Combating LGBTQ+ health disparities by instituting a family medicine curriculum

2021 ◽  
pp. 009121742110352
Author(s):  
Nina Grace Ruedas ◽  
Terri Wall ◽  
Christopher Wainwright
Keyword(s):  
Health Care ◽  
Medical Education ◽  
Health Disparities ◽  
Family Medicine ◽  
The United States ◽  
Residency Programs ◽  
Health Curriculum ◽  
Family Medicine Residency ◽  
Lgbtq Health ◽  
Growing Population

Research shows that a growing number of people in the United States are identifying as LGBTQ+. Therefore, it is more important than ever that clinicians are trained to be knowledgeable, inclusive, and culturally aware. Unfortunately, there is a lack of LGBTQ+ health education requirements in graduate medical education. As a result, fewer clinicians are prepared to care for this growing population. The shortage of knowledgeable clinicians contributes to LGBTQ+ health disparities and barriers to care. One strategy to combat these deficiencies in health care is for Family Medicine residency programs to create and carry out an LGBTQ+ health curriculum. This article will review LGBTQ+ health topics, identify efforts that Family Medicine residency programs can make, and summarize curriculum developments made by the St. Vincent's Family Medicine Residency Program.

scholarly journals Trauma-Informed Care Training in Family Medicine Residency Programs

2018 ◽  
Vol 50 (8) ◽  
pp. 617-622 ◽  
Author(s):  
Melissa E. Dichter ◽  
Anne Teitelman ◽  
Heather Klusaritz ◽  
Douglas M. Maurer ◽  
Peter F. Cronholm ◽  
...  
Keyword(s):  
Health Care ◽  
Family Medicine ◽  
Primary Care Patient ◽  
Psychological Trauma ◽  
The United States ◽  
Care Utilization ◽  
Residency Programs ◽  
Family Medicine Residency ◽  
Trauma Informed Care ◽  
Trauma Informed

Background and Objectives: Experiences of psychological trauma are common among primary care patient populations, and adversely affect patients’ health and health care utilization. Trauma-informed care (TIC) is a framework for identifying and responding to patients’ experiences of psychological trauma to avoid retraumatization. The purpose of this study was to evaluate the current state of TIC training in family medicine residency programs in the United States in order to identify opportunities for and barriers to TIC training. Methods: Items addressing the four core domains of TIC were incorporated into the 2017 Council of Academy Family Medicine Educational Research Alliance (CERA) survey of program directors. The items assessed the presence, content, and sufficiency of TIC curriculum, as well as barriers to further integration of TIC training. Results: Approximately 50% of programs responded to the survey. Of 263 respondents, 71 (27%) reported TIC training in their curriculum, but the majority devoted less than 5 hours annually to core content. The content most commonly addressed recognizing signs of trauma, most frequently using didactic formats. Overall, just over one-half of the programs reported that their curriculum met patients’ TIC needs “somewhat” (48.5%) or “a great deal” (4.6%). Lack of a champion followed by lack of time were the most commonly cited barriers to integrating TIC training. Conclusions: Despite the acknowledged importance of effects of trauma in health care, this study identified insufficient exposure to training in the core TIC domains in family medicine residency programs, underscoring a need for greater integration of TIC training during residency.

scholarly journals Residency Setting Association With Resident Substance Use Disorder Training: A CERA Secondary Data Analysis

2020 ◽  
Vol 52 (3) ◽  
pp. 198-201
Author(s):  
Joshua St. Louis ◽  
Emma Worringer ◽  
Wendy B. Barr
Keyword(s):  
Substance Use ◽  
Family Medicine ◽  
Residency Program ◽  
Secondary Analysis ◽  
Secondary Data ◽  
The United States ◽  
Resident Training ◽  
Addiction Medicine ◽  
Residency Programs ◽  
Family Medicine Residency

Background and Objectives: As the opioid crisis worsens across the United States, the factors that impact physician training in management of substance use disorders become more relevant. A thorough understanding of these factors is necessary for family medicine residency programs to inform their own residency curricula. The objective of our study was to identify factors that correlate with increased residency training in addiction medicine across a broad sample of family medicine residencies. Methods: We performed secondary analysis of a national family medicine residency program director survey conducted in 2015-2016 (CERA Survey PD-8). We obtained data from the Council of Academic Family Medicine Educational Research Alliance (CERA) Data Clearinghouse. We analyzed residency clinic site designation as a patient-centered medical home (PCMH), federally-qualified health center (FQHC), or both, for their correlation with faculty member possession of DEA-X buprenorphine waiver license, as well as required residency curriculum in addiction medicine. Results: Residency programs situated in an FQHC were more likely to have faculty members who possessed DEA-X buprenorphine waiver licenses (P=.025). Residency clinics that were both a PCMH as well as an FQHC also correlated strongly (P=.001). Furthermore, residencies with faculty who possessed a DEA-X license were significantly more likely to have a required curriculum in addiction medicine (P=.002). Conclusions: Our quantitative secondary analysis of CERA survey data of family medicine residency program directors revealed that resident training in addiction medicine is strongly correlated with both residency clinic setting (FQHC or FQHC/PCMH) as well as residency faculty possession of DEA-X licenses.

scholarly journals An Update of Oral Health Curricula in US Family Medicine Residency Programs

2018 ◽  
Vol 50 (6) ◽  
pp. 437-443 ◽  
Author(s):  
Hugh Silk ◽  
Judith A. Savageau ◽  
Kate Sullivan ◽  
Gail Sawosik ◽  
Min Wang
Keyword(s):  
Oral Health ◽  
Family Medicine ◽  
Online Survey ◽  
Program Directors ◽  
Residency Programs ◽  
Health Curriculum ◽  
Family Medicine Residency ◽  
Important Health ◽  
Dental Professional ◽  
Residency Program Directors

Background and Objectives: National initiatives have encouraged oral health training for family physicians and other nondental providers for almost 2 decades. Our national survey assesses progress of family medicine residency programs on this important health topic since our last survey in 2011. Methods: Family medicine residency program directors (PDs) completed an online survey covering various themes including number of hours of oral health (OH) teaching, topics covered, barriers, evaluation, positive influences, and program demographics. Results: Compared to 2011, more PDs feel OH should be addressed by physicians (86% in 2017 vs 79% in 2011), yet fewer programs are teaching OH (81% vs 96%) with fewer hours overall (31% vs 45% with 4 or more hours). Satisfaction with the competence of graduating residents in OH significantly decreased (17% in 2017 vs 32% in 2011). Program directors who report graduates being well prepared to answer board questions on oral health topics are more likely to have an oral health champion (P<0.001) and report satisfaction with the graduates’ level of oral health competency (P<0.001). Programs with an oral health champion, or having a relationship with a state or national oral health coalition, or having routine teaching from a dental professional are significantly more likely to have more hours of oral health curriculum (P<0.001). Conclusions: Family medicine PDs are more aware of the importance of oral health, yet less oral health is being taught in residency programs. Developing more faculty oral health champions and connecting programs to dental faculty and coalitions may help reduce this educational void.

scholarly journals Disability Policies and Practices in Family Medicine Residencies: A CERA Study

2021 ◽  
Vol 53 (3) ◽  
pp. 211-214
Author(s):  
Lisa M. Meeks ◽  
Ben Case ◽  
Heidi Joshi ◽  
Diane M. Harper ◽  
Lisa Graves
Keyword(s):  
Medical Education ◽  
Family Medicine ◽  
Students With Disabilities ◽  
Primary Source ◽  
Disability Policy ◽  
Hospital System ◽  
Residency Programs ◽  
Family Medicine Residency ◽  
Disability Disclosure ◽  
Policies And Practices

Background and Objectives: Increasing the diversity of family medicine residency programs includes matriculating residents with disabilities. Accrediting agencies and associations provide mandates and recommendations to assist programs with building inclusive policies and practices. The purpose of this study was (1) to assess programs’ compliance with Accreditation Council for Graduate Medical Education (ACGME) mandates and alignment with Association of American Medical Colleges (AAMC) best practices; (2) to understand perceptions of sources of accommodation funding; and (3) to document family medicine chairs’ primary source of disability-related information. Methods: Data were collected as part of the 2019 Council of Academic Family Medicine Educational Research Alliance Chairs’ Survey. Respondents answered questions about disability policy, disability disclosure structure, source of accommodation funding, and source of information regarding disability. Results: Half (56%) of responding chairs reported maintaining a disability policy in alignment with ACGME mandates, while half (52%) maintain a disability disclosure structure in opposition to AAMC recommendations. Funding sources for accommodation were reported as unknown (32.9%), the hospital system (27.1%), or the departmental budget (24.3%). Chairs listed human resources (50.7%) or diversity, equity, and inclusion offices (23.9%) as the main sources of disability guidance. Conclusions: The number of students with disabilities in medical education is growing, increasing the likelihood that family medicine residency programs will select and train residents with disabilities. Results from this study suggest an urgent need to review disability policy and processes within departments to ensure alignment with current guidance on disability inclusion. Department chairs, as institutional leaders, are well positioned to lead this change.

scholarly journals Financing the Fourth Year: Experiences of Required 4-Year Family Medicine Residency Programs

2021 ◽  
Vol 53 (3) ◽  
pp. 195-199
Author(s):  
Alan B. Douglass ◽  
Wendy B. Barr ◽  
Joe M. Skariah ◽  
Kelly J. Hill ◽  
Yadira Acevedo ◽  
...  
Keyword(s):  
Family Medicine ◽  
Health Center ◽  
Medical Center ◽  
Educational Innovation ◽  
Health Resources ◽  
The United States ◽  
Successful Implementation ◽  
Residency Programs ◽  
Family Medicine Residency ◽  
Curricular Model

Abstract: The optimal length of family medicine training has been debated since the specialty’s inception. Currently there are four residency programs in the United States that require 4 years of training for all residents through participation in the Accreditation Council for Graduate Medical Education Length of Training Pilot. Financing the additional year of training has been perceived as a barrier to broader dissemination of this educational innovation. Utilizing varied approaches, the family medicine residency programs at Middlesex Health, Greater Lawrence Health Center, Oregon Health and Science University, and MidMichigan Medical Center all demonstrated successful implementation of a required 4-year curricular model. Total resident complement increased in all programs, and the number of residents per class increased in half of the programs. All programs maintained or improved their contribution margins to their sponsoring institutions through additional revenue generation from sources including endowment funding, family medicine center professional fees, institutional collaborations, and Health Resources and Services Administration Teaching Health Center funding. Operating expense per resident remained stable or decreased. These findings demonstrate that extension of training in family medicine to 4 years is financially feasible, and can be funded through a variety of models.

scholarly journals Education and Attitudes on Medical Cannabis in Family Medicine Residency Programs

2020 ◽  
Vol 52 (10) ◽  
pp. 730-735
Author(s):  
Ann M. Philbrick ◽  
Christine Danner ◽  
Abayomi Oyenuga ◽  
Chrystian Pereira ◽  
Jason Ricco ◽  
...  
Keyword(s):  
United States ◽  
Family Medicine ◽  
The United States ◽  
Clinical Experiences ◽  
Medical Cannabis ◽  
Residency Programs ◽  
Family Medicine Residency ◽  
Medicine Resident ◽  
Current State ◽  
Research Alliance

Background and Objectives: Medical cannabis has become increasingly prevalent in the United States, however the extent of family medicine resident education on this topic remains unknown. The objective of this study was to ascertain the current state of medical cannabis education across this population and identify patterns in education based on state legality and program director (PD) practices. Methods: Survey questions were part of the Council of Academic Family Medicine Educational Research Alliance (CERA) omnibus survey from May 2019 to July 2019. PDs from all Accreditation Council for Graduate Medical Education (ACGME)-accredited US family medicine residency programs received survey invitations by email. Results: A total of 251 (40.7%) PDs responded, with 209 (83.6% [209/250]) reporting at least 1 hour of didactic curriculum regarding cannabis. The most common context was substance misuse (mean 3.0±4.1 hours per 3 years), followed by pain management (2.7±3.4 hours), and management of other conditions (2.1±2.7 hours). Thirty-eight programs (15.2% [38/250]) offered clinical experiences related to medical cannabis, and PDs who had previously prescribed or recommended medical cannabis were more likely to offer this experience (P<.0001). Experiences peaked after 3 to 5 years of medical cannabis legality. PD confidence in resident counseling skills was low overall, but did increase among programs with clinical experiences (P=.0033). Conclusions: The current trajectory of medical cannabis use in the United States makes it likely that residents will care for patients interested in medical cannabis, therefore it is important residents be prepared to address this reality. Opportunities exist for improving medical cannabis education in family medicine residency programs.

scholarly journals Integrating mental health professionals in residencies to reduce health disparities

2017 ◽  
Vol 52 (3) ◽  
pp. 286-297 ◽  
Author(s):  
Emilee Delbridge ◽  
Max Zubatsky ◽  
Jocelyn Fowler
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Disparities ◽  
Family Medicine ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Mental Health Treatment ◽  
The United States ◽  
Health Treatment ◽  
Family Medicine Residency

Health disparities in primary care remain a continual challenge for both practitioners and patients alike. Integrating mental health services into routine patient care has been one approach to address such issues, including access to care, stigma of health-care providers, and facilitating underserved patients’ needs. This article addresses examples of training programs that have included mental health learners and licensed providers into family medicine residency training clinics. Descriptions of these models at two Midwestern Family Medicine residency clinics in the United States are highlighted. Examples of cross-training both medical residents and mental health students are described, detailing specific areas where this integration improves mental health and medical outcomes in patients. Challenges to effective integration are discussed, including larger system buy-in, medical providers’ knowledge of mental health treatment, and the skills for clinical providers to possess in order to present mental health options to patients. Patients who traditionally experience multiple barriers to mental health treatment now have increased access to comprehensive care. As a result of more primary care clinics ascribing to an integrated care model of practice, providers may benefit from not only increased coordination of patient services but also utilizing behavioral health professionals to address health barriers in patients’ lives.

scholarly journals Entrustable Professional Activity Utilization: A CERA Study of Family Medicine Residency Program Directors

2019 ◽  
Vol 51 (6) ◽  
pp. 471-476
Author(s):  
Jennie B. Jarrett ◽  
Jumana Antoun ◽  
Memoona Hasnain
Keyword(s):  
United States ◽  
Medical Education ◽  
Family Medicine ◽  
Residency Program ◽  
Online Survey ◽  
Assessment Tool ◽  
The United States ◽  
Professional Activity ◽  
Assessment Framework ◽  
Family Medicine Residency

Background and Objectives: Entrustable professional activities (EPAs) is a novel assessment framework in competency-based medical education. While there are published pilot reports about utilization and validation of EPAs within undergraduate medical education (UME), there is a paucity of research within graduate medical education (GME). This study aimed to explore the landscape of EPAs within family medicine GME, particularly related to the understanding of EPAs, extent of utilization, and benefits and challenges of EPAs implementation as an assessment framework within family medicine residency programs (FMRPs) in the United States. Methods: A cross-sectional survey, as part of the 2017 Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA) Family Medicine Residency Program (FMRP) Director omnibus online survey was conducted in fall, 2017. ACGME-accredited FMRP directors were invited by email to participate. Results: The survey response rate was 53.1% (267/503). Overall, 90.1% (237/263) of FMRP directors were aware of EPAs as an assessment framework and 82.8% (197/238) understood the principles of EPAs, but 39.9% (95/238) were not confident in utilizing EPAs. Only 15.1% (36/238) of FMRP directors reported currently employing EPAs as an assessment tool. Identified benefits of EPAs use included increased transparency and congruence of expectations between learners and FRMP as well as facilitation for formative feedback. Identified barriers of EPA incorporation included difficulty integrating EPAs into the current assessment framework and faculty development. Conclusions: While EPAs are well recognized and understood by FMRP directors, there is significant lack of utilization of this assessment framework within FMRP in the United States.

scholarly journals The relationship between regional medical campus enrollment and rates of matching to family medicine residency

2020 ◽  
Vol 11 (3) ◽  
pp. e73-e81
Author(s):  
Dorothy Bakker ◽  
Christopher Russell ◽  
Mary Lou Schmuck ◽  
Amanda Bell ◽  
Margo Mountjoy ◽  
...  
Keyword(s):  
Medical Education ◽  
Family Medicine ◽  
Role Models ◽  
Leadership Role ◽  
Medical Council ◽  
Pass Rates ◽  
Residency Programs ◽  
Family Medicine Residency ◽  
Regional Medical ◽  
Regional Campus

Background: The Michael G. DeGroote School of Medicine expanded its medical education across three campus sites (Hamilton, Niagara Regional and Waterloo Regional) in 2007. Ensuring the efficacy and equivalency of the quality of training are important accreditation considerations in distributed medical education.  In addition, given the social accountability mission implicit to distributed medical education, the proportion of learners at each campus that match to family medicine residency programs upon graduation is of particular interest. Methods: By way of between campus comparisons of Canadian Residency Matching Service (CaRMS) match rates, this study investigates the family medicine match proportion of medical students from McMaster’s three medical education campuses. These analyses are further supported by between campus comparisons of Personal Progress Index (PPI), Objective Structured Clinical Examination (OSCE), Medical Council of Canada Qualifying Examination-Part 1 (MCCQE1) performances that offer insight into the equivalency and efficacy of the educational outcomes at each campus. Results: The Niagara Regional Campus (NRC) demonstrated a significantly greater proportion of students matched to family medicine. With respect to education equivalency, the proportion of students’ PPI scores that were more than two SD below the mean was comparable across campuses.  OSCE analysis yielded less than 2% differences across campuses with no differences in the last year of training.  The MCCQE1 pass rates were not statistically significant between campuses and there were no differences in CaRMS match rates. With respect to education efficacy, there were no differences among the three campuses’ pass rates on the MCCQE1 and CaRMS match rates with the national rates. Conclusions: Students in all campuses received equivalent educational experiences and were efficacious when compared to national metrics, while residency matches to family medicine were greater in the NRC. The reasons for this difference may be a factor of resident and leadership role-models as well as the local hospital and community environment.

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