Evaluation of Family Medicine Residency Programs for Diversity, Equity, and Inclusion Milestones.

BACKGROUND AND OBJECTIVES: In 2020, the Association of Family Medicine Residency Directors (AFMRD) Diversity and Health Equity (DHE) Task Force developed and piloted a framework to measure diversity, equity, and inclusion (DEI) initiatives in medical residencies across five domains: curriculum, evaluation, institution, resident pathway, and faculty pathway. The objectives were (1) to measure DEI initiatives across multiple domains in family medicine residencies using the DEI milestones and (2) to obtain current national baseline data providing criteria against which to measure effectiveness of initiatives and create tailored benchmarks. METHODS: We developed a cross-sectional survey of 12 quantitative residency characteristic items and the five DEI milestone ratings, and distributed the survey to program directors of family medicine residencies accredited by the Accreditation Council for Graduate Medical Education in the spring of 2022. We generated descriptive statistics, including item frequencies and cross-tabulations, and completed subgroup comparisons with analysis of variance. RESULTS: We collected aggregate milestone data for 194 family medicine residencies of 588 eligible programs (33% response rate). Respondents represented 48 states and US territories: 107 community-based, university-affiliated; 48 community-based; 34 university-based; and 5 military/other programs. Overall, the curriculum milestone was rated the highest (mean=2.54, SD=1.03), whereas the faculty pathway (mean=1.94, SD=1.04) and resident pathway (mean=2.02, SD=1.06) milestones were rated lowest. CONCLUSIONS: DEI milestone data may support residency programs as they assess their institution's developmental progress across five key domains. Additionally, aggregate data may shed light on collective strengths and areas for improvement.

Social Determinants of Health in Family Medicine Residency: A National Survey of Program Directors.

BACKGROUND AND OBJECTIVES: Social factors account for most health outcomes, underscoring the need to address social determinants of health (SDH) to eliminate health disparities. Our objectives are (1) to describe the scope of formal SDH curricula in family medicine residency, (2) to identify residency program characteristics associated with integrated core curriculum components to teach SDH, and (3) to identify barriers to addressing SDH in residency. METHODS: We distributed a cross-sectional survey to all family medicine residency program directors (PDs) accredited by the Accreditation Council for Graduate Medical Education as identified by the Association of Family Medicine Residency Directors. RESULTS: Of 624 eligible program directors, 279 completed the survey (45% response rate). Overall, 41.2% of respondents reported significant formal SDH training in their program. Though a majority (93.9%) agreed that screening for social needs should be a standard of care, most (58.9%) did not use standardized screening tools. The most common barriers to addressing SDH were lack of clinical resources (eg, social workers, legal advocates), lack of community resources (eg, food banks, substance use disorder treatment), and inadequate screening instruments or integration into the electronic medical record system. Availability of referral resources was associated with PDs' increased perception of resident SDH competency. CONCLUSIONS: Nearly all respondents agreed that screening for social needs should be a standard part of care; however, this vision is not yet realized. To better train the next generation of physicians to identify and meaningfully address social needs, additional research is needed. This research might include mixed-methods approaches that incorporate qualitative assessments to define best practices and patient-centered outcomes related to identifying and responding to SDH.

Diversity, Equity, and Inclusion Milestones: Creation of a Tool to Evaluate Graduate Medical Education Programs.

Background: As the Accreditation Council for Graduate Medical Education (ACGME) began to ask programs to report their efforts surrounding diversity, equity, and inclusion (DEI), program directors felt ill prepared to evaluate their programs and measure change. Objective: To develop a tool that would allow graduate medical education (GME) programs to evaluate the current state of DEI within their residencies, identify areas of need, and track progress; to evaluate feasibility of using this assessment method within family medicine training programs; and to analyze and report pilot data from implementation of these milestones within family medicine residency programs. Methods: The Association of Family Medicine Residency Directors (AFMRD) Diversity and Health Equity (DHE) Task Force developed a tool for program DEI evaluation modeled after the ACGME Milestones. These milestones focus on DEI assessment in 5 key domains: Institution, Curriculum, Evaluation, Resident Personnel, and Faculty Personnel. After finalizing a draft, a pilot implementation of the milestones was conducted by a convenience sample of 10 AFMRD DHE Task Force members for their own programs. Results: Scores varied widely across surveyed programs for all milestones. Highest average scores were seen for the Curriculum milestone (2.65) and the lowest for the Faculty Personnel milestone (2.0). Milestone assessments were completed within 10 to 40 minutes using various methods. Conclusions: The AFMRD DEI Milestones were developed for program assessment, goal setting, and tracking of progress related to DEI within residency programs. The pilot implementation showed these milestones were easily used by family medicine faculty members in diverse settings.

COVID-19 and Gender Differences in Family Medicine Scholarship.

This bibliometric analysis seeks to explore how the COVID-19 pandemic impacted submission rates to Annals of Family Medicine by gender. Women represented 46.3% of all manuscript submissions included in our study (n = 1,964/4,238), spanning from January 1, 2015 to July 15, 2020. The overall volume of submissions increased during COVID-19 in comparison to pre-pandemic months; however, this increase was not evenly distributed among men and women (122% increase vs 101% increase, respectively). In the early months of the pandemic, 244 submissions were authored by men (58.5%), and 173 submissions were authored by women (41.5%). The gap in women's submission rates is troubling, as it suggests they may be at greater risk of falling behind male colleagues during and beyond the COVID-19 pandemic.

Community: The Heart of Family Medicine.

Family physicians have the privilege of caring for patients throughout their lifespan and witness the impact all facets of life have on the health of individuals and the health of communities. The importance of engaging the community in the success of population-based initiatives to drive social change has been proven repeatedly and family medicine residencies should include community as the fifth "C." At a minimum, this includes incorporating the following three recommendations: (1) define community on initial accreditation, at self-study, and whenever major community changes occur; (2) utilize a community needs assessment as part of goal setting of activities with Annual Action Plan; and (3) evaluate residents and faculty on understanding of and cooperation with community needs. We must highlight engagement with the community as a central aspect of family medicine so that all programs focus on this important aspect of our work.

Human Immunodeficiency Virus Care: A Primary Care Provider's Guide.

This article provides a broad understanding of the human immunodeficiency virus (HIV) epidemic and how to provide appropriate care as a primary care provider. One important aspect to this is in understanding the effect that HIV has in the lesbian, gay, bisexual, transgender, and queer+ community. Through this article, clinicians will be better equipped to provide appropriate HIV primary care.

Psychiatric Emergencies.

Psychiatric emergencies are acute disturbances in thought, behavior, mood, or social relationship that require immediate intervention as defined by the patient, family, or social unit to save the patient and/or others from imminent danger. Ensuring the safety of the patient, surrounding persons, and the medical team is the first step of evaluation. Treatment focuses on stabilization of the patient, then on specific symptoms and ultimately the cause of symptoms. There are important legal considerations, particularly regarding involuntary admissions. It is important to debrief with the patient, surrounding family, and the health care team to ensure a continued therapeutic alliance and the emotional health of all involved.

Contraceptive needs of women seeking care from a publicly funded sexually transmitted infection clinic.

OBJECTIVES: To determine the contraceptive needs [including emergency contraception (EC)] of women seeking care from a publicly funded sexually transmitted infection (STI) clinic and to better understand women's knowledge of and attitudes towards EC. METHODS: An anonymous survey was administered to 197 women seeking services at one Chicago Department of Public Health STI clinic. RESULTS: After excluding women unlikely to become pregnant within the next year because of age, sexual orientation, hysterectomy and those who desired pregnancy (n=47), data from 150 women were available for analysis. Thirteen percent were using "very effective" contraception (intrauterine contraception, implant or sterilization) and 26% were using "effective" contraception (contraceptive pill, patch, ring or injectable). Approximately 23% (95% CI 16.5-30.0%) may have benefited from immediate use of EC as they reported at least one act of unprotected intercourse within the past 5 days. CONCLUSION: Many women seeking care from public STI clinics are at high risk of unintended pregnancy. A substantial number of women have an immediate need of EC at the time of their clinical visit. Efforts are needed to improve provision of EC as well as effective ongoing contraception for this population.