Changes in Preparation and Practice Patterns Among New Family Physicians.

Family physicians' scope of practice is declining despite being well prepared to provide a range of clinical services. To evaluate whether this is a new phenomenon, we compared the proportions of regional family medicine residency graduates who report practicing and those who report feeling more than adequately prepared to practice various procedures and clinical services from 2 points in time-a survey in 2000 of graduates from 1996-1999 (n = 293) and a survey in 2012 or 2014 of graduates from 2010-2013 (n = 408). The recent graduates felt better prepared, but reported a narrower scope of practice than those who graduated more than a decade earlier. These findings suggest that family medicine residency training has improved over time but the declining scope of practice is a concerning trend.

Antiracism in Residency: A Multimethod Intervention to Increase Racial Diversity in a Community-Based Residency Program.

BACKGROUND AND OBJECTIVES: In order to address racial health inequity, it is imperative to create diverse physician workforce and leadership. We describe and report on the outcomes of a comprehensive diversity initiative at our residency with the goal of increasing the racial diversity of residents and faculty. METHODS: At a community-based family medicine residency program, we instituted a multifaceted diversity initiative. The four components were mission statement revision, a diversity task force, an antiracism curriculum, and an ongoing system to evaluate progress. RESULTS: From 2014 to 2017, the proportion of persons of color among the residents increased from 28% (10/36) to 68% (27/40). Faculty diversity increased from 9% to 27% over the same period. CONCLUSIONS: This multimethod diversity initiative dramatically increased the proportion of underrepresented and other minorities in the residency program. The intervention succeeded due to the commitment of leadership and resources to addressing racism and making diversity a top priority on an institutional level.

Racial and Ethnic Health Disparities Curricula in US Medical Schools: A CERA Study.

INTRODUCTION: Health disparities among African Americans are an historic and pervasive problem in US health care. We examined the presence, requirements, and content of curricula in US medical schools dedicated to racial and ethnic health disparities. METHODS: We conducted a national CERA survey of Family Medicine department chairs. Chairs were asked about disparities curricula in their institutions. RESULTS: Ninety-two percent reported that their medical school curriculum included focus on racial and ethnic disparities. However, many were dissatisfied with the content and quality of their curricular offerings. There were no significant departmental predictors of the quality of health disparities curricula. CONCLUSION: The majority of medical schools address health disparities in their curricula, but optimally covering this important content remains a persistent challenge in medical school education.

The Generation in Between: A Perspective from the Keystone IV Conference.

Keystone IV affirmed the value of relationships in family medicine, but each generation of family physicians took away different impressions and lessons. "Generation III," between the Baby Boomers and Millennials, reported conflict between their professional ideal of family medicine and the realities of current practice. But the Keystone conference also helped them appreciate core values of family medicine, their shared experience, and new opportunities for leadership.

Insights from exemplar practices on achieving organizational structures in primary care.

PURPOSE: Interprofessional practice (IPP) is associated with better patient care outcomes and patient and provider satisfaction, yet little is known about the organizational structures that support effective IPP. METHODS: We selected 9 diverse clinical practice sites with exemplary IPP and conducted site visits with nonparticipant observations and interviewed 80 physicians, nurses, pharmacists, dieticians, medical and hospital assistants, nurse practitioners, physician assistants, clinic managers, physical and occupational therapists, respiratory therapists, social workers, psychologists, and others. We independently coded field notes and interviews and identified themes and trends using a grounded theory approach. Sites were evaluated for IPP using key features identified by the 2011 Interprofessional Education Collaboration Expert Panel. RESULTS: The primary themes at sites with high IPP were coordination of care and mutual respect. Four key organizational features were associated with these 2 themes: independent responsibilities for each professional; organizational structures for providers to learn about each other's roles; a structure and culture promoting accessible, frequent communication about patients; and strong leadership in IPP-supportive values. CONCLUSIONS: To achieve interprofessional collaboration, practice teams require structural supports that facilitate coordination of care and mutual respect.

Socrates was not a pimp: changing the paradigm of questioning in medical education.

The slang term "pimping" is widely recognized by learners and educators in the clinical learning environment as the act of more senior members of the medical team publicly asking questions of more junior members. Although questioning as a pedagogical practice has many benefits, pimping, as described in the literature, evokes negative emotions in learners and leads to an environment that is not conducive to adult learning. Medical educators may employ pimping as a pedagogic technique because of beliefs that it is a Socratic teaching method. Although problems with pimping have previously been identified, no alternative techniques for questioning in the clinical environment were suggested. The authors posit that using the term "pimping" to describe questioning in medical education is harmful and unprofessional, and they propose clearly defining pimping as "questioning with the intent to shame or humiliate the learner to maintain the power hierarchy in medical education." Explicitly separating pimping from the larger practice of questioning allows the authors to make three recommendations for improving questioning practices. First, educators should examine the purpose of each question they pose to learners. Second, they should apply historic and modern interpretations of Socratic teaching methods that promote critical thinking skills. Finally, they should consider adult learning theories to make concrete changes to their questioning practices. These changes can result in questioning that is more learner centered, aids in the acquisition of knowledge and skills, performs helpful formative and summative assessments of the learner, and improves community in the clinical learning environment.

Rewards and challenges of community health center practice.

BACKGROUND: More than 1100 community health centers (CHCs) in the United States provide primary care to 20 million underserved patients annually. CHCs have struggled to recruit and retain qualified physicians. OBJECTIVE: To understand physicians' work experiences in CHCs and identify major sources of satisfaction and dissatisfaction. METHODS: Using purposeful sampling, we conducted semistructured interviews with 12 family physicians practicing in CHCs. Interview questions assessed physicians' experiences in CHCs and sources of satisfaction and dissatisfaction. Interview notes were coded and analyzed by 2 investigators using a grounded theory approach to identify key themes. RESULTS: Though family physicians feel tremendous satisfaction from care of underserved patients, they are frustrated with the overwhelming workload they experience. Family physicians also report poor administrative management while working in CHCs. CONCLUSIONS: Implementation of the Affordable Care Act, which relies on expansion of CHC services, may be adversely affected by family physicians' frustrations with CHC practice. Further research to explore and potentially improve the CHC work environment may be needed.

Osteopathic physicians and international medical graduates in the rural primary care physician workforce.

BACKGROUND AND OBJECTIVES: Primary care physician (PCP) shortages are a longstanding problem in the rural United States. This study describes the 2005 supply of two important components of the rural PCP workforce: rural osteopathic (DO) and international medical graduate (IMG) PCPs. METHODS: American Medical Association (AMA) and American Osteopathic Association (AOA) 2005 Masterfiles were combined to identify clinically active, non-resident, non-federal physicians aged 70 or younger. Rural-Urban Commuting Area codes were used to categorize practice locations as urban, large rural, small rural, or isolated small rural. National- and state-level analyses were performed. PCPs included family physicians, general internists, and general pediatricians. RESULTS: DOs comprised 4.9% and IMGs 22.2% of the total clinically active workforce. However, they contributed 10.4% and 19.3%, respectively, to the rural PCP workforce, although their relative representation varied geographically. DO PCPs were more likely than allopathic PCPs to practice in rural places (20.5% versus 14.9%, respectively). IMG PCPs were more likely than other PCPs to practice in rural persistent poverty locations (12.4% versus 9.1%). The proportion of rural PCP workforce represented by DOs increased with increasing rurality and that of IMGs decreased. CONCLUSIONS: DO and IMG PCPs constitute a vital portion of the rural health care workforce. Their ongoing participation is necessary in addressing existing rural PCP shortages and handling the influx of newly insured residents as the Patient Protection and Affordable Care Act (ACA) comes into effect. The impact on rural DO and IMG PCP supply of ACA measures intended to increase their numbers remains to be seen.