional observational study was conducted among physicians that are members of the Slovenian Family Medicine Society. Results. The study included 122 family physicians from all 12 Slovenian regions. The great majority (86.9%) reported they had previously prescribed OCS to asthma patients. The largest share of these (45.1%) tended to prescribe a limited number of tablets, although many (42.6%) also prescribed the entire pack. Regarding the adverse effects associated with OCS, the physicians listed a range of potential problems, highlighting hyperglycemia and exacerbated diabetes, the impact on bone density, a suppressed immune system and increased risk of infection as the most common. Conclusion. In the future, it is vital to improve family physicians’ awareness of when OCS may be prescribed to treat severe asthma, and to define the clinical pathway for severe asthma, which should also involve interdisciplinary collaboration.

Improving Equitable Access by Standardizing DMPA and Emergency Contraception Administration Practices in Family Medicine Clinics

Improving Equitable Access by Standardizing DMPA and Emergency Contraception Administration Practices in Family Medicine Clinics

Electronic Health Record–Based Screening for Intimate Partner Violence

Intimate partner violence (IPV) is a significant public health issue, with a 25% lifetime prevalence. Screening for IPV in primary care is a recommended practice whose effectiveness is debated. To assess the effect of an electronic health record (EHR)-based multifactorial intervention screening on the detection of IPV risk in primary care practice. This cluster randomized clinical trial used a stepped-wedge design to assign 15 family medicine primary care clinics in the Medical University of South Carolina Health System in the Charleston region to 3 matched blocks from October 6, 2020, to March 31, 2023. All women aged 18 to 49 years who were seen in these clinics participated in this study. A noninterruptive EHR alert combined with confidential screening by computer questionnaire using the EHR platform followed by risk assessment and a decision support template. The main outcomes were the rate at which patients were screened for IPV across the clinics and the rate at which patients at risk for IPV were detected by screening procedures. The study clinics cared for 8895 unique patients (mean [SD] age, 34.6 [8.7] years; 1270 [14.3%] with Medicaid or Medicare and 7625 [85.7%] with private, military, or other insurance) over the study period eligible for the screening intervention. The intervention had significant effects on the overall rate of screening for IPV, increasing the rate of screening from 45.2% (10 268 of 22 730 patient visits) to 65.3% (22 303 of 34 157 patient visits) when the noninterruptive alert was active (relative risk, 1.46 [95% CI, 1.44-1.49]; P < .001). The confidential screening process was more effective than baseline nurse-led oral screening at identifying patients reporting past-year IPV (130 of 8895 patients [1.5%] vs 9 of 17 433 patients [0.1%]). The intervention was largely effective in increasing screening adherence and the positive detection rate of IPV in primary care. A highly private approach to screening for IPV in primary care may be necessary to achieve adequate detection rates while addressing potential safety issues of patients experiencing IPV. ClinicalTrials.gov Identifier: NCT06284148.

I Think, Therefore I Am: A Reflection of Family Nurse Practitioners

&lt;p&gt;隨著台灣人口老化和社區醫療照護需求增加，在原本的內外婦兒、精神和麻醉專科護理師外應運而生「家庭專科護理師」，從傳統的急性照護邁向基層照護，更多的在門診、社區、居家、長照、偏鄉離島等場域提供民眾專業健康照護服務。本文從簡介國人健康形態的轉變延伸到對家庭專科護理師的需求、發展與培育，以國立陽明交通大學為例，分享家庭專科護理師養成的核心能力架構，並佐以核心訓練理念，達到：全生命歷程轉銜（從新生兒到老人）、急慢性疾病無縫接軌（照護能力養成）、醫護進階合作、國際領航訓練和無邊界學習擴充（線上虛擬實境），同時配合學生過去的教育背景（有無專科護理師碩士學位）提供完整或是轉銜家庭專科護理師訓練，讓學習更有效率。期待家庭專科護理師不僅僅是第一線的民眾健康照護提供者，更是具有國際觀和科技識能的進階護理專家。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Taiwan is going to be a super-aged society and has increased needs of primary care providers. There-fore, the demand for family nurse practitioners (FNPs) is expected high and strong in addition to the roles in medical, surgical, women health, pediatric, psychological, and anesthetic areas that nurse practitioners have contributed in Taiwan. FNPs are specialized in providing preventative and primary care to individuals and families across the lifespan in various care settings, including primary care clinics, family medicine practice, urgent care centers, long-term care facilities, home health agencies or in the places where medical services needed. National Yang Ming Chiao Tung University&amp;rsquo;s FNP master program emphasizes hands-on, real-life care in meeting all core competence requirements across the lifespan from infants to the elderly, from acute illness to chronic diseases, physician-nurses advanced collaborations, international visits and virtual education. We expect that our FNP graduates have the competence and confidence in their clinical practices and leading the advanced nursing prac-tice with global vision and technology skills in the new era&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Electronic Health Record Usability, Satisfaction, and Burnout for Family Physicians

Electronic health record (EHR) work has been associated with decreased physician well-being. Understanding the association between EHR usability and physician satisfaction and burnout, and whether team and technology strategies moderate this association, is critical to informing efforts to address EHR-associated physician burnout. To measure family physician satisfaction with their EHR and EHR usability across functions and evaluate the association of EHR usability with satisfaction and burnout, as well as the moderating association of 4 team and technology EHR efficiency strategies. This study uses data from a cross-sectional survey conducted from December 12, 2021, to October 17, 2022, of all family physicians seeking American Board of Family Medicine recertification in 2022. Physicians perceived EHR usability across 6 domains, as well as adoption of 4 EHR efficiency strategies: scribes, support from other staff, templated text, and voice recognition or transcription. Physician EHR satisfaction and frequency of experiencing burnout measured with a single survey item ("I feel burned out from my work"), with answers ranging from "never" to "every day." Of the 2067 physicians (1246 [60.3%] younger than 50 years; 1051 men [50.9%]; and 1729 [86.0%] practicing in an urban area) who responded to the survey, 562 (27.2%) were very satisfied and 775 (37.5%) were somewhat satisfied, while 346 (16.7%) were somewhat dissatisfied and 198 (9.6%) were very dissatisfied with their EHR. Readability of information had the highest usability, with 543 physicians (26.3%) rating it as excellent, while usefulness of alerts had the lowest usability, with 262 physicians (12.7%) rating it as excellent. In multivariable models, good or excellent usability for entering data (β = 0.09 [95% CI, 0.05-0.14]; P < .001), alignment with workflow processes (β = 0.11 [95% CI, 0.06-0.16]; P < .001), ease of finding information (β = 0.14 [95% CI, 0.09-0.19]; P < .001), and usefulness of alerts (β = 0.11 [95% CI, 0.06-0.16]; P < .001) were associated with physicians being very satisfied with their EHR. In addition, being very satisfied with the EHR was associated with reduced frequency of burnout (β = -0.64 [95% CI, -1.06 to -0.22]; P < .001). In moderation analysis, only physicians with highly usable EHRs saw improvements in satisfaction from adopting efficiency strategies. In this survey study of physician EHR usability and satisfaction, approximately one-fourth of family physicians reported being very satisfied with their EHR, while another one-fourth reported being somewhat or very dissatisfied, a concerning finding amplified by the inverse association between EHR satisfaction and burnout. Electronic health record-based alerts had the lowest reported usability, suggesting EHR vendors should focus their efforts on improving alerts. Electronic health record efficiency strategies were broadly adopted, but only physicians with highly usable EHRs realized gains in EHR satisfaction from using these strategies, suggesting that EHR burden-reduction interventions are likely to have heterogenous associations across physicians with different EHRs.

Insights into Retrofitting Fellowships in Family Planning with Principles of Equality, Race, and Cultural Literacy

The Centering Equality, Race, and Cultural Literacy in Family Planning (CERCL-FP) program aims to break racial silence and dismantle structural racism in the field of family planning, by providing racial equity workshops and trainings. ObjectiveThe objective of this study was to begin a multi-phased, rigorous evaluation to determine the impact and outcomes of the work of CERCL-FP. Study DesignA needs assessment with former graduates and current directors of fellowships in family planning was conducted using qualitative interviews. The focus of these interviews was to determine the ability, readiness, and willingness of the field of family planning to retrofit new curricula grounded in equity, race, and cultural literacy. ResultsNine (N=9) interviews were completed with seven board certified obstetrician-gynecologists and two board certified family medicine physicians. Three themes were identified: 1) Establishing the Distribution of Work; 2) The Push/Pull of Change from Inside and Outside: Curricula and Faculty Responsibilities; and 3) Reproductive Justice and Fellowships in Family Planning. Despite acknowledging the need to retrofit the field of family planning with content grounded in equity, race, and cultural literacy, there are structural, institutional, and individual level barriers that have limited the adoption of CERCL-FP curricula within family planning curriculum nationwide. ConclusionFindings from this study illuminate multiple barriers that should be considered when expanding foundational knowledge of clinicians and researchers.

Topical Corticophobia Among Healthcare Professionals in Saudi Arabia: A Cross-Sectional Study.

Corticophobia constitutes a complex challenge affecting patients and healthcare professionals alike, resulting in suboptimal management and treatment of dermatological conditions. This study aims to investigate corticophobia among physicians in Saudi Arabia and identify associated factors. This is a retrospective, observational, cross-sectional study that included 700 participants. The sample constituted dermatologists, pediatricians, and family medicine practitioners at different levels (consultants, fellows, and residents) in Saudi Arabia. Data were collected via an electronic survey addressing demographic information and corticophobia-related questions. A total of 700 participants were included in the data analysis. Dermatologists were the most comfortable prescribing steroids (32%), followed by family medicine physicians (25%), and pediatricians (18%). Pediatricians were the most hesitant to prescribe steroids. Fellows were the most confident in prescribing steroids. Physicians from the northern and western regions were least likely to be hesitant in prescribing steroids. In conclusion, this study reveals that in Saudi Arabia, dermatologists were the most comfortable prescribing topical corticosteroids, with pediatricians being the most hesitant. The findings emphasize the importance of education in addressing corticophobia among healthcare professionals, which could improve treatment adherence and patient outcomes. Further research and targeted educational interventions are necessary to enhance understanding and confidence in prescribing topical corticosteroids among healthcare professionals.

Family and Community Medicine Training: Challenges and Innovation in the Wake of COVID-19

Family and Community Medicine Training: Challenges and Innovation in the Wake of COVID-19

Análisis comparativo de los Programas de Formación Sanitaria Especializada de Medicina Familiar y Comunitaria, Medicina Interna, Medicina Intensiva, Anestesiología y Reanimación y Medicina de Urgencias y Emergencias

Objetivo. Analizar si con las especialidades actuales se adquieren los conocimientos y habilidades necesarios para desempeñar las funciones propias de la Medicina de Urgencias y Emergencias (MUE). Método. Mediante análisis de contenido documental, se comparan los programas formativos de Medicina Interna (MI), Medicina Intensiva (MIV), Anestesiología y Reanimación (AyR) y Medicina Familiar y Comunitaria (MFyC) vigentes a fecha de junio de 2021, accesibles tanto en el portal web de Ministerio de Sanidad (MS), como a través de las sociedades científicas de las especialidades, incluidos los borradores no oficiales y propuestas de actualización de los programas y del programa de formación elaborado por la Comisión Promotora de la Especialidad de MUE, presentado por SEMES (Sociedad Española de Medicina de Urgencias y Emergencias) al MS en 2010 y actualizado en 2021. Resultados. Los programas formativos de las especialidades existentes en la actualidad contemplan el manejo de las enfermedades urgentes de forma heterogénea en sus distintas áreas asistenciales (MI en las áreas de hospitalización, AyR en el perioperatorio y MIV en unidades de críticos) o como extensión de la actividad asistencial en el centro de salud (MFyC). Los periodos formativos en el área de la MUE son variables y se realizan en el caso de AyR, MIV y MFyC en un formato exclusivo de guardias (AyR y MIV únicamente durante el primer año y MFyC a lo largo de los 4 años de residencia, con porcentaje decreciente conforme avanza el tiempo de formación), y en el de MI a través de un rotatorio inicial de 3 meses durante su primera etapa formativa, y el resto del tiempo a través de guardias, sin especificar su número. La propuesta del programa de formación en MUE detalla un contacto amplio y específico tanto en los SUH, incluyendo todas sus áreas asistenciales propias (observación, urgencias traumatológicas y pediátricas) como en los dispositivos de emergencias extrahospitalarias y centros coordinadores de urgencias y emergencias. Conclusiones. No es posible la adecuada preparación para desarrollar la MUE con la oferta formativa actual. La MUE presenta un cuerpo doctrinal y ámbito de actuación propios que son diferentes de los de otras especialidades. Esto provoca que en España exista un vacío formativo que se solventaría mediante la creación de una especialidad primaria en MUE.

Bipolar disorder in the practice of family medicine

In recent years, the subject of discussion among world psychiatrists has been the issue of the large spread of mental illnesses among the population, including bipolar disorder, its diagnosis and modern principles of therapy. It is known that bipolar affective disorder (BAR) is more common for young and able-bodied people, while their usual state is replaced by an alternation of severe depression and mania with episodes of even background mood. It is also worth noting that the BAR is often associated with suicidal thoughts, disability and a tendency to alcoholism. This problem can be stopped by effective therapy initiated in a timely manner and return a person to his usual life, therefore, the study of this issue carries a high social significance.

Socio-Cultural and Professional Integration of Foreign-Born and Foreign-Educated Physicians in German Outpatient Care: an Interview-Based Study in Baden-Württemberg and Hessen

Introduction In recent years, it has become increasingly hard to fill outpatient physician vacancies in all parts of Germany. This development is particularly pronounced in general practice. At the same time, the number of doctors trained abroad is increasing, predominantly in the inpatient sector. In the next few years, foreign-born and -trained physicians will presumably be increasingly active also in the field of family medicine. The aim of this study was to explore experiences, support needs and possible improvements from the perspective of such physicians in the outpatient sector with a focus on primary care.Method In this qualitative study, semi-structured interviews were conducted with physicians not raised and trained in Germany and working in the outpatient setting in Germany. The evaluation was carried out by means of qualitative content analysis. Categories were derived in a deductive-inductive manner.Results Thirteen physicians (of which nine were primary care physicians) were interviewed. Next to the deductively derived main categories (departure, des-orientation, adaptation) four subcategories as overarching problems emerged in the interviews: Administrative tasks, communication and professional as well as social adaptation / integration in Germany. Proposed solutions were categorized in structuring measures (official, easily accessible guidelines for physician migration, paid qualification period), specific preparatory courses for the outpatient sector, and personal support such as mentoring and networking of outpatient physicians in training.Conclusions Some of the problem areas mentioned were similar to those known from the inpatient setting. To support sustainable recruitment in the outpatient sector, specific preparatory courses and the promotion of networking among physicians appeared to be additional measures that would benefit physicians applying for positions in the outpatient sector and also easy to implement.

When and What: Family Physicians' Perspective on Clinical Communication Skills and Professionalism Education during the Medical Training Program in Riyadh, Saudi Arabia

Background: Effective communication skills are crucial for health professionals in order to build a favorable rapport with their patients, so enhancing their overall well-being and quality of life. From this standpoint, the implementation of communication skills training may serve as effective techniques to enhance the care delivered by healthcare personnel and the overall quality of healthcare services. Aim: To investigate the perspectives of family physicians, on the necessary communication and professionalism skills for medical students, as well as the best time during medical training programs to attain these competencies in Riyadh, Saudi Arabia. Methods: A cross-sectional survey-based study was conducted among family medicine physicians in different hospitals, Riyadh, Saudi Arabia. Participants responded to inquiries on the communication abilities and professionalism competencies while discussing the timing of competency achievement. An online questionnaire was sent to all the physicians. The questionnaire consisted of three sections: Gathering demographic information, Questionnaire on professional engagements, and a timeline estimation of each doctor's acquisition of communication skills and professionalism competencies. The data analysis was performed using SPSS, Version 26.0. Prior to analysis, data cleaning and entering were conducted. A test is considered significant if the P-value is below 0.05. Results: A total of 301 participants, aged between 30 and 41 years old, took part in the current research. Approximately 51.5% of the participants were family physician specialists, whereas around 25.9% were residents and 4% were students. A majority of FM respondents (56.5%) said that FM residency is the most opportune period in the medical training program to include the bio-psycho-social context. Respondents (50.5%) felt that it is during this time that they get a better understanding of the patient's viewpoint and that of their family. Approximately 48.5% of FM participants believe that the FM residency is the most favorable period of medical training to take into account the beliefs, needs, and perspectives of patients and their families. However, 58.5% of participants feel that this residency provides an opportunity to develop strong critical thinking skills. Furthermore, 50.2% of participants believe that the FM residency equips them with the ability to handle uncertainty effectively and adapt to various situations and contexts. The majority of FM participants were doing clinical activities at different stages; After Residency (93.8%), Residency (80.8%), or Undergraduate (86.8%). In addition, teaching practice was significantly related to the stages of communication training (P&lt;0.001); most of FM participants practice teaching after Residency (90.6%), and 53% of them practice teaching in their Residency. there is a significant relation between the clinical activity done and the stage of professionalism training (P=0.005), the majority of FM participants were doing clinical activities at different stages; After Residency (93.9%), Residency (83.6%), or Undergraduate (76.3%). In addition, the preceptor was significantly related to the stages of professionalismtraining (P=0.010); 45.5% of FM participants after residency were preceptors. Conclusion: The perspectives of these family doctors' medical educators may aid in formulating the necessary objectives for medical training, which might influence the structure of medical curricula and promote lifelong learning initiatives. Future research should focus on certifying these key competencies and enhancing evaluation methodologies, with a particular emphasis on evaluating their effect on healthcare. Keywords: Family Physicians, Perspectives, Clinical Communication Skills, Professionalism, Medical Training

Implementation of the clinical practice guidelines among family medicine doctors at primary health care facilities in Khartoum and Gezira states of Sudan

IntroductionThe health system in Sudan faces several challenges, including increasing numbers of patients, shortages of health supplies, and disparities in the distribution of health services. Guidelines implementation improves patients’ outcomes and ensures efficient use of the resources in such a resource limited country. The study aimed to assess the implementation of the clinical practice guidelines among family medicine doctors working in the primary health care centers in Khartoum and Gezira states to provide baseline data about the current practice in Sudan.MethodsDescriptive cross-sectional facility-based survey, conducted from April to December 2021, on 373 of the practicing family-medicine doctors. A total of 101 Primary health care centers were surveyed (77 centers in Khartoum state and 24 in Gezira state). The questionnaire was pilot tested on a small group of physicians to improve clarity and reduce response bias. Descriptive statistics were used to summarize the data and analyzed by frequency tables. Chi square and logistic regression tests were used to determine the association between categorized variables. P value < 0.05 was considered statistically significant.ResultsMost of the practicing family-medicine doctors (98.4%) reported implementation of the guidelines. Moreover, (68.6%) of them received training programs which were organized and funded by the Sudan Ministry of Health. The local Sudanese guidelines were difficult to access and not regularly updated. Services unavailability and inaccessibility (87.1%), health insurance factors (83.9%), and patient factors (81.2%) were the most frequent barriers to guidelines implementation. Service cost (79.9%), lack of regular training programs (79.9%), absence of local guidelines (77.2%), lack of continuity in the comprehensive care process (63.0%), and lack of time (57.1%) were also reported as barriers to guidelines implementation.ConclusionGuidelines implementation is limited by unavailability and inaccessibility of the health services and the health insurance limited coverage. Expansion of the health insurance coverage, organization of continuous training programs, encouragement of regular auditing and issuing regulations to ensure the use of updated guidelines, dissemination of the updated national guidelines along with establishing clinical governance in Sudan can be useful tools for policymakers in the optimum allocation of public health resources.

“A day in the life” – telemedicine in family medicine and its relationship with practicing physicians’ satisfaction: a cross-sectional study

BackgroundTelemedicine has expanded rapidly in recent years, and many encounters that were conducted in person now take place remotely. This study aimed to assess primary care physicians’ (PCPs) attitudes towards the different modalities of patient care.MethodsThis is a cross-sectional nationwide descriptive study conducted in Israel. We asked PCPs to document an entire workday and answer a short questionnaire after each visit. The questions addressed the type of visit (face-to-face, remote synchronous [telephone/video], or remote asynchronous [online requests]), the perceived quality of the visit, and the physicians’ feelings at the end of each visit. Before documenting their working day, we asked the participants to answer a questionnaire about their general attitudes toward different modalities of medical visits and how they affect their well-being and burnout.ResultsSixty physicians documented 2,025 visits, of which 39% took place in person, 36% stemmed from online patient requests, 18% were telephone meetings, < 1% were video meetings, and 6% consisted of other types of contact. Mixed effects logistic regressions were used to model the visits’ evaluation. The odds ratios (ORs) for perceived medical quality of visits focused on medical tasks were lower for non-face-to-face visits: OR = 0.39, 95% CI 0.25–0.59 for remote synchronous, and OR = 0.14, 95% CI 0.09–0.23 for remote asynchronous. The perceived medical quality of visits focused on administrative tasks was lower for remote asynchronous than for face-to-face visits (OR = 0.31, 95% CI 0.14–0.65). We found no association between medical quality and patients, physicians, or clinic characteristics. The inappropriateness of the visit modality was also associated with lower medical quality (OR = 0.13, 95% CI 0.09–0.18). We found a correlation between perception of medical quality and physicians’ feelings at the end of the visits, Spearman’s r = 0.82 (p < 0.001).ConclusionsA substantial portion of the visits was dedicated to administrative tasks and remote medicine. In comparison, physicians rated face-to-face visits’ quality higher than remote visits. Policymakers should intervene to minimize administrative work, reduce PCPs’ administrative workload, and direct patients to the optimal visit modality for their complaints. These steps would increase medical quality, reduce burnout, and mitigate the shortage of PCPs.

Making family medicine work: Rural community-based and interprofessional medical education.

At the University of the Free State, the 5-year MBChB curriculum had to be complemented with community-based education exposure to meet the requirements of the Health Professions Council of South Africa. Following the faculty leadership's vision, an interprofessional training experience was conceptualised and implemented by a project team from the three schools in the Faculty of Health Sciences (Medicine, Nursing, and Health and Rehabilitation Sciences). For the past decade, 4th-year medical students participated in the 2-week rotation in the rural southern Free State province, of which 1 week is spent with students from other health professions programmes in a structured interprofessional learning experience. The other week focuses on the realities of nurse-driven primary healthcare services in a resource-deprived area, including exposure to the programme-guided care for patients with tuberculosis (TB) or chronic diseases, care for pregnant women and for babies, including vaccinations.

Family Health Clinical Officers: Key professionals to strengthen primary healthcare in Kenya.

Primary healthcare (PHC) is recognised as the means to achieve universal health coverage, a national priority for Kenya. With only approximately 200 family physicians for a population of over 54 million, innovative solutions for providing quality PHC are needed. Clinical Officers, as mid-level health workers, already provide much of the primary care across Kenya, but without specialised training. To provide highly trained Family Health practitioners, a Higher Diploma in Family Health for Clinical Officers (FHCO) was launched by the government in 2018. With experience in delivering innovative and strategic higher diplomas, AIC Kijabe Hospital has been involved in curriculum development of this new diploma since its inception, and in October 2021 the first cohort of FHCO trainees was admitted to Kijabe College of Health Science, graduating in 2023. The second cohort is underway with plans for an annual intake. The FHCO graduates are running Family Medicine clinics at AIC Kijabe Hospital and its satellite clinics and are heavily involved in teaching. They are well-trained to deliver comprehensive, evidence-based, cost-effective and holistic care. As the programme expands, we expect graduates to be working across the country and leading efforts in enhancing the health and well-being of individuals, families and communities within primary healthcare networks (PCNs). By training FHCOs, this higher diploma is an efficient and cost-effective way to improve PHC, particularly for underserved Kenyans, and thus is a key part of enabling the Kenyan Government to achieve universal health coverage. This model of training could easily be replicated in other countries.

Family medicine viewed through the public lens: A national cross-sectional study in Lebanon.

Family medicine (FM) is a medical specialty that provides continuing, comprehensive health care for the individual and the family. This study aimed to describe Lebanese citizens' knowledge, attitudes, and practices toward FM as a specialty. This is a national cross-sectional phone-based survey targeting the knowledge of the public about FM and its scope of practice. Questions were asked whether participants had primary health care doctors and their specialties. A total of 373 participants were included, with a response rate of 85.2%. Two-thirds were aware of the specialty of FM, while only 16.6% of the participants had previously visited a family physician. Most participants (69.7%) had a doctor they regularly consulted. One-third of participants had a general practitioner as their regular doctor. More than 80% of the participants agreed that FM physicians treat all family members with common and chronic diseases. Around 60% to 75% of participants knew that family physicians provide medical care to children, treat patients with psychiatric impairments, and perform minor surgeries. There was a significant gap in the participants' knowledge of FM physicians' role in managing obstetric or gynecologic patients. Despite public awareness of FM, limited understanding and system challenges hinder its utilization in Lebanon. Educational campaigns, government-supported FM practices, and collaborations with public health initiatives are crucial to bridging the knowledge gap and establishing FM as the cornerstone of primary care. This knowledge gap challenges the specialty's identity and necessitates promoting FM as the cornerstone of primary care, potentially requiring a system-wide endorsement.

The socio-demographic profile of family physician graduates of blended-learning courses in India.

India's lean cadre of 250,000 general practitioners and 30,000 government doctors has limited options to update themselves. Since 2006, Christian Medical College (CMC) Vellore has run blended-learning programs in family medicine, namely, postgraduate diploma in family medicine (PGDFM) and master in medicine in family medicine (M.MED FM) training more than 3000 doctors. A graduate follow-up study was undertaken in 2022. The aim of the study was to describe the socio-demographic characteristics of family physicians (FPs) in India who graduated between 2008 and 2018 from the FM blended-learning programs run by the CMC, Vellore. Informed by an empirical-analytic paradigm, this descriptive study used a cross-sectional survey design to uncover graduate FPs' profiles, practices and experiences. Using a purposively designed, piloted and validated electronic questionnaire, data were collected between March and July 2022, deidentified and analysed using Statistical Package for Social Sciences (SPSS)TM and Epi InfoTM. Among the 438 FP respondents (36%), there was an almost even split in gender (49.3% male, 50.7% female). Moreover, 25.8% were below the age of 40 years, 37.4% were in the 40-49 age group, and 33.8% were 50 years of age or older; 86% lived and worked in urban areas. The PGDFM or M.MED FM was the highest educational qualification of 64.4% of the doctors. Male FPs pursued postgraduate studies at a significantly younger age and earned significantly more than their female counterparts. The blended learning model creates an important pathway for doctors, especially women, to pursue higher education with flexibility. Preferential selection criteria can target rural-based physicians. Strong policy-level advocacy is needed to establish FM as a specialty with equitable pay scales. Socio-demographic profiling can be used as an effective advocacy tool.