Formal Advocacy Curricula in Family Medicine Residencies: A CERA Survey of Program Directors.

BACKGROUND AND OBJECTIVES: Health advocacy has been declared an essential physician skill in numerous professional physician charters. However, there is limited literature on whether, and how, family medicine residencies teach this skill. Our aim was to determine the prevalence of a formal mandatory advocacy curriculum among US family medicine residencies, barriers to implementation, and what characteristics might predict its presence. METHODS: Questions about residency advocacy curricula, residency characteristics, and program director (PD) attitudes toward family medicine and advocacy were included in the 2017 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency PDs. We used univariate and bivariate statistics to describe residency characteristics, PD attitudes, the presence of a formal advocacy curriculum, and the relationship between these. RESULTS: Of 478 PDs, 261 (54.6%) responded to the survey and 236/261 (90.4%) completed the full advocacy module. Just over one-third (37.7%, (89/236)) of residencies reported the presence of a mandatory formal advocacy curriculum, of which 86.7% (78/89) focused on community advocacy. The most common barrier was curricular flexibility. Having an advocacy curriculum was positively associated with faculty experience and optimistic PD attitudes toward advocacy. CONCLUSIONS: In a national survey of family medicine PDs, only one-third of responding PDs reported a mandatory advocacy curriculum, most focusing on community advocacy. The largest barrier to implementation was curricular flexibility. More research is needed to explore the best strategies to implement these types of curricula and the long-term impacts of formal training.

Student and Resident Involvement in Family Medicine for America's Health A Step Toward Leadership Development.

BACKGROUND AND OBJECTIVES: Trainees-medical students and residents-are an important constituency of family medicine. The Family Medicine for America's Health (FMAHealth) Workforce Education and Development (WED) Tactic Team attempted to engage trainees in FMAHealth objectives via a nationally accessible leadership development program. We discuss a how-to mechanism to develop similar models, while highlighting areas for improvement. METHODS: The Student and Resident Collaborative recruited a diverse group of trainees to comprise five teams: student choice of family medicine, health policy and advocacy, burnout prevention, medical student education, and workforce diversity. An early-career physician mentored team leaders and a resident served as a liaison between the Collaborative and WED Team. Each team established its own goals and objectives. A total of 36 trainees were involved with the Collaborative for any given time. RESULTS: Including trainees in a national initiative required special considerations, from recruitment to scheduling. Qualitative feedback indicated trainees valued the leadership development and networking opportunities. The experience could have been improved by clearly defining how trainees could impact the broader FMAHealth agenda. To date, the Collaborative has produced a total of 17 conference presentations and four manuscripts. CONCLUSIONS: Although trainees felt improvement in leadership skills, more robust trainee involvement in FMAHealth core teams would have made the leadership initiative stronger, while simultaneously improving sustainability among family medicine and primary care reform strategies. Nonetheless, the unique structure of the Collaborative facilitated involvement of diverse trainees, and some trainee involvement should be integrated into any future strategic planning.

Coding and evaluating facilitator posts for an online cancer survivor workshop.

One-hundred and forty-five people attended six online cancer survivor workshops. Each workshop was monitored by two facilitators, who generated a total of 1,537 online posts. The authors developed a scheme for coding facilitator posts, combining grounded codes with categories developed by Spiegel and Classen for coding therapist responses in cancer support groups. Participants received a mean of 10.6 facilitator posts. Improvement in two health outcomes (practice of mental relaxation and illness intrusiveness) were significantly correlated with supportive posts and total number of posts. The coding scheme was easily applied and appears reliable. The data suggests that more facilitation is better.