scholarly journals Redesigning Residency Training: Summary Findings From the Preparing the Personal Physician for Practice (P4) Project

2018 ◽  
Vol 50 (7) ◽  
pp. 503-517 ◽  
Author(s):  
Patricia A. Carney ◽  
M. Patrice Eiff ◽  
Elaine Waller ◽  
Samuel M. Jones ◽  
Larry A. Green
Keyword(s):  
Family Medicine ◽  
Residency Training ◽  
Narrative Analysis ◽  
Scope Of Practice ◽  
Comparative Case Study ◽  
Patient Centered ◽  
Successful Model ◽  
Personal Physician ◽  
Medicine Education

Background and Objectives: The Preparing the Personal Physician for Practice (P4) project (2007 to 2014) involved a comparative case study of experiments conducted by 14 selected family medicine programs designed to evaluate new models of residency education that aligned with the patient-centered medical home (PCMH). Changes in length, structure, content, and location of training were studied. Methods: We conducted both a critical review of P4 published Evaluation Center and site-specific papers and a qualitative narrative analysis of process reports compiled throughout the project. We mapped key findings from P4 to results obtained from a survey of program directors on their top 10 “need to know” areas in family medicine education. Results: Collectively, 830 unique residents took part in P4, which explored 80 hypotheses regarding 44 innovations. To date, 39 papers have resulted from P4 work, with the P4 Evaluation Center producing 17 manuscripts and faculty at individual sites producing 22 manuscripts. P4 investigators delivered 21 presentations and faculty from P4 participating programs delivered 133 presentations at national meetings. For brevity, we present findings derived from the analyses of project findings according to the following categories: (1) how residency training aligned with PCMH; (2) educational redesign and assessment; (3) methods of financing new residency experiences; (4) length of training; (5) scope of practice; and (6) setting standards for conducting multisite educational research. Conclusions: The P4 project was a successful model for multisite graduate medical education research. Insights gained from the P4 project could help family medicine educators with future residency program redesign.

scholarly journals Family Medicine Education at a Rural Hospital in Japan: Impact on Institution and Trainees

2021 ◽  
Vol 18 (11) ◽  
pp. 6122
Author(s):  
Ryuichi Ohta ◽  
Yoshinori Ryu ◽  
Chiaki Sano
Keyword(s):  
Family Medicine ◽  
Rural Areas ◽  
Clinical Performance ◽  
Rural Hospital ◽  
Scope Of Practice ◽  
Quantitative Aspect ◽  
Educational Systems ◽  
Theory Approach ◽  
Community Hospitals ◽  
Medicine Education

Family medicine is vital in Japan as its society ages, especially in rural areas. However, the implementation of family medicine educational systems has an impact on medical institutions and requires effective communication with stakeholders. This research—based on a mixed-method study—clarifies the changes in a rural hospital and its medical trainees achieved by implementing the family medicine educational curriculum. The quantitative aspect measured the scope of practice and the change in the clinical performance of family medicine trainees through their experience of cases—categorized according to the 10th revision of the International Statistical Classification of Disease and Related Health Problems. During the one-year training program, the trainees’ scope of practice expanded significantly in both outpatient and inpatient departments. The qualitative aspect used the grounded theory approach—observations, a focus group, and one-on-one interviews. Three themes emerged during the analysis—conflicts with the past, driving unlearning, and organizational change. Implementing family medicine education in rural community hospitals can improve trainees’ experiences as family physicians. To ensure the continuity of family medicine education, and to overcome conflicts caused by system and culture changes, methods for the moderation of conflicts and effective unlearning should be promoted in community hospitals.

scholarly journals Patient Portal Implementation and Uptake: Qualitative Comparative Case Study

10.2196/18973 ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. e18973 ◽  
Author(s):  
Melita Avdagovska ◽  
Mark Ballermann ◽  
Karin Olson ◽  
Timothy Graham ◽  
Devidas Menon ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Current Status ◽  
Comparative Case Study ◽  
Patient Portal ◽  
Care Providers ◽  
Patient Portals ◽  
National Goal ◽  
Patient Centered ◽  
The Impact

Background Giving patients access to their health information is a provincial and national goal, and it is critical to the delivery of patient-centered care. With this shift, patient portals have become more prevalent. In Alberta, the Alberta Health Services piloted a portal (MyChart). There was a need to identify factors that promoted the use of this portal. Furthermore, it was imperative to understand why there was variability in uptake within the various clinics that participated in the pilot. Objective This study aims to identify potential factors that could improve the uptake of MyChart from the perspectives of both users and nonusers at pilot sites. We focused on factors that promoted the use of MyChart along with related benefits and barriers to its use, with the intention that this information could be incorporated into the plan for its province-wide implementation. Methods A qualitative comparative case study was conducted to determine the feasibility, acceptability, and initial perceptions of users and to identify ways to increase uptake. Semistructured interviews were conducted with 56 participants (27 patients, 21 providers, 4 nonmedical staff, and 4 clinic managers) from 5 clinics. Patients were asked about the impact of MyChart on their health and health care. Providers were asked about the impact on the patient-provider relationship and workflow. Managers were asked about barriers to implementation. The interviews were recorded, transcribed verbatim, and entered into NVivo. A thematic analysis was used to analyze the data. Results Results from a comparison of factors related to uptake of MyChart in 5 clinics (2 clinics with high uptake, 1 with moderate uptake, 1 with low uptake, and 1 with no uptake) are reported. Some theoretical constructs in our study, such as intention to use, perceived value, similarity (novelty) of the technology, and patient health needs, were similar to findings published by other research teams. We also identified some new factors associated with uptake, including satisfaction or dissatisfaction with the current status quo, performance expectancy, facilitating conditions, behavioral intentions, and use behavior. All these factors had an impact on the level of uptake in each setting and created different opportunities for end users. Conclusions There is limited research on factors that influence the uptake of patient portals. We identified some factors that were consistent with those reported by others but also several new factors that were associated with the update of MyChart, a new patient portal, in the clinics we studied. On the basis of our results, we posit that a shared understanding of the technology among patients, clinicians, and managers, along with dissatisfaction with nonportal-based communications, is foundational and must be addressed for patient portals to support improvements in care.

scholarly journals Utility of self-competency ratings during residency training in family medicine education-emerging countries: findings from Japan

2017 ◽  
Vol 16 (1) ◽  
Author(s):  
Michael D. Fetters ◽  
Satoko Motohara ◽  
Lauren Ivey ◽  
Keiichiro Narumoto ◽  
Kiyoshi Sano ◽  
...  
Keyword(s):  
Family Medicine ◽  
Residency Training ◽  
Emerging Countries ◽  
Medicine Education

scholarly journals Does Community- or University-Based Residency Sponsorship Affect Graduate Perceived Preparation or Performance?

2020 ◽  
Vol 12 (5) ◽  
pp. 583-590
Author(s):  
Peter J. Carek ◽  
Lisa Mims ◽  
Stacey Kirkpatrick ◽  
Maribeth P. Williams ◽  
Runzhi Zhang ◽  
...  
Keyword(s):  
Family Medicine ◽  
Medical School ◽  
Residency Training ◽  
Scope Of Practice ◽  
Pass Rates ◽  
Community Or ◽  
Graduate Survey ◽  
School Based ◽  
National Organizations ◽  
Survey Responses

ABSTRACT Background Residency training occurs in varied settings. Whether there are differences in the training received by graduates of community- or medical school–based programs has been the subject of debate. Objective This study examined the perceived preparation for practice, scope of practice, and American Board of Family Medicine (ABFM) board examination pass rates of family physicians in relation to the type of residency program (community, medical school, or partnership) in which they trained. Methods Predetermined survey responses were abstracted from the 2016 and 2017 National Family Medicine Graduate Survey of ABFM and linked to data about residency programs obtained from the websites of national organizations. Descriptive statistics were used to summarize the data and logistic regression to examine differences between survey results based on type of residency training: community, medical school, or partnership. Results Differences in the perception of preparation as well as current scope of practice were noted for the 3 residency types. The differences in perception were mainly noted in hospital-based skills, such as intubation and ventilator management, and in women's health and family planning services, with different program types increasing preparedness perception in different domains. Conclusions In general, graduates of family medicine community-based, non-affiliated, and partnership programs perceived they were prepared for and were providing more of the services queried in the survey than graduates of medical school–based programs.

scholarly journals Five Key Leadership Actions Needed to Redesign Family Medicine Residencies

2015 ◽  
Vol 7 (2) ◽  
pp. 187-191 ◽  
Author(s):  
Stanley M. Kozakowski ◽  
M. Patrice Eiff ◽  
Larry A. Green ◽  
Perry A. Pugno ◽  
Elaine Waller ◽  
...  
Keyword(s):  
Family Medicine ◽  
Leadership Skills ◽  
Local Environment ◽  
Comparative Case Study ◽  
Sequence Length ◽  
Successful Implementation ◽  
Educational Strategies ◽  
Patient Centered ◽  
Residency Programs ◽  
Leadership Actions

Abstract Background New skills are needed to properly prepare the next generation of physicians and health professionals to practice in medical homes. Transforming residency training to address these new skills requires strong leadership. Objective We sought to increase the understanding of leadership skills useful in residency programs that plan to undertake meaningful change. Methods The Preparing the Personal Physician for Practice (P4) project (2007–2014) was a comparative case study of 14 family medicine residencies that engaged in innovative training redesign, including altering the scope, content, sequence, length, and location of training to align resident education with requirements of the patient-centered medical home. In 2012, each P4 residency team submitted a final summary report of innovations implemented, overall insights, and dissemination activities during the study. Six investigators conducted independent narrative analyses of these reports. A consensus meeting held in September 2012 was used to identify key leadership actions associated with successful educational redesign. Results Five leadership actions were associated with successful implementation of innovations and residency transformation: (1) manage change; (2) develop financial acumen; (3) adapt best evidence educational strategies to the local environment; (4) create and sustain a vision that engages stakeholders; and (5) demonstrate courage and resilience. Conclusions Residency programs are expected to change to better prepare their graduates for a changing delivery system. Insights about effective leadership skills can provide guidance for faculty to develop the skills needed to face practical realities while guiding transformation.

scholarly journals Family Medicine and Emergency Redeployment: Unrealized Potential

2022 ◽  
Vol 54 (1) ◽  
pp. 44-46
Author(s):  
Hoon Byun ◽  
John M. Westfall
Keyword(s):  
Family Medicine ◽  
Residency Training ◽  
Rural Areas ◽  
Family Physicians ◽  
Physician Assistants ◽  
Scope Of Practice ◽  
Separate Analysis ◽  
Medicare Beneficiaries ◽  
Emergency Rooms ◽  
Training Requirements

Background and Objectives: Discussions of scope of practice among family physicians has become a crucial topic amidst the COVID-19 pandemic, coupled with new attention to residency training requirements. Family medicine has seen a gradual narrowing of practice due to a host of issues, including physician choice, expanding scope of practice from physician assistants and nurses, an increased emphasis on patient volume, clinical revenue, and residency training competency requirements. We sought to demonstrate the flexibility of the family medicine workforce as shown through their scopes of practice, and argue that this is indication of their potential for redeployment during emergencies. Methods: This study computes scopes of practice for 78,416 family physicians who treat Medicare beneficiaries. We used Evaluation and Management (E/M) codes in Medicare’s 2017 Part-B public use file to calculate volumes of services done across six sites of service per physician. We aggregated counts and proportions of physicians and the E/M services they provided across sites of practice to characterize scope, and performed a separate analysis on rural physicians. Results: The study found most family physicians practicing at a single site, namely, the ambulatory clinic. However, family physicians in rural areas, where need is greater, exhibit broader scope. This suggests that a significant number of family physicians have capacity for COVID-19 deployment into other settings, such as emergency rooms or hospitals. Conclusions: Family physicians are a potential resource for emergency redeployment, however the current breadth of scope for most family physicians is not aligned with current residency training requirements and raises questions about the future of family medicine scope of practice.

scholarly journals Patient Portal Implementation and Uptake: Qualitative Comparative Case Study (Preprint)

2020 ◽  
Author(s):  
Melita Avdagovska ◽  
Mark Ballermann ◽  
Karin Olson ◽  
Timothy Graham ◽  
Devidas Menon ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Current Status ◽  
Comparative Case Study ◽  
Patient Portal ◽  
Care Providers ◽  
Patient Portals ◽  
National Goal ◽  
Patient Centered ◽  
The Impact

BACKGROUND Giving patients access to their health information is a provincial and national goal, and it is critical to the delivery of patient-centered care. With this shift, patient portals have become more prevalent. In Alberta, the Alberta Health Services piloted a portal (MyChart). There was a need to identify factors that promoted the use of this portal. Furthermore, it was imperative to understand why there was variability in uptake within the various clinics that participated in the pilot. OBJECTIVE This study aims to identify potential factors that could improve the uptake of MyChart from the perspectives of both users and nonusers at pilot sites. We focused on factors that promoted the use of MyChart along with related benefits and barriers to its use, with the intention that this information could be incorporated into the plan for its province-wide implementation. METHODS A qualitative comparative case study was conducted to determine the feasibility, acceptability, and initial perceptions of users and to identify ways to increase uptake. Semistructured interviews were conducted with 56 participants (27 patients, 21 providers, 4 nonmedical staff, and 4 clinic managers) from 5 clinics. Patients were asked about the impact of MyChart on their health and health care. Providers were asked about the impact on the patient-provider relationship and workflow. Managers were asked about barriers to implementation. The interviews were recorded, transcribed verbatim, and entered into NVivo. A thematic analysis was used to analyze the data. RESULTS Results from a comparison of factors related to uptake of MyChart in 5 clinics (2 clinics with high uptake, 1 with moderate uptake, 1 with low uptake, and 1 with no uptake) are reported. Some theoretical constructs in our study, such as intention to use, perceived value, similarity (novelty) of the technology, and patient health needs, were similar to findings published by other research teams. We also identified some new factors associated with uptake, including satisfaction or dissatisfaction with the current status quo, performance expectancy, facilitating conditions, behavioral intentions, and use behavior. All these factors had an impact on the level of uptake in each setting and created different opportunities for end users. CONCLUSIONS There is limited research on factors that influence the uptake of patient portals. We identified some factors that were consistent with those reported by others but also several new factors that were associated with the update of MyChart, a new patient portal, in the clinics we studied. On the basis of our results, we posit that a shared understanding of the technology among patients, clinicians, and managers, along with dissatisfaction with nonportal-based communications, is foundational and must be addressed for patient portals to support improvements in care.

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