Cross-Cultural Mentorship in Military Family Medicine: Defining the Problem.

BACKGROUND AND OBJECTIVES: Mentorship is critical to physician recruitment, career development, and retention. Many underrepresented in medicine (URiM) physicians experience minority taxes that can undermine their professional objectives. Use of cross-cultural mentoring skills to navigate differences between non-URiM and URiM physicians can make mentorship relationships with URiM physicians more effective. This survey examined military family physician demographics and mentorship practices. METHODS: Design and Setting: Cross-sectional study using voluntary, anonymous data from the 2021 Uniformed Services Academy of Family Physicians (USAFP) Annual Meeting Omnibus Survey. STUDY POPULATION: USAFP Members attending 2021 Virtual Annual Meeting. INTERVENTION: None. STATISTICAL ANALYSIS: Descriptive statistics and χ2 tests. RESULTS: The response rate to the omnibus survey was 52.9%, n=258. More than half of respondents did not have a URiM mentee and had not collaborated with a URiM colleague on a scholarly activity within the last 3 years. Only 54.7% of respondents could recognize and address minority taxes. URiM physicians were more likely to have a URiM mentee (65.4% vs 44.4%, P=.042) and to recognize and address minority taxes (84.6% vs 51.3%, P=.001). They also were more confident (84.6% vs 60.3%, P=.015) and more skilled in discussing racism (80.8% vs 58.2%, P=.026). CONCLUSIONS: Structured programs are needed to improve knowledge and skills to support cross-cultural mentorship. Additional studies are needed to further evaluate and identify implementation strategies.

Can We Realize Our Collaborative Potential? A Critical Review of Faculty Roles and Experiences in Interprofessional Education.

PURPOSE: Faculty within interprofessional education (IPE) are essential contributors to IPE implementation efforts. Although the majority of existing IPE literature consists of reports on IPE innovations, few insights are available into the experiences of the faculty members who deliver IPE. This critical narrative review was designed to synthesize the knowledge available about (1) roles assigned to IPE educators and (2) IPE faculty members' experiences of fulfilling these roles. METHOD: Six databases for English-language studies published between 2000 and March 2021 were searched: PubMed, Embase, Web of Science, MEDLINE, CINAHL, PsycINFO, ERIC, and MedEdPortal. A total of 1,717 manuscripts were identified for possible inclusion. After applying inclusion/exclusion criteria, 214 articles constituted the final literature corpus. Harden and Crosby's original framework of 6 roles of medical educators augmented with the manager role introduced in Harden and Lilley's 2018 framework informed the analysis. RESULTS: IPE faculty take on all 6 roles identified by Harden and Crosby: facilitator, planner, information provider, examiner, role model, and resource developer, as well as the manager role. Faculty were most commonly identified as facilitator and planner, and rarely as role models. The authors identified 3 main struggles experienced by IPE faculty: personal (e.g., confidence as a cross-professions educator), interpersonal (e.g., co-teaching IPE), and institutional (e.g., supporting IPE logistics). CONCLUSIONS: This review highlights the complexity of the roles taken on by IPE faculty and the struggles they experience in the process. The results suggest that attention to the different roles that IPE faculty play in educational interventions and to equipping faculty with the necessary competencies, tools, and support, is fundamental to the success of IPE. Future research should harness the explanatory power of theories to help explain dynamics at play between personal, interpersonal, and institutional barriers to identify interventions that can aid IPE faculty in delivering collaboration-ready professionals.

ADHD in Children: Common Questions and Answers.

Attention-deficit/hyperactivity disorder (ADHD) is a multidimensional chronic neurodevelopmental condition that affects 8.4% of U.S. children between two and 17 years of age and may pose long-term morbidity if untreated. The evaluation for ADHD begins when parents or caregivers present to primary care physicians with concerns about behavior problems or poor school or social function. A comprehensive history and physical examination should assess for comorbid or other conditions that can mimic ADHD. The combination of Diagnostic and Statistical Manual of Mental Disorders, 5th ed., criteria and validated screening tools completed by parents, teachers, or other adults can aid in establishing the diagnosis. The goals of treatment include symptom reduction and improved social and cognitive function. Psychosocial interventions are the recommended first-line treatment for preschool children (four to five years) and can improve overall function when used as an adjunct therapy in elementary school children (six to 11 years of age) and adolescents (12 to 17 years of age). Stimulant medications are well-established as an effective treatment for reducing symptoms of ADHD in elementary school children and adolescents. Nonstimulant medications are less effective but reasonable as adjunct or alternative therapy when stimulants are ineffective or not tolerated. Regular follow-up is key in the management of ADHD and should assess symptoms, overall function, presence of comorbidities, adverse effects of treatment, and medication use.

Primary Care of the Solid Organ Transplant Recipient.

The advancing science of transplantation has led to more transplants and longer survival. As a result, primary care physicians are more involved in the care of transplant recipients. Immunosuppressive therapy has significantly decreased rates of transplant rejection but accounts for more than 50% of transplant-related deaths, often due to infections and other risks related to long-term use. Cardiovascular disease is the leading cause of non-transplant-related mortality. Aggressive risk factor management is recommended for transplant recipients, including a blood pressure goal of less than 130/80 mm Hg and statin therapy in kidney, liver, and heart recipients. Fertility typically increases posttransplant, and female transplant recipients should avoid pregnancy for one year after surgery. The best contraceptive choice is usually an intrauterine device. Because of the increased risk of infection, patients should be tested for graft dysfunction or infection if suspicion arises. Testing should be coordinated with the transplant center. Malignancies are a common cause of death in transplant recipients, requiring careful attention to screening recommendations and informed discussions with patients. Family physicians should maintain an ongoing relationship with the transplant team to discuss medication changes and the risk of infection or graft rejection.

Prevalence and risk factors for pelvic floor symptoms in women in rural El Salvador.

Our aim was to assess the frequency of pelvic floor symptoms among women in rural El Salvador. After written informed consent was obtained, we administered the short form of the urodynamic distress inventory (UDI-6) plus four other pelvic floor questions to 236 women aged 30 to 75 in rural El Salvador attending a general medicine or gynecology clinic. Average (SD) age, parity, and body mass index were 48.0 (8.4) years, 5.9 (3.4), and 26.9 (4.9) kg/m(2), respectively. Ten (4.2%) women had a prior hysterectomy, 16 (6.8%) women were smokers, and 108 (45.8%) women were postmenopausal. Seventy-one percent of women reported urinary incontinence (UI); 49.3 and 61.1% of women reported urge UI and stress UI, respectively. Forty-one percent of women reported fecal incontinence (FI) of solid or liquid stool. Women with UI were significantly more likely to have had a hysterectomy compared to women without UI. Women with FI had significantly fewer years of education when compared to women without FI. In conclusion, pelvic floor symptoms are highly prevalent among women in rural El Salvador.