PRiMER (Leawood, Kan.)最新文献

{"title":"Exploring the Applications of ChatGPT in Family Medicine Education: Five Innovative Ways for Faculty Integration.","authors":"Karim Hanna","doi":"10.22454/PRiMER.2023.985351","DOIUrl":"https://doi.org/10.22454/PRiMER.2023.985351","url":null,"abstract":"","PeriodicalId":74494,"journal":{"name":"PRiMER (Leawood, Kan.)","volume":"7 ","pages":"26"},"PeriodicalIF":0.0,"publicationDate":"2023-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544634/pdf/primer-7-26.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41167620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opportunities and Barriers to Screening and Counseling for Safe Firearm Storage.","authors":"Grace Owens,&nbsp;Anh Nguyen,&nbsp;Paul Hershberger,&nbsp;Katharine Conway,&nbsp;Timothy Crawford","doi":"10.22454/PRiMER.2023.953811","DOIUrl":"https://doi.org/10.22454/PRiMER.2023.953811","url":null,"abstract":"<p><strong>Objectives: </strong>Safety practices such as storing a firearm locked and unloaded are widely promoted although not universally applied. Educating patients about firearm safety practices is effective in increasing safe firearms storage behaviors; however, screening for safe firearm storage in practice remains low. The aim of this study was to evaluate whether our clinic population was at risk for firearm-related injuries and whether opportunities existed to study risk-mitigation interventions in future work.</p><p><strong>Methods: </strong>The study was conducted at a suburban, midwestern academic family medicine clinic. Patients filled out paper surveys about firearm ownership and willingness to discuss firearms safety with clinicians. Health care personnel filled out paper or electronic surveys about their comfort level in discussing firearm safety with patients. Data then were collated and analyzed.</p><p><strong>Results: </strong>We surveyed 160 patients (60% female, 80% White), and 40.6% of respondents reported living in a home with a firearm. Respondents who stored their firearm unsafely were more willing to discuss firearm safety than to change their storage behavior. Eighteen health care personnel responded to our health care personnel survey. Perceived barriers to asking about firearms included lack of time, knowledge, or educational materials. Having a screening policy was selected as the best opportunity for improvement.</p><p><strong>Conclusions: </strong>Firearm owners appear willing to discuss firearm safety with their clinician, potentially representing an opportunity to promote risk-reduction through approaches such as motivational interviewing. In a busy outpatient setting, automating the firearm screening process could lessen the burden on clinicians.</p>","PeriodicalId":74494,"journal":{"name":"PRiMER (Leawood, Kan.)","volume":"7 ","pages":"22"},"PeriodicalIF":0.0,"publicationDate":"2023-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544631/pdf/primer-7-22.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41175119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practice Impact of a Dedicated LGBTQ+ Clinical Exposure During Residency.","authors":"Joel Amidon,&nbsp;Shannon Stark Taylor,&nbsp;Sarah Hinton","doi":"10.22454/PRiMER.2023.329607","DOIUrl":"https://doi.org/10.22454/PRiMER.2023.329607","url":null,"abstract":"<p><strong>Background and objectives: </strong>An increased focus on lesbian, gay, bisexual, transgender, queer (LGBTQ+) care in graduate medical education is needed to address health disparities in this patient population. This study assessed practice confidence and practice intentions of residents who rotated through an LGBTQ+ clinic during their residency.</p><p><strong>Methods: </strong>Residents completed three to eight half-day sessions in a dedicated LGBTQ+ clinic focusing on primary care, pre-exposure prophylaxis (PrEP), and gender-affirming care from 2019 to 2022. Prior to this clinical experience, they were provided background reading materials, care guidelines, and clinical cases. Residents were electronically surveyed at two time points after completing this clinical experience to retrospectively assess their pre-and postcurricular confidence.</p><p><strong>Results: </strong>Seventeen out of 18 (94%) residents who completed the curricular experience responded to the initial survey, which showed statistically significant differences between reported pre- and postcurricular confidence in providing primary care, PrEP, and gender affirmation care. Eight-eight percent of residents reported that they planned to or have already incorporated this care into their practice. In a follow-up survey 1 year later, 15 out of 18 (83%) responded, reporting consistent skills confidence. Seventy-one percent of participants reported currently providing LGBTQ+ care. We noted no statistical difference between the initial postconfidence survey and the follow-up survey.</p><p><strong>Conclusion: </strong>This study demonstrated positive associations between a focused curricular experience in LGBTQ+ care and both confidence providing LGBTQ+ care and planned and actual postgraduation practice patterns.</p>","PeriodicalId":74494,"journal":{"name":"PRiMER (Leawood, Kan.)","volume":"7 ","pages":"24"},"PeriodicalIF":0.0,"publicationDate":"2023-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544642/pdf/primer-7-24.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41169861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bystander Responses to Bullying and Harassment in Medical Education.","authors":"Danielle L Terry,&nbsp;Gabrielle Safian,&nbsp;Christopher Terry,&nbsp;Kajal Vachharajani","doi":"10.22454/PRiMER.2023.805720","DOIUrl":"10.22454/PRiMER.2023.805720","url":null,"abstract":"<p><strong>Background and objectives: </strong>Bullying and harassment in medical education are common. The aims of this study were (a) to describe how medical trainees respond to harassment or bullying in medical settings, and (b) to determine whether trainees respond differently based on the type of harassment.</p><p><strong>Methods: </strong>Participants were medical students, residents, and fellows (N=80) recruited from a rural teaching hospital in Pennsylvania. We invited them to complete an electronic survey and react to four standardized situations that included common harassment types in graduate medical education.</p><p><strong>Results: </strong>On average, 31.6% reported that they would consult with peer colleagues, 50.6% would provide direct support to the victim, 16.3% would approach the perpetrator or intervene directly, and 19.3% would file a formal report with a supervisor or human resources. Findings indicated that respondents as bystanders would intervene significantly more often when harassment was related to inappropriate racial or ethnic comments.</p><p><strong>Conclusions: </strong>Given that a sizable portion of trainees would speak directly with a victim, training bystanders in strategies to address or mentor others on how to address harassment more effectively could be useful in graduate medical education. Future research might explore trainees' differential reactions to harassment types toward developing more comprehensive intervention programs in graduate and undergraduate medical education.</p>","PeriodicalId":74494,"journal":{"name":"PRiMER (Leawood, Kan.)","volume":"7 ","pages":"23"},"PeriodicalIF":0.0,"publicationDate":"2023-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10544639/pdf/primer-7-23.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41154761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy of Short, Skills-based Workshops in Teaching Advocacy to Medical Students: A Pilot Study.","authors":"Reice Robinson, Ranit Mishori","doi":"10.22454/PRiMER.2023.427789","DOIUrl":"10.22454/PRiMER.2023.427789","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study evaluated the effectiveness of a short, skills-based workshop, called a Letter-Writing Lunch (LWL), in teaching advocacy to medical students.</p><p><strong>Methods: </strong>We assessed political activity, political efficacy, civic responsibility, and skill mastery via pre-, post-, and 6-month follow-up surveys. Via semistructured follow-up interviews, we explored how the intervention affected the participant's view of advocacy.</p><p><strong>Results: </strong>Students mastered identifying and contacting their representatives. Participants' political activity scores demonstrated little to no political activity at baseline and were unchanged at 6 months. Political efficacy scores increased after the event (<i>t</i>[53]=8.5, <i>P</i><.001), and they remained elevated at 6 months (<i>t</i>[25]=2.1, <i>P</i>=.047). Feelings of civic responsibility significantly increased from the pre-to postsurvey (<i>z</i>=482.5, <i>P</i><.001), but returned to baseline by 6 months. Four themes emerged from the follow-up interviews: (a) A disconnect exists between what medical students believe their responsibilities are and what they are doing; (b) medical students believe their current advocacy curriculum lacks depth and applicability; (c) students want programming that is realistic in the context of their limited time, varying passions, and current skill level; and (d) the LWL changed students' views on advocacy.</p><p><strong>Conclusions: </strong>Current skills-based education is time-intensive and fails to engage students who are not already committed to developing advocacy skills. Keeping the LWL short in length successfully targeted students with little previous advocacy experience. The event increased political efficacy and civic responsibility while making advocacy appear more accessible. The LWL is an effective and efficient way to teach advocacy to medical students.</p>","PeriodicalId":74494,"journal":{"name":"PRiMER (Leawood, Kan.)","volume":"7 ","pages":"21"},"PeriodicalIF":0.0,"publicationDate":"2023-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10351431/pdf/primer-7-21.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9892133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-Care Ultrasound Attitudes, Barriers, and Current Use Among Family Medicine Residents and Practicing Physicians.","authors":"Alicia Ludden-Schlatter, Robin L Kruse, Reiana Mahan, Luke Stephens","doi":"10.22454/PRiMER.2023.967474","DOIUrl":"10.22454/PRiMER.2023.967474","url":null,"abstract":"<p><strong>Introduction: </strong>Point-of-care ultrasound (POCUS) has high interest among learners and educators, but many barriers inhibit training and clinical use. Interest and barriers may differ between educators, trainees, and practicing physicians. This study investigates interest in POCUS, confidence in POCUS skills, and barriers to POCUS use for residents, academic family physicians, and community providers.</p><p><strong>Methods: </strong>Online surveys sent to current residents, faculty, and graduates of an academic family medicine residency compared current use, comfort, training, perceived importance, barriers, and interest in future use of POCUS.</p><p><strong>Results: </strong>Most participants (95.6%) agreed that POCUS was somewhat or extremely important to family medicine. Most participants also reported interest in all POCUS indications, other than obstetrics. Very few (5.4%) reported being extremely comfortable using POCUS. Most residents were somewhat comfortable, whereas most faculty and graduates were not at all comfortable. A majority in each group reported inexperience with equipment and interpreting images as a barrier. One-third of faculty and graduates reported \"not billable\" as a barrier. Statistically significant differences were found between groups' reports of prior training, current use, and interest in POCUS for obstetrics.</p><p><strong>Conclusions: </strong>Family medicine residents, faculty, and community physicians reported high perceived importance of and interest in nonobstetric POCUS, but low comfort level in performing POCUS. Resident and faculty barriers may vary according to practice environment and differing time constraints. Senior faculty may have less POCUS training and comfort using POCUS than residents, highlighting the importance of continuing faculty education.</p>","PeriodicalId":74494,"journal":{"name":"PRiMER (Leawood, Kan.)","volume":"7 ","pages":"13"},"PeriodicalIF":0.0,"publicationDate":"2023-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10351427/pdf/primer-7-13.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9837672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of Continuing Medical Education in Tick-Borne Disease for Front-Line Providers.","authors":"Aaron C Malkowski, Robert P Smith, Douglas MacQueen, Emily M Mader","doi":"10.22454/PRiMER.2023.497812","DOIUrl":"10.22454/PRiMER.2023.497812","url":null,"abstract":"<p><strong>Introduction: </strong>Considering increasing rates of tick-borne diseases (TBDs) in the United States, we investigated the scope of continuing medical education (CME) available to physicians on these infections.</p><p><strong>Methods: </strong>We surveyed online medical board and society databases serving front-line primary and emergency/urgent care providers for the availability of TBD-specific CME between March 2022 and June 2022. We recorded and analyzed opportunity title, author, web address, publication year, learning objectives, CME credit values, and CME credit type.</p><p><strong>Results: </strong>We identified 70 opportunities across seven databases. Thirty-seven opportunities focused on Lyme disease; 17 covered nine non-Lyme TBDs, and 16 covered general topics on TBDs. Most activities were hosted through family medicine and internal medicine specialty databases.</p><p><strong>Conclusion: </strong>These findings suggest limited availability of continuing education for multiple life-threatening TBDs of increasing importance in the United States. Increasing the availability of CME materials covering the broad scope of TBDs in targeted specialty areas is essential for increased content exposure and a necessary step to ensure our clinical workforce is adequately prepared to address this growing public health threat.</p>","PeriodicalId":74494,"journal":{"name":"PRiMER (Leawood, Kan.)","volume":"7 ","pages":"497812"},"PeriodicalIF":0.0,"publicationDate":"2023-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9957445/pdf/primer-7-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10799983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality Improvement Capacity in a Department of Family Medicine: A Mixed-Methods Study.","authors":"Lauren Oshman,&nbsp;Taylor Walton,&nbsp;Paul Schultz,&nbsp;Robin Barry,&nbsp;Linda Speer","doi":"10.22454/PRiMER.2023.889614","DOIUrl":"https://doi.org/10.22454/PRiMER.2023.889614","url":null,"abstract":"<p><strong>Background and objectives: </strong>Quality improvement capacity is defined as ongoing commitment to sustained quality improvement (QI) and requires knowledge of QI methods and commitment to QI activities from practice leadership and staff. The aim of this project was to identify the major facilitators and barriers to developing quality improvement capacity in a teaching practice of a department of family medicine.</p><p><strong>Methods: </strong>We conducted an exploratory, sequential, mixed-methods study, inviting key informants to participate in qualitative interviews and then conducting a survey of faculty, resident physicians, and staff at a community residency teaching practice affiliated with an academic medical center in the Midwest United States.</p><p><strong>Results: </strong>Among 12 qualitative key informant interviewees, facilitators of QI capacity included a strong motivation to provide high-quality care and a desire to leverage team-based care in QI interventions. Barriers included competing clinical and educational priorities, lack of faculty expertise in quality and scholarship, and lack of infrastructure to turn QI into scholarship. The survey response rate was 75% (48 of 64 total team members). The most common motivation for participation in QI work was \"making a difference\" (41, 85%), while the biggest barriers were prioritization of patient care (25, 53%), and teaching (19, 40%).</p><p><strong>Conclusion: </strong>This mixed-methods study identified key barriers and facilitators to QI capacity, of which addressing competing priorities, improving QI training, and creating infrastructure for scholarship may improve QI capacity.</p>","PeriodicalId":74494,"journal":{"name":"PRiMER (Leawood, Kan.)","volume":"7 ","pages":"17"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10351432/pdf/primer-7-17.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10353115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Faculty and Resident Perspectives of the Complexity of Wellness Program Implementation: A Qualitative Exploration.","authors":"Jill Schneiderhan,&nbsp;Thomas Bishop,&nbsp;Timothy C Guetterman,&nbsp;Meg Dobson","doi":"10.22454/PRiMER.2023.413534","DOIUrl":"https://doi.org/10.22454/PRiMER.2023.413534","url":null,"abstract":"<p><strong>Introduction: </strong>Developing and implementing a wellness curriculum in a family medicine residency program is a complex process. We developed and implemented a new wellness curriculum in line with the national wellness conversation with a focus on the allocation of dedicated resources, the use of evidence-informed interventions, and the goal to be responsive to the feedback of both residents and residency leadership. Our research aim was to better understand the complexity of wellness curriculum implementation with a focus on identification of challenges to implementation.</p><p><strong>Methods: </strong>We developed a wellness program with structured curricular elements initially focused on evidence-informed skill development that iterated after year 1 to include more process-oriented elements. For the years 2016-2019 we collected and analyzed qualitative, open-ended survey questions, anonymous resident curriculum feedback, and faculty observation forms to assess resident and faculty perspectives on the new curriculum.</p><p><strong>Results: </strong>One hundred eighty-three survey invitations were sent with 122 total responses (66.7% response rate). Forty-eight of 56 residents responded to at least one survey. We analyzed responses along with the additional qualitative data that revealed several themes impacting the work of residency wellness curriculum implementation. These included how to manage curricular time, where the locus of control for the curricular content resides, and how residents and faculty differ in their definitions of wellness.</p><p><strong>Conclusions: </strong>We believe programs will be well positioned if they further investigate the complex structures at play that influence residency wellness, including both systemic factors and individual and community level interventions, and design curriculum that is well-defined, includes essential elements, and is informed by resident participation.</p>","PeriodicalId":74494,"journal":{"name":"PRiMER (Leawood, Kan.)","volume":"7 ","pages":"16"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10351434/pdf/primer-7-16.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9837668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Contraception Among Hispanic Women and Men: A Qualitative Study.","authors":"Elizabeth Scruggs,&nbsp;Katherine L Hughey,&nbsp;Laura Crespo Albiac,&nbsp;Evan Martin,&nbsp;Mikel Llanes","doi":"10.22454/PRiMER.2023.848258","DOIUrl":"https://doi.org/10.22454/PRiMER.2023.848258","url":null,"abstract":"<p><strong>Introduction: </strong>Nationally, low-income women of Hispanic ethnicity have a significantly higher rate of unintended pregnancy than their White counterparts. This disparity leads to an increased risk for poor maternal and child outcomes that have long and short-term sequelae for health and well-being. A quantitative report in Washtenaw County, Michigan in 2017 found that both men and women were at high risk for unintended pregnancy with many women reporting no contraception use, despite not desiring a pregnancy.</p><p><strong>Methods: </strong>We used semistructured interviews to assess the opinions and experiences regarding the use of contraception among 21 Hispanic women and men of reproductive age in a Midwestern county.</p><p><strong>Results: </strong>Our study found that the use of contraception to prevent unwanted pregnancy was important to our sample of Hispanic women and men. However, concerns about side effects, limited knowledge on reproductive health, the influence of partners, and financial barriers played a role in the use of contraception.</p><p><strong>Conclusion: </strong>Our findings provide insight into the influences and barriers to contraception use among Hispanic women and men and can inform future research.</p>","PeriodicalId":74494,"journal":{"name":"PRiMER (Leawood, Kan.)","volume":"7 ","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10121024/pdf/primer-7-11.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9740623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}