Milestones as a Faculty Development Tool for Career Academic Physicians.

BACKGROUND AND OBJECTIVES: The Accreditation Council for Graduate Medical Education (ACGME) has implemented milestones for progression of residents. Career academic physicians would benefit from similar concrete guidance for scholarly activity and faculty development. After developing milestones across six recognized competencies among our family medicine academicians, we acknowledged the potential benefit of expanding the development of milestones throughout the academic medical center. METHODS: Milestones that we previously developed were modified by departmental leaders within our institution reflecting levels of career development based on benchmarks in each field. These objective measures for guiding maturation of clinical and academic skill sets were then circulated to clinicians in five residency programs throughout our academic medical center for self-evaluation. We analyzed the completed surveys to determine if an association exists between years in academics and rank across each area of competency. RESULTS: We received fifty-three responses from the 91 faculty invited. We noted a significant association in the competency of medical knowledge with progression from assistant to full professor, and we noted a trend toward significance in professionalism and progression from assistant to full professor. These objective measures of clinician development and competency suggest association with levels of academic career development by rank within the institution. CONCLUSIONS: This rubric can be helpful for directing faculty development and faculty mentorship. These milestones are general enough that other physician specialties may be able to adopt them for their own needs.

Comparison of traditional anesthesia method and jet injector anesthesia method (MadaJet XL®) for Nexplanon® insertion and removal.

BACKGROUND: This study compared a needle-free anesthesia method with traditional local anesthesia for insertion and removal of Nexplanon® long-acting removable contraceptive device. In our clinic, patients often avoid this highly effective form of contraception due to fear of needles. We sought to determine if patients perceived a difference in pain with the injection, anxiety level or pain with the procedure when local anesthesia was given with a needle v/s a needle-free jet injector device. METHODS: Patients were randomly assigned to one of two groups: jet injector or needle lidocaine delivery. Outcomes were ease of use, patient anxiety level, painfulness, and efficacy of anesthesia method. RESULTS: Patient pain perception with administration of jet injector lidocaine was statistically lower than traditional needle with no difference in anxiety or ease of use, or efficacy of the anesthesia. CONCLUSION: The jet injector device is a reasonable alternative to needle injection delivery of anesthesia prior to insertion/removal of Nexplanon® device. Further studies may determine whether this needle-free alternative for administration of local anesthetic would result in more women choosing Nexplanon® as a contraceptive method.

Diabetes detachment: How cultural, contextual, and personal barriers influence low-income young women with diabetes in Appalachia.

AIM: This study explored the experiences of young low-income women with type 2 diabetes (T2D) in Appalachia, Tennessee. BACKGROUND: Diabetes care remains suboptimal across the United States particularly in underserved communities. METHODS: The study employed a descriptive qualitative case study collecting data using in-depth interview of a group of low-income women in their 20s with T2D. Data was analyzed using qualitative content analysis. RESULTS: The findings identified three themes: "frustration and stigma lead to detachment care," "frozen by fear and unable to overcome resource limitations" and "social support and an empowered perspective lead to a positive outlook." Cultural barriers combined with contextual and personal barriers resulted in detachment from diabetes care among study participants. CONCLUSION: Within Appalachia, leveraging the existing familism values along with culturally congruent education and support can help alleviating the burden of diabetes care.