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Can Fam Physician ; 68(11): 793, 2022 11.
Article in English | MEDLINE | ID: covidwho-2118833
3.
Fam Med ; 54(10): 791-797, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2111349

ABSTRACT

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic obliged the field of graduate medical education to pivot from in-person to virtual residency interviews in 2020. The decreased travel and financial barriers of this format could potentially lead to greater diversity and equity in the primary care workforce. We aimed to evaluate changes in applicant pools from in-person to virtual interviewing cycles. METHODS: We conducted a retrospective review of Electronic Residency Application Services (ERAS) from five US family medicine residencies across five interview cycles (three in-person and two virtual; 2017/2018 through 2021/2022). We compared geographic and demographic data about applicants as well as administrative program data. RESULTS: The study included 25,271 applicants. The average distance between applicants and programs was 768 miles during in-person interview years and 772 miles during virtual interview years (P=.27). Applicants who interviewed with programs were 446 and 459 miles away, respectively (P=.06). During in-person application years, applicants with backgrounds historically underrepresented in medicine (URM) submitted an average of 21% of applications; this increased approximately 1% during virtual interviewing years (OR, 1.08; P=.03). There were no other differences between in-person and virtual application years in rates of URM applicants. Residency programs received more applications from US medical schools (OR, 1.46; P<.0001) and were more likely to interview a US medical school applicant (OR, 2.26; P<.0001) in virtual years. Program fill rates appeared to be lower during virtual years. CONCLUSIONS: The virtual interviewing format did not appear to substantially increase the geographic, racial, or ethnic diversity of applicants, and was associated with increased applications from US medical schools.


Subject(s)
COVID-19 , Internship and Residency , Humans , Family Practice , Pandemics , Education, Medical, Graduate
4.
Fam Med ; 54(10): 798-803, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2111347

ABSTRACT

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic led to the institution of virtual interviewing for nearly all family medicine residency programs in 2020 and 2021. This paradigm shift challenged the perspectives of family medicine program directors across the United States, in part because of the financial impact on the operations of many residency programs. We sought to investigate program directors' opinions on the 2020-2021 interview season, as well whether future interview season planning would be influenced by the financial outcomes of this season. METHODS: We conducted a cross-sectional survey, as part of the fall 2021 CERA Program Director omnibus online survey. Family medicine program directors were invited by email to participate. We conducted multivariate logistic regression of the likelihood of supporting a fully-virtual interviewing model. RESULTS: The module survey response rate was 41.7% (263/631); 91.3% of programs reported conducting a fully-virtual 2020-2021 interview season. Program directors who reported that the cost savings recouped from virtual versus in-person interviewing could be used for other residency operating costs (32.4%) were almost four times more likely to support moving to a fully-virtual interviewing model (odds ratio: 3.94, confidence interval: 1.69-9.18). When compared to a residency program's benefit from meeting and assessing applicants in person, applicants benefitting from less financial burden during a fully-virtual interview season was not seen by responding program directors as a significant reason to remain virtual. CONCLUSIONS: While family medicine residency program directors who recouped interview expenses during fully-virtual recruiting seasons are more likely to support ongoing, fully-virtual models, financial incentivization did not overall impact support for virtual interviewing among program directors with statistical significance.


Subject(s)
COVID-19 , Internship and Residency , United States , Humans , Family Practice/education , Cross-Sectional Studies , Pandemics
5.
Aust J Gen Pract ; 51(11): 879-883, 2022 11.
Article in English | MEDLINE | ID: covidwho-2100931

ABSTRACT

BACKGROUND: International travel is resuming, but the COVID-19 pandemic has radically changed the context in terms of regulation, risks and models of travel. OBJECTIVE: Providing travel health advice is an important role for general practice. The aim of this article is to cover the changed context and wide-ranging implications of the COVID­19 pandemic for travel health advice. DISCUSSION: Travel in the COVID-19 era requires travellers to be well informed and prepared to comply with complex and evolving public health measures. There are changing patterns of infectious disease risk related to the impacts of the pandemic, increasing antimicrobial resistance and climate change. New models of travel include a shift towards greater environmental sustainability.


Subject(s)
COVID-19 , Pandemics , Humans , Pandemics/prevention & control , COVID-19/epidemiology , COVID-19/prevention & control , Travel , Family Practice , Data Collection
6.
Br J Gen Pract ; 72(725): e907-e915, 2022 12.
Article in English | MEDLINE | ID: covidwho-2081799

ABSTRACT

BACKGROUND: Following a large-scale, pandemic-driven shift to remote consulting in UK general practice in 2020, 2021 saw a partial return to in-person consultations. This occurred in the context of extreme workload pressures because of backlogs, staff shortages, and task shifting. AIM: To study media depictions of remote consultations in UK general practice at a time of system stress. DESIGN AND SETTING: Thematic analysis of national newspaper articles about remote GP consultations from two time periods: 13-26 May 2021, following an NHS England letter, and 14-27 October 2021, following a government-backed directive, both stipulating a return to in-person consulting. METHOD: Articles were identified through, and retrieved from, LexisNexis. A coding system of themes and narrative devices was developed iteratively to inform data analysis. RESULTS: In total, 25 articles reported on the letter and 75 on the directive. Newspaper coverage of remote consulting was strikingly negative. The right-leaning press in particular praised the return to in-person consultations, depicting remote care as creating access barriers and compromising safety. Two newspapers led national campaigns pressuring the government to require GPs to offer in-person consultations. GPs were quoted as reluctant to return to an 'in-person by default' service (as it would further pressurise a system already close to breaking point). CONCLUSION: Remote consultations have become associated in the media with poor practice. Some newspapers were actively leading the 'war' on general practice rather than merely reporting on it. Proactive dialogue between practitioners and the media might help minimise polarisation and improve perceptions around general practice.


Subject(s)
General Practice , Remote Consultation , Humans , Family Practice , Workload , England
7.
Br J Gen Pract ; 72(714): 40-41, 2022 01.
Article in English | MEDLINE | ID: covidwho-2084825
8.
Br J Gen Pract ; 72(724): e799-e808, 2022 11.
Article in English | MEDLINE | ID: covidwho-2080549

ABSTRACT

BACKGROUND: The COVID-19 pandemic has altered the provision of health care and expanded telehealth consultations. AIM: To study the effect of the COVID-19 pandemic on contact patterns in general practice, and to identify patient groups at risk of losing care. DESIGN AND SETTING: Register-based study of Danish general practice, including daytime and out-of-hours (OOH) services. METHOD: All individuals residing in Denmark from 1 January 2017 to 31 October 2020 were included. The incidence rate for six contact types in general practice and adjusted incidence rate ratio were calculated by comparing the incidence rate in the pandemic period with the adjusted expected incidence rate based on the incidence rate in the pre-pandemic period. RESULTS: The number of face-to-face in-clinic consultations declined during the lockdown in March 2020. A subsequent increase in the number of clinic consultations was observed, rising to a level above that of the pre-pandemic period; this increase resulted mainly from the introduction of telehealth consultations (that is, video and extended telephone). The number of daytime email consultations increased, whereas the number of daytime home visits decreased. Likewise, the number of OOH telephone consultations increased, whereas the number of OOH home visits and clinic consultations decreased. Consultation rates of patients who are vulnerable, that is, those with low education, old age, and comorbidity, were most adversely affected by the pandemic. The most adverse impact in OOH clinic consultations was seen for children aged 0-9 years. CONCLUSION: New methods are called for to ensure access to general practice for patients who are vulnerable during a pandemic. The potential of telehealth consultations should be further investigated.


Subject(s)
COVID-19 , General Practice , Telemedicine , Child , Humans , COVID-19/epidemiology , Pandemics , Communicable Disease Control , Family Practice
9.
Fam Med ; 54(9): 694-699, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2056797

ABSTRACT

BACKGROUND AND OBJECTIVES: Given their broad scope of training, family medicine residents were uniquely situated to care for the American public throughout the COVID-19 pandemic, yet little has been written about their experiences. The objective of this report is to capture the diversity of experiences and contributions of family medicine residents across the United States to the care of the American public during the COVID-19 pandemic. METHODS: Investigators recruited resident interviewees from four residencies throughout the United States via convenience sample. These residencies represented a diversity of geography, rurality, and structure (hospital based vs community based). Investigators conducted 30 to 60-minute, semistructured interviews with family medicine residents. Interviews were recorded and examined for themes. RESULTS: Three major themes emerged through the interview process. First, family medicine residents were a critical component of the inpatient response to COVID-19 in a variety of geographies from urban centers to rural towns to Native American reservations. Second, family medicine residents continued to provide expanded outpatient care to include telehealth, immunization clinics, and public health campaigns to meet the needs of the community. Finally, not only did these residents have an immense impact in the response to COVID-19, but the pandemic also had an immense impact on them, both personally and professionally. CONCLUSIONS: The story of family medicine contributions to the care of the public during COVID-19 reflects the history of COVID-19 in the United States, and the critical role trainees and family medicine physicians have in the US health care system.


Subject(s)
COVID-19 , Internship and Residency , Telemedicine , Family Practice/education , Humans , Pandemics , United States/epidemiology
10.
BMC Prim Care ; 23(1): 254, 2022 09 27.
Article in English | MEDLINE | ID: covidwho-2053866

ABSTRACT

BACKGROUND: Most COVID-19 patients with severe symptoms are treated in hospitals. General practices are responsible for assessing most ambulatory patients. However, they face several challenges managing COVID-19 patients, and those with non-COVID-19 conditions. In April of 2020, we designed a software tool for the structured surveillance of high-risk home-quarantined COVID-19 patients in general practice (CovidCare) including several telephone monitorings, in order to support general practices and early identification of severe courses. This study presents the qualitative results of a mixed-methods process evaluation study on CovidCare. METHODS: In a qualitative process evaluation study conducted between March and May 2021, we explored the perspectives of seven general practitioners (GPs) and twelve VERAHs (medical care assistants with special training) on CovidCare using semi-structured interviews based on the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance). We used deductive qualitative content analysis employing the RE-AIM framework to assess the utilisation and implementation of CovidCare. RESULTS: Overall, most health care professionals were satisfied with CovidCare. They highlighted 1) a good orientation for the management of COVID-19 patients, especially due to a high level of uncertainty at the beginning of the pandemic, 2) the possibility to gain new knowledge, and 3) the structured data collection as facilitators for the implementation of CovidCare. Moreover, CovidCare reduced the workload for GPs while some VERAHs perceived a higher workload as they were responsible for large parts of the CovidCare management. However, CovidCare positively affected the VERAHs' job satisfaction as most patients provided positive feedback and felt less anxious about coping with their disease. Previous experience with the software and an easy integration into daily practice were considered to be crucial utilisation drivers. Time and personnel resources were identified as major barriers. To further improve CovidCare, participants suggested a less comprehensive version of CovidCare, the expansion of inclusion criteria as well as an app for the patients' self-management. CONCLUSION: The COVID-19 surveillance and care tool for COVID-19 patients with increased risk was perceived as useful by GPs and VERAHs. Supportive remote health care tools such as CovidCare are a viable means to maintain comprehensive and continuous health care during a pandemic and may strengthen the primary care system. TRIAL REGISTRATION: German Clinical Trials Register DRKS00022054 ; date of registration: 02/06/2020.


Subject(s)
COVID-19 , General Practice , General Practitioners , COVID-19/epidemiology , Family Practice , Humans , Qualitative Research
11.
Viruses ; 14(9)2022 09 09.
Article in English | MEDLINE | ID: covidwho-2033137

ABSTRACT

Fifty-five patients who suffered from COVID-19, who were still very ill after several months, with extreme fatigue, effort exhaustion, brain fog, anomia, memory disorder, anosmia, dysgeusia, and other multi-systemic health problems have been followed in a family practice setting between May 2021 and July 2022. Data extracted from the medical records of the 55 patients (40 women), mean age 42.4 (12 to 79 years), and a qualitative study of 6 of them using a semi-open-ended questionnaire allowed to highlight the clinical picture described by WHO as post-acute COVID-19 syndrome (PACS) also known as long COVID. We used brain single-photon emission computed tomography (SPECT-CT) in thirty-two patients with a high severity index and a highly impaired functional status, demonstrating vascular encephalopathy in twenty nine patients and supporting the hypothesis of a persistent cerebral vascular flow disorder in post COVID-19 condition. The patients will benefit from the consortium COVID Human Genetic Effort (covidhge.com) to explore the genetic and immunological basis of their problem, as 23/55 cases don't have immunological certainty of a COVID-19 infection. There is no known verified treatment. Analyzing the data from the first 52 patients, three categories of patients emerged over time: 16 patients made a full recovery after 6-8 months, 15 patients were able to return to life and work after 12-18 months with some sequelae, both groups being considered cured. In the third group, 21 patients are still very ill and unable to resume their work and life after 18 months. The biopsychosocial consequences on patients' lives are severe and family doctors are left out in the cold. It is necessary to test the reproducibility of this description, conducted on a small number of patients. Nevertheless, identifying, monitoring and supporting these patients is a necessity in family medicine.


Subject(s)
COVID-19 , Adult , Belgium/epidemiology , COVID-19/complications , Family Practice , Female , Follow-Up Studies , Humans , Reproducibility of Results , SARS-CoV-2 , Treatment Outcome
12.
Curr Oncol ; 29(9): 6485-6495, 2022 09 10.
Article in English | MEDLINE | ID: covidwho-2032871

ABSTRACT

BACKGROUND: Family physicians have low knowledge and preparedness to manage patients with cancer. A breast oncology clinical rotation was developed for family medicine residents to address this gap in medical education. OBJECTIVES AND METHODS: A breast oncology rotation for family residents was evaluated using a pre-post knowledge questionnaire and semi-structured interviews comparing rotation (RRs) versus non-rotation (NRRs) residents. Quantitative and qualitative data were collected via a pre-post knowledge questionnaire and semi-structured interviews, respectively. ANALYSIS: Quantitative data were analysed using descriptive statistics and paired t-tests to compare pre-post-rotation knowledge and preparedness. Qualitative data were coded inductively, analysed, and grouped into categories and themes. Data sets were integrated. RESULTS: The study was terminated early due to the COVID-19 pandemic. Six RRs completed the study; 19 and 2 NRRs completed the quantitative and qualitative portions, respectively. RRs' knowledge scores did not improve, but there was a non-significant increase in preparedness (5.3 to 8.4, p = 0.17) post-rotation. RRs described important rotation outcomes: knowledge of the patient work-up, referral process, and patient treatment trajectory; skills in risk assessment, clinical examination, and empathy, and comfort in counseling. DISCUSSION AND CONCLUSION: Important educational outcomes were obtained despite no change in knowledge scores. This rotation can be adapted to other training programs including an oncology primer to enable trainee integration of new information.


Subject(s)
COVID-19 , Internship and Residency , Family Practice/education , Humans , Medical Oncology , Pandemics
13.
Aust J Gen Pract ; 51(9): 696-702, 2022 09.
Article in English | MEDLINE | ID: covidwho-2026512

ABSTRACT

BACKGROUND AND OBJECTIVES: There is growing evidence regarding the effectiveness of registrar training through video cameras, which has relevance for quality supervision during times of crises such as the global COVID-19 pandemic. METHOD: Interviews were conducted in 2012 with supervisors, registrars and patients evaluating video camera use for tele-supervision across six rural sites in Gippsland, Australia. Thematic analysis was employed in 2013 - and re-examined in 2021 in light of the global COVID-19 pandemic - to explore user experience with video technology. RESULTS: Participants identified advantages of video supervision addressing distance and temporal issues, also emphasising quality supervision and education. Challenges included patient confidentiality, internet stability and loss of serendipitous 'corridor conversations'. DISCUSSION: Remote supervision is no longer simply an issue for rural and remote training. During crises such as a global pandemic, tele-supervision becomes the purview of all. There are distinct merits and limitations in adopting video technology, warranting consideration of individual training contexts. These findings can help inform remote supervision via video in varied milieu.


Subject(s)
COVID-19 , General Practice , Rural Health Services , Family Practice , General Practice/education , Humans , Pandemics/prevention & control
14.
Obstet Gynecol ; 140(2): 143-145, 2022 08 01.
Article in English | MEDLINE | ID: covidwho-2008647
15.
Int J Psychiatry Med ; 57(6): 547-553, 2022 11.
Article in English | MEDLINE | ID: covidwho-2002031

ABSTRACT

The Lawrence Family Medicine residency was created in the 1990s as the first community health center- sponsored residency with the goal of reducing health disparities. Balint groups have been a part of the wellbeing and behavioral health curriculum for many years. The population of Lawrence, MA is primarily a resource-poor, Latinx, immigrant population. In March of 2020, the Covid pandemic highlighted health disparities in this community. The spike in cases in 2020 also impacted the residency community with overwhelming needs of sick and dying patients in newly created, resident and faculty-run Covid units. Our early ignorance about transmission, prophylaxis, treatment and even prognosis made the work incredibly difficult. George Floyd's murder added the additional stress of social unrest in response to a persistent pattern of racism and unequal justice. To help process trauma residents felt working in terrifying conditions, often in medically futile situations with patients who spent their last hours without family at the bedside, we turned to biweekly Balint groups and added additional resident support sessions on the off weeks. Residents seamlessly adopted videoconferencing as the Balint platform, allowing them to attend a group session without risk of infection. The residents, being a diverse group, were able to offer multiple perspectives and process the traumatic issues of disproportionate suffering for their patients, uncertainty and frustration of the COVID-19 pandemic and systemic racism. We found a video Balint group permitted residents to explore their divergent experiences and feelings and offer support to each other in a very uncertain time.


Subject(s)
COVID-19 , Internship and Residency , Humans , Family Practice/education , Pandemics , Curriculum
16.
Int J Environ Res Public Health ; 19(15)2022 07 22.
Article in English | MEDLINE | ID: covidwho-1994022

ABSTRACT

BACKGROUND: There is a need to familiarize medical students with the specifics of video consultations. This paper presents the concept and tests of a digitally synchronous distance seminar in which medical students practice video consultations as an aid to a family physician's activity in a patient-oriented manner. The aim of the evaluation was to analyze the strengths, weaknesses, opportunities, and threats (S.W.O.T.) of the teaching concept. METHODS: A total of 12 students carried out video consultations independently and under medical supervision. The seminar included two elements: (A) All students and teachers were video consulted in a family practice; (B) A small group performed a video consultation in a patient´s home environment. The students' evaluation was conducted with two questionnaires (pre/post), which were analyzed with descriptive statistics and qualitative content analysis. The S.W.O.T. analysis was elaborated by the author team based on the results of the questionnaires and the interviews with the teachers. RESULTS: Students learned the limits and possibilities of teleconsultations and deepened their family medical knowledge. Strengths: Among others; increase interest in video consultations, patient contact, focused work. Weaknesses: Among others; technical difficulties and the time it requires. OPPORTUNITIES: Among others; involve students with multiple workloads in patient teaching. RISKS: Among others; no integration into the curriculum yet, few personnel resources. CONCLUSIONS: The learning model familiarizes medical students with competences in family medical patient care using video communication. The results of S.W.O.T. analyses can be weighted differently. Project groups can decide individually if they want to integrate the learning concept into their curriculum and which further improvements are necessary.


Subject(s)
Students, Medical , Telemedicine , Curriculum , Family Practice , Humans , Patient Care
17.
Med Sci (Basel) ; 10(3)2022 08 08.
Article in English | MEDLINE | ID: covidwho-1979315

ABSTRACT

In health professions education, team-based learning (TBL) has been used to help learners develop clinical reasoning and decision-making skills. The COVID-19 pandemic has challenged institutions to move curriculum delivery from largely in-person to online. With the anticipated return to in-person instruction and arguments made in favor of online instruction in certain circumstances, evidence is needed to support decision making in curriculum planning. The purpose of this study was to examine the effect of delivery mode (in-person vs. online) on student learning of clinical reasoning and clinical decision-making (CR/CDM) in the family medicine clerkship. Data from three cohorts of third-year medical students were included in the study: 2018/2019 cohort, in-person; 2019/2020 cohort, half of the cohort in-person, half of the cohort online; 2020/2021 cohort, online. Students' performance data-individual readiness assurance test (IRAT) and group readiness assurance test (GRAT) scores-were used. The Generalized Estimating Equations (GEE) analysis was performed. As expected, students scored higher in GRAT than IRAT across the three cohorts. No significant IRAT-GRAT differences were observed between in-person and online delivery of TBL sessions. Student learning of CR/CDM in TBL is comparable between the two modes of delivery in the family medicine clerkship. Future research in other clerkships, years of medical education, and professional programs is needed to inform decision making regarding the TBL delivery mode.


Subject(s)
COVID-19 , Students, Medical , Clinical Reasoning , Educational Measurement , Family Practice , Humans , Pandemics , Problem-Based Learning
18.
Can Fam Physician ; 66(12): 940, 2020 12.
Article in English | MEDLINE | ID: covidwho-1384054
19.
J Am Board Fam Med ; 35(4): 649-651, 2022.
Article in English | MEDLINE | ID: covidwho-1963340

ABSTRACT

As usual, this issue of the JABFM contains research as broad as the specialty of family medicine itself. The social determinants of health are again a prominent topic. COVID-19 topics in this issue include over-the-counter supplements as adjunct treatments and the influence of public health safety measures on influenza rates during the pandemic. Two separate reports look at the way cancer survivors interact with primary care and the difficulties encountered. A CERA study describes how departments of family medicine are tackling the challenge of training tomorrow's family physicians in point-of care-ultrasound. Physician workforce studies examine pay inequities and burnout. An impressive number other commonly encountered issues in family medicine are addressed using a wide variety of methods and data sources.


Subject(s)
COVID-19 , Cancer Survivors , Neoplasms , COVID-19/epidemiology , Family Practice , Humans , Neoplasms/epidemiology , Neoplasms/therapy , Physicians, Family , Social Determinants of Health
20.
J R Soc Med ; 115(7): 276-278, 2022 07.
Article in English | MEDLINE | ID: covidwho-1956976
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