To Post or Not to Post: Does Applicants’ Social Media Affect Family Medicine Resident Recruitment?

Background and Objectives: Current literature on review of applicant social media (SoMe) content for resident recruitment is scarce. With the recent increase in the use of privacy settings, and the cost of the recruitment process, the aim of this study was to describe the practice and outcomes of review of applicant SoMe in resident recruitment and its association with program director or program characteristics. Methods: This study was part of the 2020 Council of Academic Family Medicine’s Educational Research Alliance (CERA) annual survey of family medicine residency program directors (PDs) in the United States. Results: The overall response rate for the survey was 39.8% (249/626). About 40% of PDs reported reviewing applicant SoMe content. The majority (88.9%) of programs did not inform applicants of their SoMe review practices. The most common findings of SoMe review were that the content raised no concerns (38/94; 40.4%) or was consistent with the application material (34/94; 36.2%). Forty PDs (17.0%) have ever moved an applicant up or down the rank list based on SoMe review. Review of applicant SoMe was not statistically associated with program size, program type, PD age, PD SoMe use, or program SoMe use. Conclusions: SoMe review has not become routine practice in family medicine resident recruitment. The outcome of SoMe review was mostly consistent with the applicant profile without any concerns and only very few changed the ranking order. This calls for more studies to explore the value of SoMe review for resident selection regarding its effect on future performance.

A Longitudinal Study of Burnout and Well-being in Family Medicine Resident Physicians

Background and Objectives: The Accreditation Council for Graduate Medical Education (ACGME) core competencies for residency learning and work environment standards acknowledge high levels of burnout and depression in resident physicians and the critical importance of physician well-being to patient care and effective education. The objective of this study was to follow family medicine resident physicians’ well-being throughout residency. Methods: Family medicine resident physicians from 12 programs completed validated assessments (burnout, depression, perceived stress, satisfaction with life, positive and negative affect, emotional intelligence, mindfulness, gratitude) at residency start, second year start, and graduation. Resident physicians were from the 2011, 2012, and 2013 graduating classes (N=158). Results: Two indicators of burnout (emotional exhaustion, depersonalization) increased between the start of residency and the start of the second year, remaining elevated at graduation. Emotional intelligence was lower at graduation than at the start of residency. In contrast, other measures of well-being (stress, life satisfaction, affect) improved during the second and third years. Depression, mindfulness, and gratitude remained stable. Increased levels of burnout risk at graduation were negatively associated with emotional intelligence, mindfulness, and gratitude. Conclusions: While the stressful impact of residency is transitory for some measures of well-being, that is not the case for burnout or emotional intelligence. Burnout levels peak after the first year of residency and remain high through graduation. Targeted interventions to identify and address burnout in residency need to be evaluated in future studies.

Integrating Buprenorphine Treatment Into Family Medicine Resident Clinic

Background and Objectives: Medication-assisted treatment (MAT) for opioid use disorder with buprenorphine in primary care is effective and patient-accessible yet remains underutilized, including among residency training programs. One concern in residency programs is that MAT patients must be seen at least monthly and will overwhelm residents’ clinic schedules and dilute their clinical experience. Our family medicine residency initiated an MAT program integrated into residents’ continuity clinic schedules. After 2 years we assessed the chronic medical comorbidities we were managing in our MAT population.Methods: We performed a retrospective review of all active patients receiving MAT. We collected basic demographic data and whether we were the patient’s primary care provider (PCP) or were only providing MAT. For the patients for whom we were the PCP we recorded the chronic comorbidities that required medical management.Results: One hundred fifty-seven active patients were 52% male and 48% female. The mean age was 38 years (SD=10) with a range of 22 to 77 years, with nine patients over age 60 years (6%). One hundred three patients used us as their PCP (66%). For these patients the mean number of chronic comorbidities was 2.3; only 10 patients reported no comorbidities. Psychiatric comorbidities were the most common with 69% of patients with a mood disorder, although nonpsychiatric comorbidities still averaged 1.5 per patient.Conclusions: MAT integrated into family medicine resident continuity clinics provides a broad and substantial primary care clinical experience for residents.

Keeping the Family in Family Medicine

In this personal reflection, as a Family Medicine resident at an Academic Center in Northeast Florida, as well as being a chronic illness patient myself, I explore the notion of dying alone and away from family. Although COVID-19 has changed the practice of medicine in many ways, prior to that, and before the instillation of hospital no-visitor policies and stay at home orders, I experienced a case of a patient dying alone in the hospital. These chronicles that case and the impact it had on me afterward in regard to my own family and how I hope the future of medicine can address this.