Even one voice: Teaching legislative advocacy as a core competency in family medicine.

Credentialing bodies increasingly focus on advocacy as a competency to be developed by physicians during residency. The skills of advocacy are especially important with the increased attention on social determinants of health and as restrictive state and federal health policy decisions gain widespread attention in the national news media. This movement is reflected in the ACGME's recently revised statement on the training mission of family medicine residencies and with their most recent update of the Milestones which identifies advocacy as a core competency. Additionally, the major family medicine organizations and governing bodies all similarly identify advocacy as an important professional responsibility for family physicians. Advocacy is a broad term that can be applied across a range of settings and scenarios. For the purposes of this paper we focus primarily on legislative advocacy as a specific area for growing curricular experiences in family medicine residency programs.

Implementation of collaborative psychiatric care in a family medicine clinic: A quality assurance study.

In recent decades, numerous primary care clinics throughout the United States have implemented a collaborative care model of psychiatry in their practice. In this care model, patients with a psychiatric diagnosis meet with a team commonly composed of a primary care provider, behavioral health provider, and psychiatric consultants to develop a well-informed treatment plan. The St. Mary's Family Medicine Center in Grand Junction, Colorado implemented this care model in March 2020. Here, we evaluated its implementation and assessed its efficacy in producing favorable patient outcomes. We performed retrospective chart reviews and database queries in the clinic's electronic medical record system to gather relevant patient care information. We then analyzed this data through various statistical methods to assess the care model's effects on patient outcomes. Through this, we found evidence that this care model facilitates brief referral times with psychiatric specialists, and that treatment plans created here may contribute to a reduction in depressive and anxiety symptoms in a variety of patients.

Roles and responsibilities of behavioral science faculty in inpatient medicine.

OBJECTIVE: Behavioral science faculty in family medicine residencies work on inpatient medicine teaching service settings. However, there is limited research on the roles and responsibilities that behavioral science faculty fill while working in such settings. METHOD: Using a modified sequential explanatory study, researchers clarified the roles and responsibilities of behavioral science faculty. Participants completed a web-based survey (N = 60) on roles and a semistructured interview (N = 24) about the responsibilities on inpatient medicine teaching service. RESULTS: Results suggest that behavioral science faculty assume the roles of educator, patient care supporter, evaluator, mentor/advisor, and scholar/researcher and perform multiple responsibilities. CONCLUSIONS: Implications for this research inform the hiring process and training for behavioral science faculty and resident education.

Factors Influencing Family Physician Scope of Practice: A Grounded Theory Study.

BACKGROUND AND OBJECTIVES: Despite the efforts of many organizations to increase the volume of rural health care providers, rural communities continue to experience a shortage of physicians. To address this shortage, more information is needed as to how specific factors contribute to family physicians' choice to purse rural full-spectrum practice. METHODS: Interviews with 21 key informants guided a grounded theory analysis around the question of "What factors contribute to the decision to, and maintenance of, practicing full-spectrum rural medicine?" RESULTS: Analysis revealed two categories of factors that influenced choice of scope and maintenance of scope across a career: contextual and developmental factors. Contextual factors included the national health care landscape, the local setting, and personal factors. The developmental factors pertained to the point in the physician's career, and include preprofessional envisioned scope, current scope, and ideal future scope of practice. CONCLUSIONS: Results describe how a rural physician's scope of practice generally narrows as her/his career progresses. The results elaborate on how the larger health care landscape, local community, and personal factors all intersect to inform a physician's decision to pursue and/or continue practice. Results of the study were consistent with preexisting literature, but provide additional depth and suggest a theoretical relationship among factors.

Attachment-informed mentorship.

Attachment theory has been widely integrated into how clinicians view personal development and enduring relationships. Through the burgeoning field of interpersonal neurobiology, this model has also been applied to adult professional, training, and family relationships. However, the medical and integrated care literature currently lacks attempts to apply attachment principles to the mentorship relationships that are created between trainees and the faculty of a training program. Through this conceptual article, the authors introduce the attachment-informed mentorship model to bridge this gap. It is based on seven guiding principles that we hope can assist mentors and mentees: (a) Mentorship is an enduring relationship focused on the professional and personal development of the mentee. (b) Lived experience leads to attachment styles. (c) The mentoring relationship evolves across training. (d) The mentor and training program provide a secure base for the mentee. (e) The mentor and program provide a safe haven for the mentee. (f) Both mentor and mentee should address ruptures in trust. (g) Other roles may conflict with the mentor role. (PsycINFO Database Record

Balancing the Roles of a Family Medicine Residency Faculty: A Grounded Theory Study.

BACKGROUND AND OBJECTIVES: Great variety exists in the roles that family medicine residency faculty fill in the lives of their residents. A family medicine-specific model has never been created to describe and promote effective training relationships. This research aims to create a consensus model for faculty development, ethics education, and policy creation. METHODS: Using a modified grounded theory methods, researchers conducted phone interviews with 22 key informants from US family medicine residencies. Data were analyzed to delineate faculty roles, common role conflicts, and ethical principles for avoiding and managing role conflicts. Key informants were asked to apply their experience and preferences to adapt an existing model to fit with family medicine residency settings. RESULTS: The primary result of this research is the creation of a family medicine-specific model that describes faculty roles and provides insight into how to manage role conflicts with residents. Primary faculty roles include Role Model, Advisor, Teacher, Supervisor, and Evaluator. Secondary faculty roles include Friendly Colleague, Wellness Supporter, and Helping Hand. The secondary roles exist on a continuum from disengaged to enmeshed. When not balanced, the secondary roles can detract from the primary roles. Differences were found between role expectations of physician versus behavioral science faculty and larger/university/urban residencies versus smaller/community/rural residencies. CONCLUSIONS: Diversity of opinion exists related to the types of roles that are appropriate for family medicine faculty to maintain with residents. This new model is a first attempt to build consensus in the field and has application to faculty development, ethics education, and policy creation.

Meta-Kucha: the margin or the mainstream?

The inexorable push in integrated care is to move collaboration between biomedical and psychosocial clinicians into the mainstream of health care. This effort requires expanding small models to scale, convening statewide transformation initiatives, and leaving the comfortable confines of safety net clinics to prove integration in the for-profit systems that dominate American health care. CFHA's (Collaborative Family Health care Association's) Pecha Kucha Plenary assembled compelling narratives from the fringes of our health care system. The competing calls from the mainstream and from the margins force tension into our dialogue. However, for our model to be widely embraced, we need blueprints that fit most patients in most clinics. What we learned from the Pecha Kucha narratives is that people at the margins find ways of asserting their voices and achieving their needs. Sometimes it is through their own resilience and disruptiveness; other times it is through an advocate from the mainstream who shares their stories in such a compelling way that they bypass our well-crafted models and spark our souls.

Multiple role relationships in healthcare education.

Healthcare training environments, particularly in multidisciplinary training settings, present unique ethical dilemmas as a result of the multiple relationships faculty must balance while working with trainees. The historical and current perspectives on multiple roles in training environments will first be summarized. Evidence of a gap between the extant discipline specific guidelines and the realities of situations that occur in healthcare training will then be revealed, as illustrated in a case example. Primary care medicine training environments are highly nuanced, potentially leading to an infinite number of ambiguous situations that require a generalizable model for managing multiple roles. Rather than recommend specific modifications to existing ethical guidelines, a new model emphasizing role awareness and decision making when challenges in healthcare training settings arise is proposed. Recommendations for the case example using the model are offered. All professionals are prone to boundary transgressions; explicit training about and the maintenance of appropriate role balance will help to ensure high-functioning relationships and maximize the quality of patient care, resident education, faculty and resident satisfaction, and modeling of professional behavior to improve competencies as clinicians and educators.

The 2012 Don Bloch Award: presented by the Collaborative Family Healthcare Association to Larry Mauksch, MEd, October 5, 2012.

The Don Bloch Award is presented annually by the Collaborative Family Healthcare Association (CFHA) to a person who has made singular contributions to forwarding the cause of collaborative family health care. At the 2012 conference in Austin, Texas, the award was presented to Larry Mauksch of the Department of Family Medicine at the University of Washington. Three nominating talks given at that occasion and Larry's acceptance remarks are provided.

Collaboration in the presence of an electronic health record.

Recent laws in the United States incent healthcare practices to adopt electronic health records (EHRs). While there is extensive research related to EHRs generally, there is a dearth of EHR research specific to collaborative care settings. This study reports responses from 101 collaborative care offices who completed a 13-question online survey. The mixed-methods analysis provides insights as to the satisfaction, obstacles, and solutions to interdisciplinary collaboration in the presence of an EHR. Respondents reported highest satisfaction with medical billing, interdisciplinary communication, and scheduling. Satisfaction was lower as it relates to time consumption, difficult learning curve, creation of appointment notes, and health registries. This research reveals varied and conflicting approaches to addressing confidentiality and HIPAA within the EHR. Recommendations for improving EHR to better support collaborative care include the addition of modules common in mental health-specific EHR, enhanced tracking of mental health outcomes, templates for joint appointments, and improvements in population-based registry functions.

Improving quality of care for mental illness in an uninsured, low-income primary care population.

OBJECTIVE: We assessed if an ongoing, multifaceted quality improvement program improved mental health care in a low-income, uninsured primary care clinic. METHODS: We reviewed the charts of 500 consecutive patients in 1999 and 500 consecutive patients in 2004 to compare the number of mental health visits; the percentage of patients with more than three follow-up visits; the percentage with > or = 1 visit with a prescribing provider and the percentage with a psychiatric medication prescribed. We also assessed whether patients with more than one charted mental illness received more care than patients with one mental illness. RESULTS: Compared to 1999, patients in 2004 had significantly more visits in the first 120 days (acute phase) of treatment (3.16 vs. 4.81, P<.001) and more visits in up to 9 months post acute phase (3.76 vs. 4.88, P>.012). A higher percentage of patients in the acute phase (28.9% vs. 49.5%, P<.001) had three follow-up visits, saw a medical provider and received a prescription. Patients with multiple charted mental illnesses had more visits than patients with one mental illness in 2004 but not in 1999 (P<.001). CONCLUSIONS: An ongoing, multifaceted intervention improved the quality of mental health care in a primary care population with a high prevalence of mental illness.