Family Medicine Residency Research Articles

Family physicians have greater ambiguity tolerance in the clinical context: A nationwide cross‐sectional study

AbstractBackgroundAmbiguity tolerance in the clinical context is increasingly recognized as essential for physicians to work as professionals. However, the relationship between specialty and ambiguity tolerance in the clinical context has been understudied. Here, we investigated the association between specialty and ambiguity tolerance in the clinical context, focusing on differences between family physicians (FPs) and non‐FPs.MethodsWe performed a nationwide cross‐sectional study in Japan. We asked FPs from 14 family medicine residency programs across Japan and non‐FPs from monitors of an internet survey company in Japan to participate in the study. We assessed their tolerance for ambiguity using the Japanese version of the Tolerance for Ambiguity in Medical Students and Doctors (J‐TAMSAD) scale.ResultsIn total, 388 physicians (178 FPs and 210 non‐FPs) completed our anonymous online survey and were included in the analysis. After adjustment for possible confounders (gender and postgraduate years), FPs had higher J‐TAMSAD scale scores than internists/pediatricians, surgeons, and physicians with other specialties, meaning that FPs had greater ambiguity tolerance.ConclusionsThis study reveals that FPs had greater tolerance for ambiguity in the clinical context than non‐FPs. Our findings suggest that there may be a need to increase non‐FP's tolerance for ambiguity specific to the clinical context through educational interventions, since ambiguity is inherent and growing in medicine today. FPs and non‐FPs should work together to complement each other's strengths, rather than simply improving the training of non‐FPs.

Impact of an Inpatient Family Medicine Exposure: Changing Student Perception

Introduction: Currently there is a primary care physician shortage in the United States, and this shortage is expected to worsen into the foreseeable future. In 2023, only 7.5 % of US allopathic graduates entered family medicine (FM) residencies. Opportunities to create increased interest in family medicine as a career choice and address hidden curriculum messages in career choice must be explored to address shortages in family medicine. Methods: A 5-day inpatient experience with family medicine residents on a family medicine inpatient service was implemented during a required third-year core medical student clerkship in family medicine. Students who participated in this clerkship change were invited to complete a survey on how this experience altered their perceptions on the roles of family medicine physicians in inpatient medical care, intrapartum care, and care of the newborn, and how it affected their view of FM as a career choice. Results: Of the eligible students, 34% completed the survey. Participating in the FM inpatient experience significantly enhanced students’ perceptions about the depth of knowledge and skill needed for the specialty, increased students’ respect for the specialty, and contradicted students’ perceptions about the complexity of cases treated in the specialty. Conclusion: Adding an inpatient component to a third-year FM clerkship experience can significantly change the perceptions of medical students about the specialty of FM. Brief inpatient exposure to medical students has an impact on hidden curriculum messaging about family medicine.

Competency of Family Medicine Residents in Performing Skin Cancer Examination.

Early recognition of skin cancer reduces associated morbidity and improves survival. Most patients with suspicious skin lesions present to family medicine physicians. We aimed to evaluate the self-reported competency of family medicine residents in performing skin cancer examination (SCE) and assess the impact of different factors on their competency. All family medicine residents completed a previously validated questionnaire aimed at evaluating their skin cancer examination competency in this cross-sectional study. In total, 250 residents participated in this study. More than half of the residents never had a rotation in dermatology or received training under the supervision of a dermatologist. Approximately 70%, 72%, and 77% of residents had not observed SCE, received SCE training, and performed SCE, respectively. Although most residents were aware of the risk factors for skin cancer and the ABCD acronym for melanoma, only one out of ten residents screened their patients for these factors, enquired about changes in skin lesions, and personally practiced SCE. Only 16% of family medicine residents consider themselves competent in performing SCE. Training under the guidance of a dermatologist, SCE training, evaluating patients for cancer risk factors and any changes in moles, and SCE practice on personal level were associated with SCE competency. Multivariate analysis showed a significant association between the frequency of observing SCE and competency in performing SCE. Only 16% of family medicine residents considered themselves competent in performing SCE. The frequency of observation of SCE during residency was a significant predictor of self-reported competency in performing SCE.

Medical learner perspectives on elements of an educational rural generalist pathway: survey outcomes

IntroductionThe Northern Ontario School of Medicine University (NOSM U) continues to be challenged in meeting its social accountability mandate of addressing the rural health human resource crises in its catchment of Northern Ontario. Its new educational initiative, the Rural Generalist Pathway (RGP) aims to graduate family physicians specifically prepared for rural practice. This study elicits the perspective of NOSM U learners on the various components being considered for this educational pathway.MethodsA mixed methods survey was created for each of two medical learner groups, undergraduate NOSM U students and its family medicine residents. Quantitative data was analyzed for frequencies and percentages and qualitative data underwent thematic analysis.ResultsWith a response rate of 24.6% for undergraduates and 37.9% for residents, the survey discovered undergraduates consider rural clinical rotations as the most valuable experiences in rural medicine. Among the findings, both the majority of medical students and residents (87.3% and 87.9% respectively) agreed that support for a resident’s family well-being and community integration was the element of the pathway most likely to influence them in pursuing the RGP. Mentorship by a practicing rural physician was an element highly supported by 81% of undergraduate and 81.8% of postgraduate learners as likely to influence them to take the RGP.DiscussionIncorporating learner perceptions into the development of the RGP could help focus institutional resources and enhance learner participation in this pathway, producing more rural family doctors to serve Northern Ontario.

Timely radiographic detection of developmental dysplasia of the hip in family medicine residents. Educative intervention

Timely radiographic detection of developmental dysplasia of the hip in family medicine residents. Educative intervention

Three Types of Uncertainty: A Qualitative Study of Family Medicine Residents.

Many past studies have focused on uncertainty in medical practice, yet it is still not well understood in the field of family medicine, especially among residents. The aim of this study was to examine situations in which residents experience uncertainty and the coping strategies they use to deal with it. The results may have implications for advanced training programs and the specialist training in family medicine. We conducted semistandardized interviews with 15 residents and young family doctors from Hesse, Germany and asked them to describe cases in which they experienced uncertainty. In total, 40 cases were reported. Using established methods, we derived a coding system with different categories. Uncertainty occurred in a broad and heterogenous range of cases, and it often involved complex interaction of biomedical, interpersonal, and psychosocial factors. The participants described various strategies that were helpful in dealing with the three different types of uncertainty. To deal with biomedical uncertainty, the residents primarily found information-seeking and consulting more experienced colleagues to be useful. In dealing with interpersonal and psychosocial uncertainty, they applied reflective strategies. Participants suggested open communication and honest dialogue about uncertainty and the thematization of the topic at much earlier stages (eg, during medical studies). Family medicine residents experience uncertainty as an important part of their daily work. They do not necessarily interpret it as a negative phenomenon. Instead, uncertain situations often accompany learning effectiveness and an increase of self-confidence.

Burnout among Nurses, Midwives, and Physicians in Maternity Care Exposed to Traumatic Childbirth Events

Abstract Purpose: To describe the relationship between experiencing traumatic childbirth events and burnout. Study Designs and Methods: This descriptive cross-sectional study used an anonymous online survey to assess traumatic childbirth event exposure and the three independent constructs of burnout: emotional exhaustion, depersonalization, and personal accomplishment. Participants were a convenience sample of registered nurses, obstetric residents, family medicine residents, and attending obstetricians across five hospitals from December 2020 through June 2021. The traumatic childbirth event questionnaire measured the frequency of traumatic childbirth event exposure, perception of severity, and perceived influence on the participant's professional practice and personal life. Results: Data were analyzed from 150 participants. Registered nurses represented the largest percentage of participants (66%). Components of burnout varied according to race and occupation. Asian/Pacific Islanders had significantly higher mean depersonalization scores at 10.1 (SD = 6.0). Resident physicians had the highest emotional exhaustion scores (M = 34.6, SD = 8.8). Traumatic childbirth events perceived influence on practice correlates with personal accomplishments. Yet, no relationship was observed between traumatic childbirth events, emotional exhaustion, and depersonalization. Linear mixed analysis revealed that hospitals account for 7.5% of the variance in emotional exhaustion scores, 11.1% in depersonalization scores, and 1.3% in personal accomplishments scores. Clinical Implications: Maternity clinicians experience burnout at similar rates to those in other specialties. Although traumatic childbirth events are infrequent and not strongly correlated with emotional exhaustion and depersonalization, hospitals should implement effective strategies to support clinicians after such events. Educational interventions can enhance knowledge and resilience, whereas specialized training effectively alleviates burnout. Development of evidence-based strategies that prioritize the wellbeing of clinicians and patients is crucial.

The future of AI clinicians: assessing the modern standard of chatbots and their approach to diagnostic uncertainty

BackgroundArtificial intelligence (AI) chatbots have demonstrated proficiency in structured knowledge assessments; however, there is limited research on their performance in scenarios involving diagnostic uncertainty, which requires careful interpretation and complex decision-making. This study aims to evaluate the efficacy of AI chatbots, GPT-4o and Claude-3, in addressing medical scenarios characterized by diagnostic uncertainty relative to Family Medicine residents.MethodsQuestions with diagnostic uncertainty were extracted from the Progress Tests administered by the Department of Family and Community Medicine at the University of Toronto between 2022 and 2023. Diagnostic uncertainty questions were defined as those presenting clinical scenarios where symptoms, clinical findings, and patient histories do not converge on a definitive diagnosis, necessitating nuanced diagnostic reasoning and differential diagnosis. These questions were administered to a cohort of 320 Family Medicine residents in their first (PGY-1) and second (PGY-2) postgraduate years and inputted into GPT-4o and Claude-3. Errors were categorized into statistical, information, and logical errors. Statistical analyses were conducted using a binomial generalized estimating equation model, paired t-tests, and chi-squared tests.ResultsCompared to the residents, both chatbots scored lower on diagnostic uncertainty questions (p < 0.01). PGY-1 residents achieved a correctness rate of 61.1% (95% CI: 58.4–63.7), and PGY-2 residents achieved 63.3% (95% CI: 60.7–66.1). In contrast, Claude-3 correctly answered 57.7% (n = 52/90) of questions, and GPT-4o correctly answered 53.3% (n = 48/90). Claude-3 had a longer mean response time (24.0 s, 95% CI: 21.0-32.5 vs. 12.4 s, 95% CI: 9.3–15.3; p < 0.01) and produced longer answers (2001 characters, 95% CI: 1845–2212 vs. 1596 characters, 95% CI: 1395–1705; p < 0.01) compared to GPT-4o. Most errors by GPT-4o were logical errors (62.5%).ConclusionsWhile AI chatbots like GPT-4o and Claude-3 demonstrate potential in handling structured medical knowledge, their performance in scenarios involving diagnostic uncertainty remains suboptimal compared to human residents.

6631 A Week With Diabetes: Using Real-Time Continuous Glucose Monitoring In A Simulation Activity With Residents And Fellows

Abstract Disclosure: T. Gallagher: None. C. Donelly: None. R.E. Amori: None. Background: Continuous glucose monitor (CGM) use in managing diabetes mellitus is increasing rapidly. Fellows and residents often prescribe these devices, but most do not themselves have diabetes mellitus and do not use these devices personally. A real-time simulation activity can help physicians in training learn about using the technology in diabetes management and the patient experience living with diabetes mellitus. Objective: Assessing learner’s experiences using a one week real-time CGM simulation. Methods: A real-time simulation using CGM and elements of role playing can enhance knowledge of CGM use and overall diabetes care. Voluntary participants included endocrinology fellows, internal and family medicine residents, and one health professions student. One common structured learning task per day was assigned to all participants over a single seven day period of use in academic year 2022-23. Assessment of each task occurred via personal observations and reflections. Data was collected in an anonymous form and in a group debrief. Results: Eight of 10 participants completed the deidentified post simulation survey and 8/10 participated in the live debrief. Participants reported ease of CGM placement and use. They reported improved insight into the impacts of diabetes on daily activities and increased awareness of diet and exercise impact on glucose levels. Insulin dose calculations were largely correct but errors were seen. All felt the activity was beneficial to their learning. Conclusions: Real-time CGM simulation improves student, resident, and fellow knowledge of the technology and allows the learner to gain insight into a patient’s diabetes self-management. Presentation: 6/3/2024

Orthopedic Injections: A Longitudinal Musculoskeletal Curriculum in a Family Medicine Residency.

Musculoskeletal (MSK) complaints comprise more than 20% of all visits to health care providers each year. Despite required experiences in MSK care, family physicians report low confidence in diagnosing and treating MSK conditions. The purpose of this study was to analyze the effects of early and longitudinal exposure to MSK education on residents' confidence in and likelihood of performing MSK physical exams and injections in future practice. From 2017 to 2019, residents completed an annual survey assessing confidence in, frequency of, and future intentions to perform exams and injections for MSK conditions. We compared responses between family medicine residents who completed a 176-hour longitudinal sports medicine (LSM) curriculum distributed over all 3 years of residency and a comparable cohort of family medicine residents who completed a 188-hour concentrated MSK curriculum primarily in the final year of residency. We made comparisons using the Fisher exact test for categorical variables and an independent samples t test for numeric variables. We analyzed the 98 total responses from 50 residents. The proportion of residents reporting high ratings of their residency MSK education (26% to 60%), performing &gt;5 injections (38% to 73%), reporting confidence in performing injections (12% to 40%), and indicating likelihood to perform MSK injections in the future (52% to 65%) were all greater in the LSM versus concentrated MSK curriculum cohorts (P&lt;.05 for all). Early and longitudinal exposure to MSK care and sports medicine in family medicine residency led to both an increase in MSK injections during residency training and a greater desire to perform these injections in postresidency practice.

Learning Networks: How Family Medicine Departments Are Meeting the Requirement.

In 2023, the Accreditation Council for Graduate Medical Education added participation within a "learning collaborative" or "learning network" (LN)as a requirement for family medicine residencies. The structure and scope of what makes an acceptable LN was only vaguely defined. The purpose of this study was to learn how many family medicine residencies associated with departments already belong to LNs, the purpose and funding of these existing LNs, and barriers to entering LNs. An online survey was sent to family medicine department chairs through a Council of Academic Family Medicine Educational Research Alliance omnibus study from August to September 2023. Survey questions explored the purpose, structure, and funding of LNs that associated residency programs already belonged to as well as the chairs' beliefs and knowledge about LNs. Of the 227 chairs, 119 completed the survey (50.2%). About 53% reported that their department was part of an LN, with more than one-third belonging for 5 years or less; 47% had a low understanding of what an LN is; and 71% had little to no concern that collaborating in an LN would negatively affect residency recruitment. The purpose of most LNs was a mix of research, education, and clinical activities. Faculty's lack of knowledge about LNs and lack of time were the top barriers identified to joining an LN. Funding was varied, and departmental funding was positively associated with administrative control of the LN. About half of the residency programs associated with family medicine departments already belong to LNs. Wide variation among existing LNs may lead to significantly disparate outcomes for residents and residencies as they navigate this new requirement.

Skin Biopsies and Diagnostic Outcomes at a Multisite Family Medicine Residency Network.

Physicians other than dermatologists evaluate nearly 60% of all skin diseases, and 22% of these physicians are family physicians. Dermatology education is therefore an important aspect of Family Medicine training. Dermatologic procedural training in Family Medicine residency is not standardized, however, so family physicians graduate with highly variable skills. This study describes the scope and diagnostic outcomes of skin biopsies performed by residents at a multisite Family Medicine residency network in comparison with those performed by attendings at a Family Medicine faculty community practice. We performed a retrospective chart review of patients evaluated at eight Family Medicine residency training sites and one Family Medicine faculty community practice within a regional academic health system between January 2020 and October 2022. Patients with a skin finding who underwent at least one skin biopsy during their visit were included in the study. Among all of the skin findings, the incidence of skin biopsy was 3.6% (258/7104) for residents and 1.8% (175/9917) for attendings (P < 0.001). Family Medicine residents performed fewer shave biopsies (57.8% vs 77.7%, P < 0.001) and more punch biopsies (25.6% vs 11.4%, P < 0.001) compared with attendings. Most biopsies performed by residents and attendings were benign, although residents biopsied significantly more benign (79.1% vs 64.6%, P < 0.001) and malignant lesions (11.2% vs 5.7%, P = 0.049). Attendings biopsied significantly more low-to-moderate-grade dysplastic (22.3% vs 5.0%, P < 0.001) and high-grade atypical lesions (4.0% vs 0.8%, P = 0.034). Family Medicine residents at this residency network receive training in a variety of skin biopsy types. Distinct skin biopsy practices and outcomes between residents and attendings may reflect differences in patient populations, clinical expertise, and dermatology referral patterns.

Factors Affecting the Career Choice of Intern Physicians and Their Perspectives on Family Medicine Residency

Factors Affecting the Career Choice of Intern Physicians and Their Perspectives on Family Medicine Residency

Family Physician Education and Barriers to Promoting Smoking Cessation: A Multiservice Investigation.

Cigarette smoking remains the leading cause of preventable disease and death in the United States. Brief discussions with doctors increase cessation rates by two-thirds, and physicians trained in smoking cessation are more likely to perform counseling. Multiple organizations also recommend connecting counseling with lung cancer screening (LCS), yet physicians and patients report a lack of such integration. We sought to characterize the education received and the barriers to providing smoking cessation counseling, and to determine its integration with LCS among military Family Medicine physicians. This is a cross-sectional study of registered attendees of 2022 Uniformed Services Academy of Family Physicians Annual Conference. Our study aimed to: (1) Assess the amount of formal smoking cessation education during and after residency; (2) assess barriers to providing smoking cessation within the military health care system; and (3) assess if physicians connect smoking cessation counseling and LCS. Descriptive statistics with chi-squared analysis were used to analyze the survey results. With a response rate of 61% (n = 323/487), most participants reported receiving <3 sessions of formal education during residency (72.9%) and <3 h after residency (76.2%). Forty-eight percent cited their health care system never or rarely provided resources on smoking cessation. Time was the largest barrier to promoting smoking cessation (62.6%) and to integrating it with LCS (56.7%), although a considerable percentage also cited lack of supporting staff (34.3%). Furthermore, only 50.6% of respondents always reported counseling on smoking cessation with LCS. Smoking cessation education is provided in family medicine residencies but rarely offered afterwards. Time and lack of support staff and resources are recognized as notable barriers within the military health care system. A large proportion of uniformed Family Medicine physicians also do not link LCS guidelines with patient education on tobacco cessation and resources. Further research is needed to guide interventions to overcome these challenges within the military health care system.

Implementation of a Labor Dystocia Checklist to Reduce NTSV C-Section Rates.

Cesarean section (c-section) rates among nulliparous, term, singleton, and vertex (NTSV) pregnancies are increasing, posing risk to the infant and birthing parent. To reach the Healthy People 2030 goal of an NTSV c-section rate below 23.6%, teams must remain aware of their NTSV c-section rate and implement mechanisms to reduce it. This project was conducted to assess the impact of quality improvement interventions implemented by family medicine residents to reduce a hospital's NTSV rate. From 2021 to 2023, family medicine residents were educated on evidenced-based diagnosis of labor dystocia, failed induction of labor, arrest of dilation, and arrest of descent in first-time birthing parents. Learning was reinforced by implementing the Colorado Perinatal Care Quality Collaborative's labor dystocia checklist. Quarterly assessment of the hospital's NTSV rate and checklist utilization were monitored and widely reported. After the implementation of a standard checklist, the NTSV c-section rate at the tertiary care center declined from 35.6% in 2020 to a sustained rate below the 2030 Healthy People goal of 23.6%. Notably, patients with public insurance saw the greatest reduction in NTSV c-section rates. Hospital staff highlighted the benefits of using the checklist, including more effective electronic documentation of labor progression, improvement in team dynamics, and increased team communication. Using a labor dystocia checklist is a successful method for teams to reduce NTSV c-section rates and can be used as a training tool for family medicine and obstetrics and gynecology residency programs that care for laboring persons.

Pioneering family medicine: A collaborative global health education partnership in Ethiopia

In 2013, Ethiopia launched its first Family Medicine (FM) residency programme at Addis Ababa University (AAU). The University of Toronto’s Department of Family and Community Medicine (DFCM) was invited to support Addis Ababa University’s Department of Family Medicine’s (AAU-FM) educational programme activities forming the Toronto Addis Ababa Academic Collaboration in Family Medicine (TAAAC-FM). This paper describes the TAAAC-FM partnership, a capacity-strengthening initiative that focuses on four key levers of academic engagement and transformation: education offerings for AAU-FM trainees, partnership preparation of DFCM faculty, fostering AAU-FM faculty development and leadership, and lastly scholarship, knowledge sharing and mentorship. Toronto Addis Ababa Academic Collaboration in Family Medicine operates on principles of respect, flexibility and cultural sensitivity. Monthly virtual meetings and annual in-person faculty visits fostered curriculum support, teaching and leadership training, ensuring that the programme remained responsive to evolving needs. The partnership has contributed to a Community of Practice (CoP) to advance FM in Ethiopia, promoting shared learning. Addis Ababa University’s Department of Family Medicine faculty leads in various roles, engages with global FM communities, and contributes to policy development, demonstrating significant progress in FM education and leadership. Looking ahead, TAAAC-FM aims to adapt its efforts based on the capacity built with AAU-FM, continue faculty development, and strengthen linkages within the global healthcare community. The partnership’s success underscores the importance of collaborative, culturally informed high-low resource setting approaches to FM training and healthcare system strengthening, offering valuable insights for similar initiatives.

Challenges in teacher-student communication during family medicine residency: A qualitative study.

Deficiencies in communication among healthcare professionals, recognized by medical educators and healthcare institutions, can negatively impact medical education and clinical practice. Analyzing teacher-resident communication difficulties shed light on this issue and propose practical strategies for its mitigation. To identify common communication challenges between teacher and residents during Family Medicine residency and to analyze their impact on interactions with peers, the work team, and patients. Qualitative study, the critical incident technique was used to collect information of interest. Seventy teachers, and fifty third-year residents from the Mexican Republic described critical incidents related to their communication experiences during Family Medicine residency. 192 critical incidents were collected (several participants reported more than one incident), comprising 127 reports from teachers, and 65 from residents. Four themes were identified: 1) asymmetric communication, 2) assertive communication, 3) organizational communication, and 4) effective communication. The main challenges identified were abuse of power in communication, lack of communication skills, and the absence of institutional communication channels. These issues significantly impacted learning, work environment, interpersonal relationships, and medical care. This study highlights communication issues within Family Medicine residency in Mexico. The issues detected hindered learning and effective collaboration and negatively impacted the work environment, interpersonal relationships, and the quality of medical care. These findings underscore the urgent need to reorient the medical specialty curriculum towards an approach that includes communication skills.

Perspectives on virtual interviews and emerging technologies integration in family medicine residency programs: a cross-sectional survey study

BackgroundDuring the coronavirus disease of 2019 (COVID-19) pandemic, in-person interviews for the recruitment of family medicine residents shifted to online (virtual) interviews. The purpose of this study was twofold: (1) to gather the ideas about virtual interviews of family medicine applicants (interviewees), and faculty and staff who interviewed these applicants (interviewers), and (2) to describe interviewers’ and interviewees’ opinions of use of emerging technologies such as artificial intelligence (AI) and virtual reality (VR) in the recruitment process as well as during clinical practice.MethodsThis was a cross-sectional survey study. Participants were both interviewers and candidates who applied to the McGill University Family Medicine Residency Program for the 2020–2021 and 2021–2022 cycles.ResultsThe study population was constituted by N = 132 applicants and N = 60 interviewers. The response rate was 91.7% (55/60) for interviewers and 43.2% (57/132) for interviewees. Both interviewers (43.7%) and interviewees (68.5%) were satisfied with connecting through virtual interviews. Interviewers (43.75%) and interviewees (55.5%) would prefer for both options to be available. Both interviewers (50%) and interviewees (72%) were interested in emerging technologies. Almost all interviewees (95.8%) were interested in learning about AI and VR and its application in clinical practice with the majority (60.8%) agreeing that it should be taught within medical training.ConclusionAlthough experience of virtual interviewing during the COVID-19 pandemic has been positive for both interviewees and interviewers, the findings of this study suggest that it will be unlikely that virtual interviews completely replace in-person interviews for selecting candidates for family medicine residency programs in the long term as participants value aspects of in-person interviews and would want a choice in format. Since incoming family medicine physicians seem to be eager to learn and utilize emerging technologies such as AI and VR, educators and institutions should consider family physicians’ needs due to the changing technological landscape in family medicine education.

Family Medicine Resident Scholarly Activity Infrastructure, Output, and Dissemination: A CERA Survey.

Meeting scholarly activity requirements continues to be a challenge in many family medicine (FM) residency programs. Studies comprehensively describing FM resident scholarship have been limited. We sought to identify institutional factors associated with increased scholarly output and meeting requirements of the Accreditation Council for Graduate Medical Education (ACGME). Our goals were to: (1) describe scholarly activity experiences among FM residents compared with ACGME requirements; (2) classify experiences by Boyer's domains of scholarship; and (3) associate experiences with residency program characteristics and scholarly activity infrastructure. This was a cross-sectional survey. The survey questions were part of an omnibus survey to FM residency program directors conducted by the Council of Academic Family Medicine Educational Research Alliance (CERA). All ACGME-accredited US FM residency program directors, identified by the Association of Family Medicine Residency Directors, were sampled. Of the 691 eligible program directors, 298 (43%) completed the survey. The respondents reported that 25% or more residents exceeded ACGME minimum output, 17% reported that 25% or more residents published their work, and 50% reported that 25% or more residents delivered conference presentations. Programs exceeding ACGME scholarship requirements exhibit robust infrastructure characterized by access to faculty mentorship, scholarly activity curricula, Institutional Review Board, medical librarian, and statistician. These findings suggest the need for codified ACGME requirements for scholarly activity infrastructure to ensure access to resources in FM residency programs. By fostering FM resident engagement in scholarly activity, programs help to create a culture of inquiry, and address discrepancies in funding and output among FM residency programs.

Attitude, Knowledge, and Practices Regarding Prediabetes in Saudi Arabia: A Cross-Sectional Study on Family Medicine Residents.

Background Individuals with prediabetes are at an increased risk of developing type 2 diabetes mellitus (T2DM) and cardiovascular diseasesand mortality from any cause. The treatment and early detection of prediabetes and T2DM can aid in the prevention of future health complications. The aim of this research was to assess the attitude, knowledge, and practices of family medicine (FM) residents in Saudi Arabia regarding prediabetes. Methodology This is an online cross-sectional survey study that was conducted between March and May 2023. The study population consisted of family medicine residents who are currently practicing their profession in Saudi Arabia. Results A total of 101 family medicine residents participated in this study. The study participants showed a positive attitude towardprediabetes management with a mean score of 25.4 (standard deviation {SD}: 4.8) out of 30. The study participants showed a moderate level of knowledge regarding prediabetes management with a mean score of 7.0 (SD: 2.2) out of 12. The proportion of participants who were able to identify risk factors that might prompt them to screen for diabetes mellitus ranged from 47.5% (n = 48) to 96.0% (n = 97). The participants' agreement levels for questions that examined their attitude towardthe importance of prediabetes screening ranged from 73.3% (n = 74) to 90.1% (n = 91). The most commonly agreed upon barrier was the patient's lack of motivation (n = 80, 79.2%). The most commonly agreed upon interventions that facilitate management and treatment improvements of prediabetes were more resources for patient education and increased access to the diabetes prevention program (DPP), an evidence-based lifestyle change program (n = 80, 79.2%). A body mass index (BMI) of ≥35 kg/m2 was the most commonly reported factor that increases the likelihood of prescribing metformin for a patient with prediabetes. The most commonly agreed upon barrier to prescribing metformin for prediabetes patients was that patients do not like taking medications (n = 67, 66.3%). Conclusions The study participants demonstrated an average level of understanding and a positive attitude regarding the management of prediabetes. A significant percentage of the participants demonstrated comprehension of risk factors associated with diabetes, as well as appropriate screening methods, with fasting blood glucose tests being of particular interest. It is recommended to enhance prediabetes management through heightened awareness and education concerning screening methodologies and lifestyle modifications.