Trauma-Informed Care Training in Family Medicine Residency Programs

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.

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Combating LGBTQ+ health disparities by instituting a family medicine curriculum

The International Journal of Psychiatry in Medicine ◽

10.1177/00912174211035206 ◽

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.

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

Family Medicine ◽

10.22454/fammed.2020.373152 ◽

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.

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Patient loneliness in an urban, underserved family medicine residency clinic: prevalence and relationship to health care utilization

Family Practice ◽

10.1093/fampra/cmaa065 ◽

2020 ◽

Vol 37 (6) ◽

pp. 751-758

Author(s):

Stephanie A Hooker ◽

Paul Stadem ◽

Michelle D Sherman ◽

Jason Ricco

Keyword(s):

Primary Care ◽

Health Care ◽

African American ◽

Family Medicine ◽

Health Care Utilization ◽

Care Utilization ◽

Care Clinic ◽

Family Medicine Residency ◽

Ed Visits ◽

The Impact

Abstract Background Mounting evidence suggests that loneliness increases the risk of poor health outcomes, including cardiovascular disease and premature mortality.Objective: This study examined the prevalence of loneliness in an urban, underserved family medicine residency clinic and the association of loneliness with health care utilization. Methods Adult patients (N = 330; M age = 42.1 years, SD = 14.9; 63% female; 58% African American) completed the 3-item UCLA Loneliness screener at their primary care visits between November 2018 and January 2019. A retrospective case–control study design was used to compare health care utilization [hospitalizations, emergency department (ED) visits, primary care visits, no-shows and referrals] in the prior 2 years between patients who identified as lonely versus those who did not. Covariates included demographics and clinical characteristics. Results Nearly half (44%) of patients exceeded the cut-off for loneliness. Patients who were lonely were more likely to identify as African American, have depression and have a substance use disorder. Patients in the lonely group had significantly longer hospital stays and more primary care visits, no-shows and referrals than patients in the non-lonely group; there were no differences in number of hospitalizations or ED visits. Conclusions The prevalence of loneliness in an urban, underserved primary care clinic was much higher than prior prevalence estimates in primary care. Patients who are lonely may use more health care resources than patients who are not lonely. Primary care may be an ideal setting in which to identify patients who are lonely to further understand the impact of loneliness on health care outcomes.

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

Family Medicine ◽

10.22454/fammed.2021.249809 ◽

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.

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Education and Attitudes on Medical Cannabis in Family Medicine Residency Programs

Family Medicine ◽

10.22454/fammed.2020.645274 ◽

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.

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The teaching of behavioural sciences in the family medicine residency programs in Canada and in the United States

Social Science & Medicine (1967) ◽

10.1016/0037-7856(74)90055-9 ◽

1974 ◽

Vol 8 (11-12) ◽

pp. 565-574 ◽

Cited By ~ 4

Author(s):

J.Ivan Williams ◽

F.Marian Bishop ◽

Brian K.E. Hennen ◽

Thos.W. Johnson

Keyword(s):

United States ◽

Family Medicine ◽

The United States ◽

Residency Programs ◽

Family Medicine Residency ◽

The Family ◽

Behavioural Sciences

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Trends in Clinical Pharmacist Integration in Family Medicine Residency Programs in North America

Pharmacy ◽

10.3390/pharmacy8030126 ◽

2020 ◽

Vol 8 (3) ◽

pp. 126

Author(s):

Jennie B. Jarrett ◽

Jody L. Lounsbery

Keyword(s):

United States ◽

North America ◽

Family Medicine ◽

Patient Care ◽

The United States ◽

Direct Patient Care ◽

Residency Programs ◽

Clinical Pharmacists ◽

Family Medicine Residency ◽

Clinician Educators

(1) Objective: To determine the change in prevalence of clinical pharmacists as clinician educators within family medicine residency programs (FMRPs) in North America and to describe their clinical, educational and administrative scope over time. (2) Methods: A systematic review of the literature was performed starting with an electronic search of PubMed and Embase for articles published between January 1980 and December 2019. Studies were included if they surveyed clinical pharmacists regarding their clinical, educational, or other roles in FMRPs in the United States or Canada. The primary outcome was the change in prevalence of clinical pharmacists in North America. Secondary outcomes included: demographic information of clinical pharmacists, change in the prevalence in Canada and United States, and descriptions of clinical services, educational roles, and other activities of clinical pharmacists within FMRPs. (3) Results: Of the 65 articles identified, six articles met the inclusion criteria. The prevalence of clinical pharmacists as clinician educators in FMRPs in North America has grown from 24% to 53% in the United States (U.S.) and from 14% to 47% in Canada over the study period. The clinical and educational roles are similar including: the direct patient care, clinical education, and interprofessional education and practice. (4) Conclusion: The prevalence of clinical pharmacists in FMRPs is growing across North America. Clinical pharmacists are highly educated and trained to support these clinician educator positions. While educational roles are consistent, clinical pharmacists’ patient care roles are unique to their clinical site and growing.

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What Will It Take to Recruit and Train More Underrepresented Minority Physicians in Family Medicine? A CERA Survey Analysis

Family Medicine ◽

10.22454/fammed.2020.453883 ◽

2020 ◽

Vol 52 (9) ◽

pp. 661-664

Author(s):

Julia P. Roulier ◽

Jaeyun Sung

Keyword(s):

Family Medicine ◽

Family Physicians ◽

Program Directors ◽

The United States ◽

Recruitment Strategies ◽

Underrepresented Minority ◽

Survey Analysis ◽

Residency Programs ◽

Family Medicine Residency ◽

Diverse Patient Population

Background and Objectives: Both the Society of Teachers of Family Medicine (STFM) and the American Academy of Family Physicians have developed strategic plans to increase the training of underrepresented minority in medicine (URMM) family physicians to meet the needs of an increasingly diverse patient population in the United States. This study examines data from the 2017 Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA) Program Directors (PD12) Survey to assess whether recruitment strategies increase the diversity of underrepresented minority physicians in family medicine. Methods: Data were collected from an online electronic survey administered by the CERA of family medicine program directors in 2018. The data included specific questions about the diversity of URMM residents in family medicine programs and about initiatives that were used in their recruitment. We analyzed the data using the Pearson χ2 criteria for cause and effect of two variables. Results: Family medicine residency programs that have initiatives dedicated to increasing resident diversity have a higher percentage of URMM residents. Specifically, residency programs that have URMM recruitment strategies are 2.5 to 4 times more likely to have a diverse residency population than those programs without strategies (P<.001-.015). Conclusions: Striving to improve diversity in family medicine residency training in accordance with the ideals of STFM will require programs to design and implement initiatives to increase recruitment of URM residents.

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