HIV Preexposure Prophylaxis Training in Family Medicine Residencies: A National Survey

Background and Objectives: Preexposure prophylaxis (PrEP) reduces HIV transmission among high-risk individuals. Yet, the HIV epidemic continues to expand among marginalized populations and America’s Southeastern states. Various barriers remain to PrEP uptake, namely provider knowledge and education. We sought to investigate residency training, competency, and prescribing of PrEP among population size. Additionally, we asked program directors to identify barriers to PrEP. Methods: We surveyed family medicine program directors as part of the Council of Academic Family Medicine Educational Research Alliance survey from January 2018 through February 2018. Results: Our survey questions had a 52.9% (276/522) response rate. No programs in rural communities less than 30,000 population (0/27) reported significant PrEP training for their residents; those in nonrural communities of at least 30,000 reported this training more frequently (41/246, 16.7%). Compared to Fischer expected values, the finding was statistically significant (P=.019); using a 75,000 population demarcation lowered significance (P=.192). We found programs that identify significant PrEP training also cite more PrEP prescribing within their practice (OR 7.27, P<.001). Programs with significant training also report their residents graduate with greater PrEP competency (OR 18.33, P<.001). The largest barriers identified were faculty expertise, not having enough high-risk patients, inadequate screening, and resident knowledge/training. Conclusions: We identified natural associations between increased training in PrEP and perceived PrEP competencies. We identified a lack of significant PrEP training and associated PrEP competencies in rural residency programs. Barriers identified in this study can help inform curricular needs to improve primary care workforce capacity to lower HIV risk.

Evaluation of a Musculoskeletal Ultrasound Workshop in the Family Medicine Clerkship

Background and Objectives: The family medicine (FM) clerkship is appropriate for incorporating musculoskeletal ultrasound (MSKUS) education, as many outpatient visits in primary care occur for musculoskeletal (MSK) concerns. Despite rising popularity of point-of-care imaging in primary care, ultrasound (US) training in medical education is limited due to lack of resources and time. The purpose of this study is to evaluate the effects of an MSKUS workshop in the FM clerkship through student self-evaluations. Methods: Seventy-five medical students enrolled in the FM clerkship during the 2019-2020 academic year participated in hands-on MSKUS workshops staffed by faculty, residents, and a fellow. Workshops coincided with FM residency didactic teaching, allowing for protected time to host US training. Of workshop participants, 98.6% completed both pre- and postworkshop evaluations assessing confidence and acceptability of the workshop (rated on a 0-10 Likert scale, where higher scores represent more confidence or greater benefit, respectively). Results: Students noted increased confidence with use of ultrasound, recognition of MSK structures, and performance of landmark-guided procedures (preworkshop 2.6±1.6; postworkshop 7.4±1.1). Students endorsed high levels of agreement in the benefit of the workshop to their education (9.4±1.3) and MSK understanding (9.4±1.2). Conclusions: This study demonstrates the benefit of an MSKUS workshop as part of the FM clerkship and addresses previously identified challenges to providing US education. Results suggest a short-term benefit from an MSKUS workshop in confidence in MSKUS knowledge and satisfaction with the curriculum.

Students of Change: Health Policy in Action

Background and Objectives: Health policy is more impactful for public health than many other strategies as it can improve health outcomes for an entire population. Yet in the “see one, do one, teach one” environment of medical school, most students never get past the “see one” stage in learning about the powerful tools of health policy and advocacy. The University of New Mexico School of Medicine mandates health policy and advocacy education for all medical students during their family medicine clerkship rotation. The aim of this project is to describe a unique health policy and advocacy course within a family medicine clerkship. Methods: We analyzed policy briefs from 265 third-year medical students from April 2016 through April 2019. Each brief is categorized by the level of change targeted for policy reform: national, state, city, or university/school. Implemented policies are described. Results: Slightly less than one-third of the policies (30%) relate to education, 36% advocate for health system change by addressing cost, access, or quality issues, and 34% focus on public health issues. Fourteen policies have been initiated or successfully enacted. Conclusions: This curriculum gives each medical student a health policy tool kit with immediate opportunities to test their skills, learn from health policy and advocacy experts, and in some cases, implement health policies while still in medical school. A 1-week family medicine policy course can have impact beyond the classroom even during medical school, and other schools should consider this as a tool to increase the impact of their graduates.