Family Medicine Practice Research Articles

Patient and provider prediabetes knowledge, attitudes, and behavior in a large urban family medicine practice.

Context: One-third of American adults have prediabetes. However, only 11% are aware of their condition, and they often do not receive prediabetes education or management. Prior studies have indicated knowledge gaps among primary care providers and patients on prediabetes management. Objective: To understand family medicine providers' and patients' attitudes, knowledge, and behaviors regarding prediabetes and its management to inform a prediabetes management intervention. Study Design: Cross-sectional surveys. Setting: A large academic family medicine practice in downtown Philadelphia with 30,000 patients making 80,000 visits annually. Population studied: Family medicine providers (attending physicians, nurse practitioners, residents) and adult patients seen within the last year, with HbA1c in the last 6 months between 5.7-6.4% (excluding pregnant, diabetes diagnosis). Instruments: Provider survey asking demographics, knowledge, attitudes, management, DPP awareness, barriers to prediabetes treatment, and open-ended question on how the practice could improve prediabetes management. Patient survey asking demographics, awareness of diagnosis and risk, knowledge, attitudes, experiences with DPP, prediabetes experiences with PCP, and same open-ended question as provider survey. Provider survey distributed via email; patient survey via Epic MyChart patient portal. Outcome Measures: Descriptive statistics for all quantitative survey items; thematic analysis of open-ended responses. Results: Fifty-four providers and 148 patients completed the surveys (57% and 16.5% response rates, respectively). Nearly all providers (96%) felt that prediabetes screening and management is important but most (74%) prescribe metformin to ≤ 25% of eligible patients. Over half (56%) were unaware of DPP, and 52% of those aware of DPP did not know how to refer a patient. Over half (59%) of patients reported having been told they have prediabetes and 84% thought diet and lifestyle changes were effective treatment, but 65% were unaware of medication options and only 5% had been referred to DPP. In open-ended responses, providers requested more nutrition counseling and an improved DPP referral process; patients also requested nutrition counseling and classes. Conclusions: Providers and patients saw prediabetes as important but reported knowledge and management gaps, particularly for metformin and DPP, and requested additional practice resources.

Disparities in access for melanoma screening by region, specialty, and insurance: A cross-sectional audit study

BackgroundEarly detection of melanoma is critical for positive outcomes. However, access for the diagnosis of melanoma remains problematic for segments of the general population.ObjectiveTo compare the rates of dermatology and family medicine practitioner acceptances for a public insurance (Medicaid) versus private insurance (Anthem Blue Cross) and clinic wait times for an appointment for a changing pigmented skin lesion concerning melanoma in rural and urban regions in California.MethodsCross-sectional audit study between June 2017 and March 2019; scripted phone calls were made to dermatology and family medicine practices (FMPs).ResultsFamily medicine and dermatology practices in both regions had significantly decreased acceptance of Medicaid. Dermatology practices had 11.3% to 13.0% Medicaid acceptance rates that were less than FMP rates of 28% to 36%. In both regions, FMP wait times were 2.4- to 3.2-fold longer for public versus private insurance; there were little differences in wait times for the 2 insurance types in dermatology practices, in both regions.LimitationsAssessment of only 2 regions in the state of California.ConclusionDelays at FMPs and insurance types limit access to melanoma screening in California for underserved segments of the general population, which has implications for melanoma outcomes and health policy.

Teaching Family Medicine and General Practice.

The teaching of family medicine and general practice should aim to develop an appreciation of the unique nature and role of the specialty. Teachers should relate patient cases to the principles of family medicine. These principles include (1) compassionate care; (2) a generalist/holistic approach focusing on the whole person, family, and community; (3) continuity of relationship, i.e., building a patient-physician bond of trust; (4) reflective mindfulness; and (5) lifelong learning. The curriculum, instructional strategy, and assessment should be carefully aligned. Core competencies include patient-centered communication, physical examination skills, clinical procedures, palliative care, humanities in medicine, holistic care, shared decision-making, family therapy, home and community visits, chronic disease care, problem-based documentation, team-based care, data-driven improvement, information mastery, ethics and professionalism, and work-life balance. Family medicine/general practice is defined as the medical specialty that manages common and long-term illnesses, focusing on overall health and well-being. Hence, clerkship schedules should maximize clinical exposure and opportunities for self-reflection. A learner-centered approach should begin with a self-identified inventory of learning needs based on the curriculum; next, these needs should be chosen as topics for student presentations. Teaching methods should include mini-workshops: a combination of didactic lectures and small-group exercises. Individual face-to-face formative feedback should occur at midcourse and culminate in a group reflection on the learning experience. Clinical supervision should gradually decrease as each resident demonstrates safe patient care. Procedure skills training should be closely supervised, formally documented, and constitute about one-fourth of learning sessions.

Medical Personnel and Their Professional Level is the Main Component of Family Medicine

The paper focuses on new approaches to the development of family medicine in Ukraine. There has been made a brief historical overview of stages of family medicine development. The main component of the successful development of general practice–family medicine is stated to be human resources: personnel availability, personnel staffing, professional level. The medical education, including continuing professional development, plays an important role in the professional development of family physicians. The modern educational technologies are widely used in Shupyk NMAPE. The paper describes one-day scientific workshops in the format of the off-site training and videoconferences that are conducted under the methodical direction of the Academy.

Teaching family-oriented care to family medicine residents: Evaluation of a family skills curriculum.

Family-oriented care is at the heart of family medicine (FM) practice, yet research suggests an unmet need for family skills training in FM residencies. The purpose of this study is to evaluate family-oriented (FO) attitudes and observed skills of FM residents before and after completion of a longitudinal family skills curriculum.We assessed FO attitudes and observed skills of second-year FM residents (N = 12) using the "Family in Medicine" Q-sort exercise (Q-sort) and the Family-Centered Observation Form (FCOF) before and after completion of the family systems "Practicum" portion of a 20-week psychosocial medicine curriculum. Residents were observed in 19 pre- and 15 post-Practicum encounters.With regard to attitudes, 10 of 12 (83%) residents had a moderate to strong affinity for the FO viewpoint pre-Practicum; 9 of 12 (75%) maintained or strengthened their FO viewpoint post-Practicum. With regard to observed skills, FO visit content increased post-Practicum; 10/15 (67%) post-Practicum encounters included FO comments or questions compared to 5/19 (26%) pre-Practicum encounters.In this curriculum evaluation, we found our FM residents to have strong baseline FO attitudes that generally became stronger after a family skills curriculum. FO behaviors increased post-Practicum, though were still demonstrated relatively infrequently, which may be related to a variety of factors. Future directions include increasing experiential FO learning opportunities during Practicum and revising and validating the FCOF. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Direct-to-Consumer Academic Telemedicine.

Over the past 2 years, telemedicine has skyrocketed as COVID-19 propelled innovation and implementation at unparalleled rates. Within the UC Davis academic health system, a new paradigm for telemedicine emerged: direct-to-consumer telemedicine. The video-based telemedicine program has become the largest of its kind in California and is staffed by 80 providers (MDs, APPs) across five clinical departments/groups (primary care practice group, family and community medicine department, emergency medicine department, the nursing department, and the physical medicine and rehabilitation department). September 2021 marked the 1-year anniversary of a journey that has opened access, improved coordination, and become a workforce engine for our evolving virtual health infrastructure.

EP441: Evaluation of growth in perceived clinical genetics competency among primary care providers participating in genomic population health screening

Genomic information is increasingly important to patient-centered clinical care and within the rapidly evolving landscape of precision medicine. As stewards of preventative and anticipatory care, primary care providers (PCPs) are ideally positioned to lead the implementation of genomic medicine into routine clinical practice. The University of Vermont Health Network (UVMHN) recently implemented “The Genomic DNA Test” pilot program in select family medicine practices, offering adults with any health status sequencing for more than four-hundred genes with known relevance to personal health risk and recessive carrier status.

Demographic and clinical characteristics of primary care patients vaccinated against COVID-19 in spring 2021.

The aim of this study was to examine the age distribution and comorbidities of individuals vaccinated in primary care practices in April and May 2021. The analysis was based on data from the IQVIA Disease Analyzer database and included 245,948 patients who received their first COVID-19 vaccination from one of 820 family medicine practices in April or May 2021. 93.6% of individuals received a vaccination based on general indication, 6.2% based on occupational indication, and 0.2% were nursing home residents. Men were 3.5 years younger on average than women (59.2 vs. 62.7 years). 54% of women and 52% of men younger than 60 years had at least one diagnosis from the priority list. Hypertension was the most common diagnosis (23.6% of men and 20.7% of women). In men, chronic respiratory diseases such as COPD or asthma were the second most common diagnosis (11.0%), while in women, depression (17.0%) was the second most common diagnosis. In the first 2 months of vaccination in general practices, most patients vaccinated were either elderly or chronically ill. Further studies comparing the characteristics of vaccinated and unvaccinated individuals would also be of great epidemiological relevance.

Facilitators of and Barriers to Successful Implementation of the One Key Question® Pregnancy Intention Screening Tool.

Background:One Key Question® (OKQ) is a tool that embeds a patient-centered screening into routine visits with the goal of making pregnancy intention screening universal, but widespread implementation has not yet been adopted. We aimed to explore the barriers and facilitators of OKQ implementation to better understand how to best implement the tool across different settings.Methods:We invited staff and clinicians from one obstetrics and gynecology clinic and one family medicine clinic, which previously implemented OKQ, to complete surveys and qualitative interviews about their experiences with the tool. The interview guide and thematic analysis of the interview transcripts were informed by the Consolidated Framework for Implementation Research (CFIR).Main Findings:Major facilitators of OKQ implementation are the simplicity of the tool, engagement of clinic leadership, and compatibility between the perceived goals of the tool and those of practice staff and clinicians. Although participants indicated that OKQ had a minimal impact on clinic workflow during its implementation, preimplementation time concerns were a major barrier to implementation in both clinics. Barriers seen in the family medicine practice included OKQ distracting from the visit agenda, and concerns about the OKQ gold standard protocol of screening each patient at every visit. Participants even suggested asking OKQ only during annual check-up appointments.Conclusions:The perceived alignment between the tool's goals and those of clinic stakeholders was an important facilitator of OKQ implementation success. However, characteristics of the clinic setting, such as competing medical priorities and time constraints, influenced initial attitudes toward the feasibility of the intervention. Clinical Trial Registration Number: NCT03947788

Multidrug Resistant E-Coli in Patients with Urinary Tract Infections Presenting to Internal Medicine Clinics of Two Tertiary Care Hospitals in Lahore, Tip of the Iceberg

Background: The commonly presenting infections in medical outpatients’ department are that of Urinary tract. If not treated properly these can lead to hospitalization and can increase the morbidity and mortality. Escherichia coli is found to be the most frequent bacterium causing these infections. The available literature may not under representing the prevalence of E. Coli which is multi drug resistant and is seen in general medical outdoor and internal medicine clinics of our local population, because urine sample is usually sent for culture only in complicated patients. Objective: To determine the prevalence of multi drug resistant E. Coli and its resistance to the most commonly used antimicrobial agents in Internal Medicine Clinics of Bahria International Hospital, and Farooq Hospital, West wood branch, Lahore. Study Design: This is an observational study done retrospectively carried out at Internal Medicine Clinics of Bahria International Hospital Lahore and Farooq Hospital, Lahore from 1st January 2019 to 31st December 2020. Methodology: One hundred and ninety adult patients with urinary symptoms and suspected UTI were enrolled. We analyzed the available urine culture reports and susceptibility against the pathogens. The testing was interpreted according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) standards. Results: The most common microorganism was E. Coli (70%) followed by klebsiella (17.9%), enterococcus (8.9%) and Acinetobacter (3.2%) in both complicated and uncomplicated urinary tract infections. 75 % females were E. coli positive as compared to the male (58.6%). Patients aged greater than 60 and less than 20 years were mostly affected with E. coli. Most of the isolated pathogens were highly resistant to ampicillin, cotrimoxazole, and cephalexin (70%–95.5%). Conclusion: E. coli is found highly resistant to antimicrobial agents used to treat UTI at family medicine practice. No difference could be appreciated in the apportioning of resistant E. coli in both complicated and uncomplicated UTIs. This study emphasizes that we should collect data at National level and prepares a proper guideline for choosing appropriate antibiotics in patients with UTI presenting to general medical clinics. Key words: E. coli, Multidrug resistance, Urinary tract infection, Antibiotics, Pyelonephritis

Improving Influenza Vaccination Rates in an Underserved Primary Care Clinic Using a Simple Educational Tool.

Influenza is a preventable communicable illness that has a significant impact on people of all ages. In 2018, it was estimated that 80 000 people died of influenza-related illnesses. In the 2018-2019 influenza season, only 34.9% of individuals in the 18 to 49 years age group received the influenza vaccine. Despite the low vaccination rate for influenza, the vaccine has multiple evidence-based benefits that demonstrate the importance of improving its uptake among adults. According to data from the Centers for Disease Control and Prevention (CDC), the vaccine prevented around "6.2 million influenza illnesses, 3.2 million influenza-associated medical visits 91 000 influenza-associated hospitalizations, and 5700 influenza-associated deaths" in the 2017-2018 influenza season. In a suburban family medicine clinic, a primary care provider (PCP) observed that greater than 50% of adult patients in his family medicine practice declined influenza vaccine when offered during the 2018-2019 season compared with the site rate of 43.4% and the department rate of 47.9%. The goal of this project was to educate patients who initially decline the vaccine to agree to receive the vaccine and to increase the percentage of patients who get an influenza vaccine from 43.4% to 50% in adult patients at a suburban primary care clinic by having them read the CDC document and asking them after they read the document whether they would like to receive the vaccine. From October 1, 2018, to February 28, 2019, adult patients in a primary care clinic were asked whether they wanted to receive the influenza vaccination and responses were recorded. During this time, 589 patients were questioned, with 56% (n = 330) answering no, or 43% of patients receiving the influenza vaccination. In total, 658 patients were offered the flu shot during the intervention period, representing 27.7% of the patients seen in this clinic. While there was some monthly variation, the PCP was able improve the percentage of patients receiving the influenza vaccination from 43% to 60.9% with this simple educational intervention. The overall clinic rate for this time frame increased from 56.6% to 58.2%. This simple intervention was effective in improving influenza vaccine rates for one provider in a suburban safety-net clinic. It added minimal workload to the provider, and the intervention is easily replicable in other settings.

Four models of pharmacist‐integrated office‐based opioid treatment

AbstractPurposeIn 2019, one point six million Americans had opioid use disorder (OUD), yet only 18% of those patients received treatment with evidence‐based medications. Office‐based opioid treatment (OBOT) is the provision of care for OUD with buprenorphine, in various formulations including combination with naloxone, and naltrexone. Currently, there are few reports of physician‐pharmacist collaborative practice models for OBOT. The purpose of this study was to identify common roles, clinical backgrounds, and barriers of pharmacists within four pharmacist‐integrated OBOT services in one community.MethodsFour pharmacists implemented OBOT services in a family medicine (FM) residency, obstetrics‐gynecology residency, a physician‐owned FM practice, and a Federally Qualified Health Center. Each pharmacist detailed the evolution of OBOT models at their respective sites. Using a 21‐item questionnaire comprised of closed and open‐ended questions, the four pharmacists describe: the setting's OBOT; the pharmacist's OUD‐related training; pharmacist‐related OBOT activities; and barriers to implementation.ResultsOne pharmacist spends 10 to 20 h/wk on OBOT, while the others spend less than 10 h. In terms of patient care, two pharmacists conducted intake, group visits, collected vitals, and ensured naloxone access. All pharmacists counseled patients and conducted follow‐up visits. For nonpatient care activities, three pharmacists developed OBOT policies/procedures, and four coordinated care and consulted on OBOT cases. To prepare for this, two pharmacists learned about OUD in pharmacy school, two pharmacists completed the buprenorphine waiver‐training course, two pharmacists learned about OUD in residency, and three pharmacists attended continuing education. Barriers identified were lack of designated time, funding, and ability to prescribe buprenorphine.ConclusionPharmacists can effectively integrate into many OBOT settings. Future work should standardize the optimal role of the pharmacist, expand OUD pharmacy education, and advocate for pharmacists as waivered providers.

Statistical Analysis of Dermatological Condition in a Family Medicine Practice in South East Romania

Abstract Dermatological conditions are defined as the most common in all age groups. It is especially important to take into account the promptnes and correctness of the diagnosis and the administration of the treatment of choice. A large part of dermatological conditions, by theyr nature, can predispose the patient to low self-esteem with emotional imbalance and anxiety. Sometimes these can result in severe depression, rarely ending in suicide. It is difficult to count the transposition time of dermatological infections until the appearance of symptoms, because each onset of dermatological disease varies, from days, month, years and therefore contact dermatitis, psoriasis, scabies, sunstroke, chronic radiodermatitis, onychomycosis, aerated alopecia, acne, rosacea acne, vitiligo as well as lesion of the connective tissue and subcutaneous cells, the latter largely duet o their idiopathic character. The purpose of this study is the statical analysis of the cases of dermatological infections associated with medical care from a family medicine office in Lumina during the period 01.01.2022 – 31.09.2022. The author illustrates the discrepancy between the representative increase in cases of dermatological conditions among the population and the expression of daily activity.

Why I Practice Family Medicine.

Why I Practice Family Medicine.

Accelerated 3-Year MD Pathway Programs: Graduates' Perspectives on Education Quality, the Learning Environment, Residency Readiness, Debt, Burnout, and Career Plans.

PurposeTo compare perception of accelerated and traditional medical students, with respect to satisfaction with education quality, and the learning environment, residency readiness, burnout, debt, and career plans.MethodCustomized 2017 and 2018 Medical School Graduation Questionnaires (GQs) were analyzed using independent samples t tests for means and chi-square tests for percentages, comparing responses of accelerated MD program graduates (accelerated pathway [AP] students) from 9 schools with those of non-AP graduates from the same 9 schools and non-AP graduates from all surveyed schools.ResultsGQ completion rates for the 90 AP students, 2,573 non-AP students from AP schools, and 38,116 non-AP students from all schools in 2017 and 2018 were 74.4%, 82.3%, and 83.3%, respectively. AP students were as satisfied with the quality of their education and felt as prepared for residency as non-AP students. AP students reported a more positive learning climate than non-AP students from AP schools and from all schools as measured by the student–faculty interaction (15.9 vs 14.4 and 14.3, respectively; P < .001 for both pairwise comparisons) and emotional climate (10.7 vs 9.6 and 9.6, respectively; P = .004 and .003, respectively) scales. AP students had less debt than non-AP students (P < .001), and more planned to care for underserved populations and practice family medicine than non-AP students from AP schools (55.7% vs 33.9% and 37.7% vs 9.4%; P = .002 and < .001, respectively). Family expectations were a more common influence on career plans for AP students than for non-AP students from AP schools and from all schools (26.2% vs 11.3% and 11.7%, respectively; P < .001 for both pairwise comparisons).ConclusionsThese findings support accelerated programs as a potentially important intervention to address workforce shortages and rising student debt without negative impacts on student perception of burnout, education quality, or residency preparedness.

Exploring Why Financial Incentives Fail to Affect At-home Colorectal Cancer Screening: a Mixed Methods Study.

Despite success in increasing other health behaviors, financial incentives have shown limited to no effect on colorectal cancer (CRC screening. Little is known about the factors shaping why and for whom incentives improve screening. To explore the perspective of participants enrolled in a larger, four-arm pragmatic trial at urban family medicine practices which assessed and failed to detect significant effects of financial incentives on at-home CRC screening completion. We performed a mixed methods study with a subset of randomly selected patients, stratified by study arm, following completion of the pragmatic trial. Sixty patients (46.9% enrollment rate) who were eligible and overdue for colorectal cancer screening at the time of trial enrollment and who continued to receive care at family medicine practices affiliated with an urban academic health system completed the interview and questionnaire. Using Andersen's behavioral model, a semi-structured interview guide assessed motivators, barriers, and facilitators to screening completion and the impact of incentives on decision-making. Participants also completed a brief questionnaire evaluating demographics, screening beliefs, and clinical characteristics. The majority of patients (n = 49; 82%) reported that incentives would not change their decision to complete or not complete CRC screening, which was confirmed by qualitative data as largely due to high perceived health benefits. Those who stated financial incentives would impact their decision (n = 11) were significantly less likely to agree that CRC screening is beneficial (72.7% vs 95.9%; p < 0.05) or that CRC could be cured if detected early (63.6% vs 98.0%; p < 0.05). Financial incentives are likely not an effective behavioral intervention to increase CRC screening for all but may be powerful for increasing short-term benefit and therefore completion for some. Targeting financial incentive interventions according to patient screening beliefs may prove a cost-effective strategy in primary care outreach programs to increase CRC screening.

Autism Screening in Family Medicine Practice: Early Detection, Barriers and Benefits

Autism spectrum disorder is a neurodevelopmental disorder marked by social communication difficulties, restricted interests, and repetitive activities. Both genetic and environmental variables impacting the growing brain have an influence on it. Around the world, 1 in 100 children is identified with autism spectrum disorder. Estimates of prevalence has increased over time and varied significantly inside and across sociodemographic groups. Family physicians are the primary healthcare experts to whom children with autism are directed when they have signs and symptoms related to autism or for any other reason, including protective healthcare services. Early diagnosis of autism result in effective and timely management of the patients, hence family medicine practice plays a vital role in autism diagnosis as family physicians are the first contact with the patient. The purpose of this research is to review the available information about the autism screening in family medicine practice regarding early diagnosis, barriers and benefits. The significance of acquiring an early diagnosis of autism and following early therapeutic intervention is well-established in the literature, as late diagnosis is linked to greater parental stress and delayed early intervention, both of which are necessary for long-term beneficial outcomes. Early detection is critical since studies have shown that early diagnosis and intervention programs improve functional results and quality of life. As family physicians are the community's first point of contact, it's vital for them to be able to recognize autism early on in an effort to enhance early intervention and a better outcome.

Approach to goitre in family medicine practice.

Approach to goitre in family medicine practice.

A Case Study of the Health Information System in Family Medicine Practice in Canton Sarajevo

Background: Family medicine is defined as continuous, comprehensive medical care of the patient in the context of the family and the community. Continuous patient care includes prevention, diagnosis and treatment of acute and chronic diseases and palliative care. Caring for individuals during different diseases and stages in the life cycle, understanding the role of the family in disease and using community resources makes family medicine unique among medical disciplines. With the development of new technologies, there was a need for changes in the work and introduction of the Health Information System, in all areas of medicine, including family medicine. Objective: The objectives of this study are to analyze CHIS functions in family medicine, analyze CHIS data reports, complaints, and suggestions for improvement, and then, based on the results of these analyses, to offer recommendations for future development of the CHIS family medicine module. Methods: This article represents a qualitative, interpretative case study of the implementation of the CHIS in family medicine in Public Institution Health Centre of Sarajevo Canton conducted by a group of physicians using three primary data sources: medical experts’ analysis of the CHIS content, reports available in the CHIS about the number and type of services, analysis of written medical doctor and nurse complaints, and suggestions for improving the CHIS. Although qualitative data analysis predominated, quantitative data analysis was also employed. Results and Discussion: It is crucial that healthcare professionals who utilize HIS have the opportunity to provide feedback on the system and suggest modifications. The main results show that CHI is widely used in family medicine and that employees in this department provide purposeful suggestions to improve CHI, as well as that a good cooperation between the software company and the user exist. Experts in software should view these suggestions as useful information and adopt them to enhance the system so as to increase customer satisfaction and enhance the quality of health care. Health informatics as a separate scientific discipline began to be effective in academic institutions at the end of the 70’s by the presentation of actual accomplishments in this area in under and postgraduate education at biomedical faculties. The Central Health Information System (CHIS) in Sarajevo Canton was implemented in 2014 but was not fully integrated and was incompletely used at certain levels of health care. Conclusion: Thanks to the agility of the company rapid implementation of new software modules enabled the organizational transformation of the Sarajevo Canton health network.

Self-efficacy and knowledge in pediatrics among family medicine physicians in Armenia: A survey study.

Armenia has trained physicians to practice family medicine (FM) for over 20 years. The pediatric population comprises a significant proportion of patients seen by FM practices, yet to date, there have been no studies assessing the knowledge and self-efficacy of FM physicians regarding pediatric care. As the first step is needs assessment to improve the quality of care, this study aims to assess the self-efficacy and knowledge of FM physicians regarding the care of pediatric patients. We distributed a survey to attendees at an FM conference in Lori Province, Armenia. The survey instrument assessed demographics and experience, self-efficacy in providing pediatric care, and pediatric knowledge via questions adapted from the American Board of Family Medicine (ABFM). Eighty-seven percent of participants were female. Roughly half (45%) had trained through an FM residency program, while the remainder had retrained to become FM physicians following a residency in another field. Almost all (97%) practiced outside of the capital city, Yerevan. About half believed that their didactic (51%) and clinical education (48%) prepared them either "extremely" or "very" well. Overall, there was no clear relationship between participants' reported self-efficacy in a given area of pediatrics and their score in that area on the knowledge portion of the survey. Our findings reveal opportunities for improvement in knowledge related to pediatric care in FM physicians in Armenia, as well as a lack of relationship between reported self-efficacy and knowledge. Thus, future programs should not rely solely on self-reported gaps to identify or prioritize areas of focus. Further study is recommended in other specialties in Armenia and internationally to improve future programs.