scholarly journals Academic Achievement, Professionalism, and Burnout in Family Medicine Residents

2021 ◽  
Vol 53 (6) ◽  
pp. 423-432
Author(s):  
Caitlin Davis ◽  
Meenu Krishnasamy ◽  
Zachary J. Morgan ◽  
Andrew W. Bazemore ◽  
Lars E. Peterson
Keyword(s):  
Family Medicine ◽  
Medical Knowledge ◽  
Professional Conduct ◽  
Multilevel Regression ◽  
Physician Burnout ◽  
Certification Examination ◽  
International Medical Education ◽  
Investigation Methods ◽  
The Subject ◽  
Family Medicine Residents

Background and Objectives: Physician burnout has been shown to have roots in training environments. Whether burnout in residency is associated with the attainment of critical educational milestones has not been studied, and is the subject of this investigation. Methods: We used data from a cohort of graduating family medicine residents registering for the 2019 American Board of Family Medicine initial certification examination with complete data from registration questionnaire, milestone data, in-training examination (ITE) scores, and residency characteristics. We used bivariate and multilevel multivariate analyses to measure the associations between four professionalism milestones ratings and ITE performance with burnout. Results: Our sample included 2,509 residents; 36.8% met the criteria for burnout. Multilevel regression modeling showed a correlation between burnout and failure to meet only one of four professionalism milestones, specifically professional conduct and accountability (OR 1.41, 95% CI 1.07-1.87), while no statistically significant relationship was demonstrated between burnout and being in the lowest quartile of ITE scores. Other factors negatively associated with burnout included international medical education (OR 0.60, 95% CI 0.48-0.76) and higher salary compared to cost of housing (OR 0.62, 95% CI 0.46-0.82). Conclusions: We found significant association between self-reported burnout and failing to meet expectations for professional conduct and accountability, but no relationship between burnout and medical knowledge as measured by lower ITE performance. Further investigation of how this impacts downstream conduct and accountability behaviors is needed, but educators can use this information to examine program-level interventions that can specifically address burnout and development of physician professionalism.

scholarly journals Family Physician Burnout and Resilience: A Cross-Sectional Analysis

2019 ◽  
Vol 51 (8) ◽  
pp. 657-663 ◽  
Author(s):  
Katherine Buck ◽  
Meredith Williamson ◽  
Stacy Ogbeide ◽  
Bethany Norberg
Keyword(s):  
Family Medicine ◽  
Emotional Exhaustion ◽  
Workplace Stress ◽  
Practice Change ◽  
Effect Sizes ◽  
Research Network ◽  
Outcome Variable ◽  
Physician Burnout ◽  
Cross Sectional ◽  
Family Medicine Residents

Background and Objectives: Current physician burnout levels are at historically high levels, especially in family medicine, with many factors playing a role. The goal of this study was to understand demographic, psychological, environmental, behavioral, and workplace characteristics that impact physician wellness and burnout, focusing on family medicine physicians and residents. Methods: Survey respondents were 295 family medicine residents and faculty members across 11 residency programs within the Residency Research Network of Texas (RRNeT). Subjects completed multiple measures to assess resilience, burnout, psychological flexibility, and workplace stress. Respondents also reported personal wellness practices and demographic information. The primary outcome variables were burnout (depersonalization, emotional exhaustion, and personal achievement) and resilience. Results: The predictor variables contributed significant variance (depersonalization=27.1%, emotional exhaustion=39%, accomplishment=37.7%, resilience=37%) and resulted in large effect sizes (depersonalization f²=.371, emotional exhaustion f²=.639, accomplishment f²=.605, resilience f²=.587) among the three burnout models and the resilience model for the sample. Similar variance and effect sizes were present for independent resident and program faculty samples, with resilience being the only outcome variable with significant differences in variance between the samples. Conclusions: This study demonstrates the roles of both individual and organization change needed to impact provider wellness, with special attention to resilience across faculty and residents. The results of this study may inform workplace policies (ie, organizational practice change) and wellness programming and curricula (ie, individual level) for family medicine residents and program faculty.

scholarly journals Family Medicine Residency Graduates' Preparation for Quality Improvement Leadership

2019 ◽  
Vol 11 (5) ◽  
pp. 558-564
Author(s):  
Jonathan Lichkus ◽  
Bo Fang ◽  
Lars E. Peterson
Keyword(s):  
Quality Improvement ◽  
Family Medicine ◽  
Response Rate ◽  
Team Leadership ◽  
Certification Examination ◽  
Family Medicine Residency ◽  
The Past ◽  
Demographic Questionnaire ◽  
Standard Component ◽  
Family Medicine Residents

ABSTRACT Background Training in quality improvement (QI) is a standard component of family medicine residency education. Graduating family medicine residents' ability to lead QI initiatives is unknown. Objective We assessed the preparedness of graduating family medicine residents to lead QI projects and to identify factors that may increase such readiness. Methods Milestone data for all graduating family medicine residents were linked to a practice demographic questionnaire completed by the same residents who registered for the American Board of Family Medicine certification examination between 2014 and 2017. The change in self-assessed QI preparedness over time and its association with faculty-assigned milestone ratings were examined using descriptive and regression analyses. Results The questionnaire had a 100% response rate (12 208 responded). Between 2014 and 2017, the percentage of residents who self-reported being “extremely” or “moderately” prepared to lead QI projects increased from 72.7% (2208 of 3038) to 75.8% (2434 of 3210, P = .009). Self-reported QI team leadership was associated with 93% higher odds of feeling extremely prepared compared to moderately prepared (odds ratio 1.93, 95% CI 1.58–2.35). The average midyear faculty-assigned milestone rating for QI among residents who felt “extremely” prepared was 3.28 compared to 3.14 among those who felt “not at all” prepared. Conclusions Over the past 4 years, family medicine residents' self-assessed preparedness to lead QI projects has barely increased. There was no correlation between self-assessed preparation and faculty-assigned milestone rating. However, we found a small association between self-reported QI leadership and self-assessed QI preparedness.

scholarly journals Family Medicine Residents' Debt and Certification Examination Performance

PRiMER ◽  
2019 ◽  
Vol 3 ◽  
Author(s):  
Julie P. Phillips ◽  
Lars E. Peterson ◽  
Iris Kovar-Gough ◽  
Thomas R. O'Neill ◽  
Michael R. Peabody ◽  
...  
Keyword(s):  
Family Medicine ◽  
The United States ◽  
Cross Sectional ◽  
Certification Examination ◽  
Debt Level ◽  
Examination Performance ◽  
Educational Debt ◽  
The Relationship ◽  
High Educational ◽  
Family Medicine Residents

Introduction: Previous studies have found that medical students and internal medicine residents with high educational debt perform less well on examinations. The purpose of this study was to examine the relationship between educational debt and family medicine residents’ performance on initial in-training and board certification examinations. Methods: Our study was a cross-sectional secondary analysis of American Board of Family Medicine (ABFM) data collected from residents (N=5,828) who registered for the Family Medicine Certification Examination (FMCE) in 2014 and 2015, representing 85.8% of graduating family medicine residents in the United States in those years. Multivariable linear and logistic regression modeling was used to examine the relationship between debt level and examination scores, and also to explore the relationship between debt level and passing the initial FMCE. Results: After controlling for demographic variables, residents with high debt ($150,000 to $249,999) and very high debt (more than $250,000) performed significantly worse than those with no debt on the initial in-training examination (score differences of 14.2 [CI 8.6, 19.8] and 15.8 [CI 10.3, 21.4] points, respectively) and FMCE (score differences of 19.3 points [CI 13.4, 25.3] and 30.4 points [CI 24.6, 36.3], respectively). Additionally, those with debt above $250,000 had half the odds of passing their initial FMCE (OR 0.45; CI 0.27-0.75). Conclusions: High educational debt is associated with lower examination performance among family medicine residents. This may be because residents with more debt have more stress or fewer day-to-day financial resources. However, confounding factors may also contribute to this association.

scholarly journals Perceived knowledge of psychiatry and family medicine residents regarding medical management of schizophrenia, hypertension, diabetes mellitus, and dyslipidemia: opportunities to refine the residency training

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiangbo Ying ◽  
Jinhui Wan ◽  
Kang Sim ◽  
Ee-Jin Darren Seah ◽  
Mythily Subramaniam
Keyword(s):  
Diabetes Mellitus ◽  
Family Medicine ◽  
Residency Training ◽  
Medical Management ◽  
Demographic Data ◽  
Significant Proportion ◽  
Psychiatry Residents ◽  
Training Curriculum ◽  
Cross Sectional Survey ◽  
Family Medicine Residents

Abstract Background Psychiatry and Family Medicine residents frequently see patients with comorbid mental and physical disorders. Little is known about the difference in knowledge of Psychiatry residents and Family Medicine residents regarding management of common conditions they encounter. This study aimed to assess the knowledge of Psychiatry and Family Medicine residents regarding medical management of schizophrenia, hypertension, diabetes mellitus, and dyslipidemia, as the findings could help to refine the training curriculum for residency training. Methods A cross-sectional survey design was used. Psychiatry and Family Medicine residents pursuing their residency in Singapore were recruited from November 2019 to June 2020. The survey questionnaire consisted of questions which assessed the knowledge regarding medical management of schizophrenia, hypertension, diabetes mellitus, and dyslipidemia. Descriptive statistics were used to describe the demographic data; T-tests or Mann-Whitney U tests to compare the differences between groups; and multiple regression analyses to assess the factors associated with Psychiatry residents’ knowledge of hypertension, diabetes mellitus, and dyslipidemia. Results Fifty-seven out of 70 (81.4%) Psychiatry residents and 58 out of 61 (95.1%) Family Medicine residents participated in the study. The majority of Psychiatry residents encountered patients with hypertension (93.0%), diabetes mellitus (87.7%) and dyslipidemia (91.2%) on a daily to weekly basis. Psychiatry residents had higher scores on questions about schizophrenia versus Family Medicine residents (mean 50.70 versus 43.28, p < 0.001). However, Psychiatry residents scored lower on questions about hypertension (mean 33.86 versus 40.98, p < 0.001), diabetes mellitus (mean 45.68 versus 49.79, p = 0.005) and dyslipidemia (mean 37.04 versus 44.31, p < 0.001). Receiving undergraduate medical education locally, compared to receiving it overseas, was associated with better knowledge of hypertension (beta = 0.515, p = 0.009) and dyslipidemia (beta = 0.559, p = 0.005); while younger age (26–30 versus > 35 and 31–35 versus > 35) was associated with better knowledge of hypertension (beta = 1.361, p = 0.002 and beta = 1.225, p = 0.003). A significant proportion of Psychiatry residents (61.4%) did not agree that the training provided to manage hypertension, diabetes mellitus, and dyslipidemia was adequate. Similarly, majority of Family Medicine residents (62.1%) did not agree that they had adequate training to manage schizophrenia. Conclusions This study raises the awareness of Psychiatry residents’ sense of discomfort in managing hypertension, diabetes mellitus, or dyslipidemia and conversely Family Medicine residents in management of schizophrenia, which can be further addressed during the training postings within the residency programs. Future studies are needed to look at local (such as training curriculum) and systemic factors (such as practice trends and culture) in order to better align residency selection criteria and training foci with real world practice factors over time.

scholarly journals Assessing and Documenting the Cognitive Performance of Family Medicine Residents Practicing Outpatient Medicine

2014 ◽  
Vol 6 (3) ◽  
pp. 526-531 ◽  
Author(s):  
Allen F. Shaughnessy ◽  
Katherine T. Chang ◽  
Jennifer Sparks ◽  
Molly Cohen-Osher ◽  
Joseph Gravel
Keyword(s):  
Family Medicine ◽  
Cognitive Performance ◽  
Cognitive Skills ◽  
Medical Knowledge ◽  
Time Consistency ◽  
Faculty Members ◽  
Knowledge Domain ◽  
Ambulatory Medicine ◽  
The Individual ◽  
Over Time

Abstract Background Development of cognitive skills for competent medical practice is a goal of residency education. Cognitive skills must be developed for many different clinical situations. Innovation We developed the Resident Cognitive Skills Documentation (CogDoc) as a method for capturing faculty members' real-time assessment of residents' cognitive performance while they precepted them in a family medicine office. The tool captures 3 dimensions of cognitive skills: medical knowledge, understanding, and its application. This article describes CogDoc development, our experience with its use, and its reliability and feasibility. Methods After development and pilot-testing, we introduced the CogDoc at a single training site, collecting all completed forms for 14 months to determine completion rate, competence development over time, consistency among preceptors, and resident use of the data. Results Thirty-eight faculty members completed 5021 CogDoc forms, documenting 29% of all patient visits by 33 residents. Competency was documented in all entrustable professional activities. Competence was statistically different among residents of different years of training for all 3 dimensions and progressively increased within all residency classes over time. Reliability scores were high: 0.9204 for the medical knowledge domain, 0.9405 for understanding, and 0.9414 for application. Almost every resident reported accessing the individual forms or summaries documenting their performance. Conclusions The CogDoc approach allows for ongoing assessment and documentation of resident competence, and, when compiled over time, depicts a comprehensive assessment of residents' cognitive development and ability to make decisions in ambulatory medicine. This approach meets criteria for an acceptable tool for assessing cognitive skills.

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