Cabotegravir (Apretude) for Pre-exposure Prophylaxis for HIV Type 1 Infection.

Cabotegravir (Apretude) is an extended-release injectable HIV type 1 (HIV-1) antiretroviral integrase strand transfer inhibitor. Cabotegravir is labeled for use in adults and adolescents weighing at least 35 kg (77 lb) who are HIV-negative but at risk of HIV-1. It is used as pre-exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV-1 infection, the most common form of HIV.1.

Preparing for the End of Life: Medical Students Completing Their Own Advance Directives Described Increased Empathy for Patients.

BACKGROUND AND OBJECTIVES: Family medicine offers the opportunity to integrate advance care planning into routine primary care, connecting relationship-centered orientation with thoughtful action before a terminal diagnosis. However, physicians are undertrained in end-of-life counseling and care. To address this educational gap, we had clerkship students complete their own advance directives and submit a written reflection about the experience. The aim of this study was to learn about how students report on the value of completing their own advance directives, according to their written reflections. We hypothesized that self-described empathy, previously defined as understanding patients' emotions and communicating that understanding back to patients, would increase, as reported by students in their reflections. METHODS: We analyzed 548 written reflections over 3 academic years using a qualitative content analysis approach. An iterative process included open coding, building of themes, and verification with the text by four professionally diverse researchers. RESULTS: After completing their own advance directives, students reported increased empathy for patients facing end-of-life decisions and discussed the intention to change their future clinical practice regarding helping patients plan for the end of life. CONCLUSIONS: Using experiential empathy, an approach to teaching and cultivating empathy in which the participants experience the topic first-hand, we directed medical students to consider their own end-of-life wishes. Upon reflection, many noted this process changed their attitudes and clinical approaches to patients' death. This learning experience could be one meaningful component of a longitudinal and comprehensive curriculum to prepare medical school graduates to help patients plan for and face the end of life.

Revealing the Hidden Clerkship Curriculum: A Qualitative Analysis.

BACKGROUND AND OBJECTIVES: Family medicine (FM) clerkships have learning objectives to define what students should learn by the end of their clerkship, but how do we know what larger lessons students are taking away? This study aimed to explore the FM clerkship explicit and hidden curriculum. METHODS: Students were asked to list their top five take-home points at the end of their FM clerkship at two institutions. A total of 668 written reflections were qualitatively analyzed. RESULTS: Thirteen code categories emerged: scope of practice, health care systems, role of FM in the system, traits of a family doctor, values of FM, cultural competency and social justice, challenges of FM care, evidence-based medicine, clinical skills for a student, personal impact, life skills and tips, patient centeredness, and clinical pearls. Prominent subcategories included prevention, team-based care, doctor-patient relationship, and continuity of care. CONCLUSIONS: When compared to the FM clerkship learning objectives at both institutions, four code categories emerged that were not part of the explicit objectives: traits of a family doctor, challenges in FM care, personal impact, and life skills and tips. Conversely, some nuances of the learning objective of FM in the health care system regarding decreasing cost and improving health outcomes and equity were not represented in the coded categories of student responses. These findings could potentially help FM clerkships nationally define ways to improve messaging around challenges in FM care and help the 25 x 2030 initiative to produce more family physicians in the United States.

Expert Consensus Statement on Proficiency Standards for Dermoscopy Education in Primary Care.

BACKGROUND: Primary care providers (PCPs) frequently address dermatologic concerns and perform skin examinations during clinical encounters. For PCPs who evaluate concerning skin lesions, dermoscopy (a noninvasive skin visualization technique) has been shown to increase the sensitivity for skin cancer diagnosis compared with unassisted clinical examinations. Because no formal consensus existed on the fundamental knowledge and skills that PCPs should have with respect to dermoscopy for skin cancer detection, the objective of this study was to develop an expert consensus statement on proficiency standards for PCPs learning or using dermoscopy. METHODS: A 2-phase modified Delphi method was used to develop 2 proficiency standards. In the study's first phase, a focus group of PCPs and dermatologists generated a list of dermoscopic diagnoses and associated features. In the second phase, a larger panel evaluated the proposed list and determined whether each diagnosis was reflective of a foundational or intermediate proficiency or neither. RESULTS: Of the 35 initial panelists, 5 PCPs were lost to follow-up or withdrew; 30 completed the fifth and last round. The final consensus-based list contained 39 dermoscopic diagnoses and associated features. CONCLUSIONS: This consensus statement will inform the development of PCP-targeted dermoscopy training initiatives designed to support early cancer detection.

Envisioning nutrition teaching as a three-course meal: a blended approach to knowledge, application and assessment.

Medical students receive inadequate training in nutrition counselling, but the best way to teach this topic is unknown. To address this research gap, we developed a longitudinal blended programme - combining physical classroom experiences with online education - to teach nutrition counselling in a primary care clinical course. The learning experience comprised a pre-class online module to convey knowledge; a formative, ungraded standardised patient exercise on dietary modification to practise skills; and a written exam on nutrition knowledge and an Objective Structured Clinical Exam assessing nutrition counselling skills. We likened this three-part curriculum to a complete meal, with its self-paced online 'appetiser', in-class 'entrée' of clinical practice with patients, and 'dessert' of an assessment. We ascertained feasibility, discovered positive student reactions, and, via exam performance analysis, noted achievement of the learning objectives. This three-course meal model can be applied to any learning experience that teaches and assesses skills.

Medical School Characteristics, Policies, and Practices That Support Primary Care Specialty Choice: A Scoping Review of 5 Decades of Research.

BACKGROUND AND OBJECTIVES: The United States, like many other nations, faces a chronic shortage of primary care physicians. The purpose of this scoping review was to synthesize literature describing evidence-based institutional practices and interventions that support medical students' choices of primary care specialties, published in the United States, Canada, Australia, and New Zealand. METHODS: We surveyed peer-reviewed, published research. An experienced medical librarian conducted searches of multiple databases. Articles were selected for inclusion based on explicit criteria. We charted articles by topic, methodology, year of publication, journal, country of origin, and presence or absence of funding. We then scored included articles for quality. Finally, we defined and described six common stages of development of institutional interventions. RESULTS: We reviewed 8,083 articles and identified 199 articles meeting inclusion criteria and 41 related articles. As a group, studies were of low quality, but improved over time. Most were quantitative studies conducted in the United States. Many studies utilized one of four common methodologic approaches: retrospective surveys, studies of programs or curricula, large-scale multi-institution comparisons, and single-institution exemplars. Most studies developed groundwork or examined effectiveness or impact, with few studies of planning or piloting. Few studies examined state or regional workforce outcomes. CONCLUSIONS: Research examining medical school interventions and institutional practices to support primary care specialty choice would benefit from stronger theoretical grounding, greater investment in planning and piloting, consistent use of language, more qualitative methods, and innovative approaches. Robust funding mechanisms are needed to advance these goals.

The Relationship Between Medical School Clerkships and Primary Care Specialty Choice: A Narrative Review.

BACKGROUND AND OBJECTIVES: There is a persistent shortage of primary care physicians in the United States. Medical schools can help meet societal primary care health needs by graduating more students who select family medicine and other primary care careers. The objective of this narrative review was to evaluate the relationship between clerkships and primary care specialty choice. METHODS: We conducted a systematic literature search and narrative review of research articles examining the association between clerkships and primary care specialty choice. We evaluated the quality of included articles using a validated scale, assessed for methodology and outcomes, and synthesized using a narrative approach. RESULTS: We identified 59 articles meeting our research criteria. A required primary care clerkship in the core clerkship year was associated with increased primary care specialty choice. This finding was strongest for family medicine clerkships and family medicine specialty choice. Clerkships that were longer, were of higher quality, exposed students to a wider scope of primary care practice, and occurred within an institutional climate supportive of primary care were also correlated with more students choosing a primary care specialty. While student self-reported interest in primary care often increased following a primary care clerkship, this interest was not always sustained or consistently associated with a primary care residency match or primary care career. CONCLUSIONS: Required family medicine and primary care clerkships were correlated with primary care specialty choice. More high-quality research is needed to better understand how to maximize the impact of clerkships on primary care specialty choice.

The science of education: using learning theory to solve teaching problems in medical education.

Although theories do not play a major role in clinical medicine, the application of established theories of education can improve medical teaching. By understanding and harnessing learning theories, clinician educators can solve common teaching problems, thoughtfully craft their teaching sessions, determine whether learners or residents have achieved the intended learning objectives, and even earn higher course ratings. Key theories to be aware of include cognitive load theory, social learning theory, experiential learning, constructivism, humanism, behaviourism and connectivism. Various teaching problems are presented, along with explanations rooted in educational theory and possible solutions for use in the clinical educational setting.

Brought about by necessity: how the pandemic accelerated a transformation of continuing professional development.

The COVID-19 pandemic has had a profound impact on medical education and accelerated an evolution in continuing professional development that was already underway. Physicians around the world have had to quickly learn a new evolving clinical entity and do so in a virtual manner. As local and international travel ceased, academic and practice deliberations on diagnosis and treatment of novel diseases which historically have occurred during in-person conferences have shifted to virtual forums enabled with technology and social media. Medical educators have the added complexity of learning to teach and assess trainees virtually as remote learning has become a necessity. National and international organisations have increased collaborative efforts to ensure the latest clinical information is disseminated promptly to front-line physicians. The shift to virtual learning has democratised clinical information, allowing for wider global participation and transforming how we approach continuing professional development.

Silver linings: A thematic analysis of case studies describing advances in health professions education during the COVID-19 pandemic.

PURPOSE: In addition to the damaging public health, social and economic effects of COVID-19, health professions faculty around the world have faced staggering upheaval in the education of their students and junior doctors. Despite the formidable challenges, some silver linings have emerged in health professions education. The paper aims to describe themes from reflections of international health professions educators on these silver linings using an appreciative inquiry framework. MATERIALS AND METHODS: We performed a qualitative analysis of written reflections from a group of 115 international educators from medicine, nursing, dentistry, and the allied health professions describing a personal experience with an educational approach or work strategy arising during the COVID-19 pandemic that should be sustained. RESULTS: We identified 13 thematic units of reflections regarding advances in health professions education during the pandemic. The most notably optimistic and pioneering were Advancement of the Profession, Professional Connections, and Accelerating Change. Other frequent themes included unexpected successes in Virtual Teaching and Clinical Teaching. CONCLUSION: Several points of optimism from this otherwise catastrophic world event have emerged. This analysis serves as a useful guide for further research to understand, sustain and promote positive changes during a global pandemic on health professions education.

No Magic Pill: A Prescription for Enhanced Shared Decision-Making for Depression Treatment.

For over 2 decades, there have been debates, sometimes contentious, about the efficacy and safety of antidepressants. Growing awareness of the difficulty some patients have when discontinuing these medications has intensified these debates. Recently, Cipriani and colleagues published the largest meta-analysis to date that assessed the efficacy and tolerability of antidepressants. They concluded that all were more efficacious than placebo, and they also synthesized the trial results from head-to-head studies in an effort to guide pharmacologic treatment for major depressive disorder in adults. Although the researchers acknowledged many limitations in their analysis, including the fact that effect sizes were modest at best, the media overstated the results of the study. Both the meta-analysis and the news stories reinvigorated the debates about whether or not antidepressants "work." Unfortunately, however, the key question-how can this meta-analysis help physicians in assisting their patients with a difficult decision about depression treatment options?-was lost in the controversy. In this commentary, we identify the questions and challenges that were not addressed in the current debate and offer specific suggestions for enhancing shared decision making for physicians working in primary care settings.