Community Health, Advocacy, and Managing Populations (CHAMP) Longitudinal Residency Education and Evaluation.

PURPOSE: Longitudinal education initiatives designed to prepare residents to address health disparities and social determinants of health (SDH) are needed. This report addresses this gap by describing a family medicine residency's Community Health, Advocacy, and Managing Populations (CHAMP) curriculum and its evaluation by learners, faculty, and community partners. The CHAMP longitudinal curriculum is explicitly designed to prepare residents to address health disparities and SDH. We report early outcomes, including community partner feedback, of this innovative curriculum. METHODS: Data were obtained through standardized rotation evaluations, thematic analysis of structured group and individual interviews, and aggregated competency milestone data. Kirkpatrick's four-level model to evaluate effectiveness of training was used to frame design and analysis of learner, faculty, and community partner evaluations. RESULTS: Twenty residents have completed the year-one curriculum, 8 residents the year-two curriculum, and 8 residents the year-two and year-three elective. Community partners, residents, faculty, and leadership all were satisfied with the curriculum, particularly regarding relationship building and mentorship. Overall satisfaction with the rotation, quantitatively and qualitatively, was positive. Competency milestone ratings improved within each year of training: first-year residents by 0.6 (3.0 for 2015-2016 and 3.6 for 2016-2017) and second-year residents by 0.1 (5.2 vs 5.3). CONCLUSIONS: The CHAMP curriculum uniquely a) spans all three years of residency; b) combines block mandatory rotations with a longitudinal elective experience; and c) integrates community health, advocacy, and managing populations to meet accreditation requirements and prepare residents to address health disparities and SDH.

Wisconsin physician opinions on health care reform.

OBJECTIVE: To determine Wisconsin physicians' opinions regarding health care reform. METHODS: The University of Wisconsin Survey Research Center performed a 46-question mail survey of 2500 randomly selected physicians from the Wisconsin Medical Society master list of practicing physicians. Respondents rated opinions on a 5-point Likert scale. Demographics of respondents (sex practice type, geographic location, age) were compared to non-responders and the overall Wisconsin physician population. Data analysis quantified opinions regarding the health care system in Wisconsin and nationally, elements of health care reform proposals, and the role of public policy and government in health care. The analysis emphasized a comparison of primary care versus specialist physician responses. RESULTS: The survey yielded a 38% response rate. Respondent demographics were representative of Wisconsin physicians and very similar to nonresponders. Respondents revealed support for several topics, regardless of the respondent's practice type. Respondents also were in agreement on which elements of reform were most frequently favored and most frequently opposed. Nevertheless, there were many areas where primary care physicians strongly differed from specialists, such as favoring legislation for national health insurance (65.6% primary care versus 46.2% specialist). CONCLUSIONS: Wisconsin physicians responding to this survey expressed dissatisfaction with the health care system in which they currently practice and noted a clear desire for system reform. While most respondents agree on a few key priorities, primary care physicians significantly differ in their preferred strategies for reform and, in particular, the role of government in a reformed system. These results indicate a need for more dialogue and education among physicians in order to achieve a consensus that might help promote reform.

Emerging complementary and alternative medicine policy initiatives and the need for dialogue.

OBJECTIVES: This article explores the regulation of complementary and alternative medicine (CAM) and uses Swedish policy to bring to light paradoxes between CAM policies and CAM practice. It asserts that increases in CAM use challenge national health policies across the globe to simultaneously prioritize patient safety and treatment efficacy yet offer choices that promote patient ownership of health. In response to these challenges, many countries have established or are in the process of establishing a national CAM policy. METHODS: Using Sweden as an example, current health law, the CAM policy-practice paradox, and efforts to change CAM policy are considered. This article offers recommendations for future policy development based on recent Norwegian reforms and World Health Organization guidelines and calls for dialogue on this topic. CONCLUSIONS: It is of the utmost importance that the rarely discussed paradoxes between CAM policy and CAM practice are addressed in health sector reforms globally.

Short report: factors that affect specialty choice and career plans of Wisconsin's medical students.

OBJECTIVE: To identify factors that influence specialty choice among Wisconsin medical students and provide insight into approaches to encourage more students to pursue careers in primary care. METHODS: The importance of several factors in medical student career choice was surveyed using a Web survey convenience sample of all Wisconsin medical students. Students intending to pursue a career in primary care and in other specialties were compared. RESULTS: Respondents, regardless of specialty choice or gender, identified a similar group of factors as highly influential, and similar group of factors as non-influential in their decision-making. However, significantly more primary care students than other specialty students considered interest in underserved populations, relationships with patients, scope of practice, and role models important in their career choice. Significantly more primary care students than other specialty students responded that salary and competitiveness were "not at all" important. A greater number of other specialty students than primary care students stated that interest in scope of practice, role models, and training years were "not at all" important. Debt-related factors were reported as "not at all" important by nearly one-third of respondents. CONCLUSIONS: Although primary care and other specialty students report making their career plans based on the impact of similar factors, significant differences between primary care and other specialty students were reported in key areas. These results validate many previously reported factors, and indicate that salary and years of training may have been overemphasized in understanding student career choice. The results of this survey may be useful for Wisconsin medical schools in order to sustain, support, and foster student interest in primary care.