scholarly journals Clinic First: Prioritizing Primary Care Outpatient Training for Family Medicine Residents at Group Health Cooperative

2015 ◽  
Vol 30 (10) ◽  
pp. 1557-1560 ◽  
Author(s):  
Kathleen Barnes ◽  
Carl G Morris
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Group Health ◽  
Group Health Cooperative ◽  
Family Medicine Residents

scholarly journals Impact of Interprofessional Care Conferences Across Primary Care and Mental Health Organizations on Family Medicine Resident Learning

2021 ◽  
Vol 53 (4) ◽  
pp. 289-294
Author(s):  
Keri D. Hager ◽  
Jen Nelson Albee ◽  
Carolyn O'Donnell ◽  
Sarah Jackson ◽  
Amelia King ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Family Medicine ◽  
Medication Safety ◽  
Safety Monitoring ◽  
Holistic Care ◽  
Interprofessional Care ◽  
Care Conference ◽  
Family Medicine Residents

Background and Objectives: Patients with severe mental illness often lack care coordination between primary care and mental health providers which can negatively impact patient outcomes. Team-based care is integral in the effective management of patients with multiple comorbidities, with the family physician central in coordinating holistic care. Family medicine residency programs must provide models of effective interprofessional collaboration and mental health treatment to prepare residents to navigate an evolving health care landscape. The objective of this study was to evaluate family medicine residents’ learning about providing holistic care with an interprofessional team and medication safety monitoring from the interprofessional cross-organizational care conference experience. Methods: To bridge care and cultivate the necessary skills, a family medicine clinic and mental health clinic implemented monthly interprofessional care conferences to coordinate care for their shared patients during 2019. Residents who participated in the care conference each (n=11) completed a retrospective pre/postsurvey (11/11=100% response rate) to gather perceptions of what they learned from the interprofessional care conference experience. Results: After participating in the care conference, all residents agreed they understood the elements that must be considered to provide holistic patient care, were confident conducting medication safety monitoring for their patients taking second-generation antipsychotics (eg, lipids, A1C, ECG), and agreed the care conference helped them develop a more comprehensive patient-centered care plan. Additionally, they all intend to work collaboratively across professions in the future. Conclusions: Interprofessional and cross-organizational care conferences create an authentic learning environment that enhances family medicine residents’ understanding and confidence in providing collaborative and holistic care for patients with severe and persistent mental illness.

scholarly journals Improving Hierarchical Condition Category Coding by Family Medicine Residents Using a Web-Based, Interactive Module

2021 ◽  
Vol 53 (3) ◽  
pp. 220-222
Author(s):  
Stuart Zeltzer ◽  
Monique Vanderhoof ◽  
Brian Garvey
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Response Rate ◽  
Positive Impact ◽  
Clinical Communication ◽  
Web Based ◽  
Knowledge Question ◽  
Junior Residents ◽  
Family Medicine Residents ◽  
Hierarchical Condition Category

Background and Objectives: The proper documentation of Hierarchical Condition Category (HCC) codes is essential for risk-adjusted reimbursement, chart accuracy, and clinical communication within primary care, but represents a significant training gap in resident education. Our goal was to improve the understanding and confidence level of family medicine residents with HCC coding during outpatient primary care visits. Methods: We developed and distributed a web-based, interactive module to family medicine residents at our academic institution. We assessed module impact through pre- and postsurveys focusing on knowledge, confidence, and experience with HCC coding. Results: Twenty-eight of 48 preeducation surveys were returned (response rate of 58%), including 16 junior (PGY-1-2) and 12 senior (PGY-3-4) residents. A majority of residents answered each HCC knowledge question correctly. Median baseline confidence with HCC coding for all respondents was 4 (interquartile range [IQR]: 2, 6; scale 0-10; 10=most confident): senior residents 6 (IQR: 5, 7) versus junior residents 2 (IQR: 2, 4). Forty-six percent of respondents noted some previous education on HCC codes, including 75% of senior vs 25% of junior residents. Twenty-six residents completed the educational module. Posttest surveys (n=5, response rate: 19%) demonstrated median confidence of 7 (IQR: 4, 8.5). Conclusions: Family medicine residents displayed a high degree of knowledge but low confidence with HCC coding. Posteducation surveys suggest the possibility of a positive impact of our e-module, though further intervention roll out and data collection are needed to evaluate this effect.

scholarly journals Improving After-Clinic Work Workflow in a Family Medicine Residency

2021 ◽  
Vol 8 (4) ◽  
Author(s):  
Nguyen V ◽  
◽  
Jaqua E ◽  
Oh A ◽  
Altamirano M ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Patient Care ◽  
Primary Care Physicians ◽  
Training Session ◽  
P Value ◽  
Post Intervention ◽  
Family Medicine Residency ◽  
Resident Physicians ◽  
Family Medicine Residents

Introduction: The broad range of patients and diagnoses addressed by primary care physicians lends to a larger after-work clinic load. The resulting after-clinic work, including various in-basket tasks, can be a substantial burden to physicians, and potentially leading to burnout. The goal of this study is to generate a standardized workflow to improve physician after-clinic work efficiency and patient care. Methods: A nine-question pre- and post-intervention survey about afterclinic work management was administered to family medicine residents at a multi-specialty FQHC in California. The intervention was done in June 2020 and included a twenty-minute training session explaining how to implement a standardized in-basket management flowchart in a family medicine residency clinic. Results: Pre- and post-intervention data were analyzed using nonindependent paired sample t-tests. The survey was sent to all 40 family medicine residents. Pre- and post-intervention survey response rate was 77.5% and 97.5% respectively. The result of the nine questions post intervention were statistically significant (p value of <0.001). The standardized flowchart addressed adequate supervision of resident physicians’ patient care. Conclusion: The post-intervention results showed that having a clear and standardized flowchart enhanced the overall knowledge and understanding by the resident physicians in how to management the in-basket workflow. With increased patient access via telehealth and enhanced electronic medical records, it is essential to have effective teaching and supervision of resident physician after-clinic work. Successful teaching of after-clinic work will improve work-life balance and the overall success of the new primary care physician.

scholarly journals Practice patterns among early-career primary care (ECPC) physicians and workforce planning implications: protocol for a mixed methods study

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e030477
Author(s):  
M Ruth Lavergne ◽  
Laurie J Goldsmith ◽  
Agnes Grudniewicz ◽  
David Rudoler ◽  
Emily Gard Marshall ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Family Medicine ◽  
Practice Patterns ◽  
Early Career ◽  
Mixed Methods Study ◽  
Policy Implications ◽  
Changes Over Time ◽  
Over Time ◽  
Family Medicine Residents

IntroductionCanadians report persistent problems accessing primary care despite an increasing per-capita supply of primary care physicians (PCPs). There is speculation that PCPs, especially those early in their careers, may now be working less and/or choosing to practice in focused clinical areas rather than comprehensive family medicine, but little evidence to support or refute this. The goal of this study is to inform primary care planning by: (1) identifying values and preferences shaping the practice intentions and choices of family medicine residents and early career PCPs, (2) comparing practice patterns of early-career and established PCPs to determine if changes over time reflect cohort effects (attributes unique to the most recent cohort of PCPs) or period effects (changes over time across all PCPs) and (3) integrating findings to understand the dynamics among practice intentions, practice choices and practice patterns and to identify policy implications.Methods and analysisWe plan a mixed-methods study in the Canadian provinces of British Columbia, Ontario and Nova Scotia. We will conduct semi-structured in-depth interviews with family medicine residents and early-career PCPs and analyse survey data collected by the College of Family Physicians of Canada. We will also analyse linked administrative health data within each province. Mixed methods integration both within the study and as an end-of-study step will inform how practice intentions, choices and patterns are interrelated and inform policy recommendations.Ethics and disseminationThis study was approved by the Simon Fraser University Research Ethics Board with harmonised approval from partner institutions. This study will produce a framework to understand practice choices, new measures for comparing practice patterns across jurisdictions and information necessary for planners to ensure adequate provider supply and patient access to primary care.

scholarly journals SUN-LB116 Improved Family Medicine Resident Diabetes Care Through Participation in a Diabetes Clinic

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Key Douthitt ◽  
Wanda Taylor ◽  
Piercy Jonathan ◽  
Crystal Fletcher-Jones ◽  
Juanita Hughes ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Care Provider ◽  
Diabetes Care ◽  
Primary Care Provider ◽  
Primary Care Physicians ◽  
Diabetes Clinic ◽  
Dietary Counseling ◽  
Eye Exams ◽  
Family Medicine Residents

Abstract As the population ages and the prevalence of diabetes increases, the demand for endocrinology services, especially in underserved areas, will continue to exceed availability. Primary care residency training programs must prepare residents to care for high risk patients with diabetes who cannot access specialists. We hypothesized that resident participation in an inter-professional diabetes clinic run by primary care physicians would lead to improved diabetes care in resident patient panels. A diabetes clinic was created in an existing primary care practice at a Federally Qualified Health Center in Eastern Kentucky. All non-pregnant, adult, Type II diabetes patients with a HgbA1C of 8.0% or greater were invited to participate in the clinic. Initial visits included evaluations by a dentist, mental health counselor, social worker, nutritionist, primary care provider, and pharmacist. Four first-year and four second-year family medicine residents rotated through the diabetes clinic and followed the patients as they saw each member of the health care team. On follow-up visits, a resident served as the primary care provider for each patient and participated in post-clinic meetings of the entire healthcare team. Resident patient charts were reviewed 3 months prior to the year-long intervention and data collected was compared to resident patient charts 3 months following the intervention. Ninety patients served as the pre-intervention sample and 108 were in the post-intervention sample. Chi-square analysis showed a statistically significant increase in patients with A1C less than 8.0% pre (57.7%) to post (71.3%) p=0.0468. Overall, there were significant increases in all health-associated behaviors. Patients receiving eye exams increased from pre (29%) to post (66%) intervention significantly; z=-5.2, P&lt;.001. Patients receiving a urine microalbumin test increased from pre (61%) to post (82%) intervention; z=-3.2, P&lt;.001. Patients receiving dietary counseling increased from pre (54%) to post (79%) intervention; z=-3.6, P&lt;.001. Patients receiving foot exams increased from pre (34%) to post (48%) intervention, z=-1.9; p=.03. Resident involvement in a multidisciplinary diabetes clinic led by primary care physicians resulted in a statistically significant increase in HgbA1Cs &lt; 8 among patients in their regular clinic and resulted in a statistically significant increase in their diabetic patients receiving eye exams, dietary counseling, foot exams, and urine microalbumin tests. This study suggests that teaching family medicine residents important diabetes care skills with an inter-professional team approach through the use of a diabetes clinic may be superior to standard educational practices.

scholarly journals Family Medicine Resident Knowledge of Adverse Childhood Experiences

PRiMER ◽  
2021 ◽  
Vol 5 ◽  
Author(s):  
Kimberly Collins ◽  
Carolin Spice ◽  
Bailey C. Ingraham ◽  
Morhaf Al Achkar
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Adverse Childhood Experiences ◽  
Primary Care Providers ◽  
Comfort Level ◽  
Care Providers ◽  
Childhood Experiences ◽  
Knowledge And Attitudes ◽  
Adverse Childhood ◽  
Family Medicine Residents

Introduction: Exposure to adverse childhood experiences (ACEs) has been associated with poor health in adulthood. Primary care providers can provide more appropriate medical care and intervene if they ask patients about ACEs. The purpose of this study is to determine existing knowledge and attitudes about ACEs among family medicine residents within the Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) region. Methods: Researchers developed a nine-question survey to assess family medicine residents’ knowledge and attitudes about ACEs, and their comfort level in addressing ACEs. The survey was distributed to 540 residents in 22 family medicine residency programs in the WWAMI region. Results: Most residents reported they had some (32%) or moderate (35%) knowledge of the ACEs study. However, 30% reported no knowledge of the ACEs study, and very few (3%) reported significant knowledge. Of 117 respondents reporting at least some prior knowledge of ACEs, 42% had first heard about ACEs during residency. The ACEs topics that respondents felt least comfortable addressing during a patient encounter were a patient’s personal history of sexual abuse (75%) and witnessing physical abuse (47%). Most residents (84%) indicated that they would like to see ACEs integrated into their residency curriculum. Discussion: This study demonstrates a gap in residency training on the topic of ACEs in family medicine residencies within the WWAMI region. Residents are uncomfortable addressing ACEs with patients but are receptive to learning about this topic. More teaching about ACEs can increase residents’ comfort level with addressing these topics in the primary care setting.

scholarly journals Medicine in the 21st Century: Recommended Essential Geriatrics Competencies for Internal Medicine and Family Medicine Residents

2010 ◽  
Vol 2 (3) ◽  
pp. 373-383 ◽  
Author(s):  
Brent C. Williams ◽  
Gregg Warshaw ◽  
Anne Rebecca Fabiny ◽  
Nancy Lundebjerg, MPA ◽  
Annette Medina-Walpole ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Medical Education ◽  
Family Medicine ◽  
Graduate Medical Education ◽  
Care Hospital ◽  
Residency Programs ◽  
Accreditation Council ◽  
Graduate Medical ◽  
Family Medicine Residents

Abstract Background Physician workforce projections by the Institute of Medicine require enhanced training in geriatrics for all primary care and subspecialty physicians. Defining essential geriatrics competencies for internal medicine and family medicine residents would improve training for primary care and subspecialty physicians. The objectives of this study were to (1) define essential geriatrics competencies common to internal medicine and family medicine residents that build on established national geriatrics competencies for medical students, are feasible within current residency programs, are assessable, and address the Accreditation Council for Graduate Medical Education competencies; and (2) involve key stakeholder organizations in their development and implementation. Methods Initial candidate competencies were defined through small group meetings and a survey of more than 100 experts, followed by detailed item review by 26 program directors and residency clinical educators from key professional organizations. Throughout, an 8-member working group made revisions to maintain consistency and compatibility among the competencies. Support and participation by key stakeholder organizations were secured throughout the project. Results The process identified 26 competencies in 7 domains: Medication Management; Cognitive, Affective, and Behavioral Health; Complex or Chronic Illness(es) in Older Adults; Palliative and End-of-Life Care; Hospital Patient Safety; Transitions of Care; and Ambulatory Care. The competencies map directly onto the medical student geriatric competencies and the 6 Accreditation Council for Graduate Medical Education Competencies. Conclusions Through a consensus-building process that included leadership and members of key stakeholder organizations, a concise set of essential geriatrics competencies for internal medicine and family medicine residencies has been developed. These competencies are well aligned with concerns for residency training raised in a recent Medicare Payment Advisory Commission report to Congress. Work is underway through stakeholder organizations to disseminate and assess the competencies among internal medicine and family medicine residency programs.

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