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Campbell KM, Schlag KE, Oni K, Amaechi O, Foster KE, Walcher C, Porterfield L. Overcoming Mission Competition in Departments of Family Medicine. Fam Med 2024; 56:5-8. [PMID: 38055852 PMCID: PMC10836619 DOI: 10.22454/fammed.2023.564792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Departments of family medicine are centered around the tripartite mission of education, research, and clinical care. Historically, these three missions have been balanced and interdependent; however, changes in the funding and structures of health systems have resulted in shrinking education and research missions and an increased emphasis on clinical care. In the wake of waning state and federal contributions to primary care research, many departments of family medicine have adopted a private practice approach. This approach is centered on generating revenue for the institution, incentivizing physicians to remain clinically focused through productivity and intense attention to volume targets. As a department's focus shifts to the clinical care mission, education and research are increasingly neglected and underresourced. Meanwhile, the administrative burden of electronic health records (EHRs) has further encroached on time previously allocated to research, with the EHR burden disproportionately affecting the primary care workforce. To counteract mission competition in departments of family medicine and to recover the vital missions of education and scholarship, devising a clear plan for reclaiming and sustaining a tripartite mission is important. Advocating for increased primary care research funding, enhancing EHRs, balancing clinical and education metrics, and supporting primary care research, especially for groups underrepresented in medicine, are interventions to help fully support education and research missions and to recover and sustain mission balance in departments of family medicine.
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Affiliation(s)
- Kendall M Campbell
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX
| | - Karen E Schlag
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX
| | - Keyona Oni
- Department of Family Medicine, Atrium Health-Carolinas Medical Center, Charlotte, NC
| | - Octavia Amaechi
- Spartanburg Regional Family Medicine Residency Program, Medical University of South Carolina Area Health Education Consortium, Spartanburg, SC
| | - Krys E Foster
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Christen Walcher
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX
| | - Laura Porterfield
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX
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Seidenberg P, Shokar N, Vera J, Weidner A, Sutter J. A 5-YEAR UPDATE ON THE BUILDING RESEARCH CAPACITY INITIATIVE. Ann Fam Med 2021; 19:471-472. [PMID: 34546960 PMCID: PMC8437568 DOI: 10.1370/afm.2746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Ponka D, Coffman M, Fraser-Barclay KE, Fortier RDW, Howe A, Kidd M, Lennon RP, Madaki JKA, Mash B, Mohd Sidik S, van Weel C, Zawaly K, Goodyear-Smith F. Fostering global primary care research: a capacity-building approach. BMJ Glob Health 2021; 5:bmjgh-2020-002470. [PMID: 32624501 PMCID: PMC7337619 DOI: 10.1136/bmjgh-2020-002470] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 01/15/2023] Open
Abstract
The Alma Ata and Astana Declarations reaffirm the importance of high-quality primary healthcare (PHC), yet the capacity to undertake PHC research—a core element of high-quality PHC—in low-income and middle-income countries (LMIC) is limited. Our aim is to explore the current risks or barriers to primary care research capacity building, identify the ongoing tensions that need to be resolved and offer some solutions, focusing on emerging contexts. This paper arose from a workshop held at the 2019 North American Primary Care Research Group Annual Meeting addressing research capacity building in LMICs. Five case studies (three from Africa, one from South-East Asia and one from South America) illustrate tensions and solutions to strengthening PHC research around the world. Research must be conducted in local contexts and be responsive to the needs of patients, populations and practitioners in the community. The case studies exemplify that research capacity can be strengthened at the micro (practice), meso (institutional) and macro (national policy and international collaboration) levels. Clinicians may lack coverage to enable research time; however, practice-based research is precisely the most relevant for PHC. Increasing research capacity requires local skills, training, investment in infrastructure, and support of local academics and PHC service providers to select, host and manage locally needed research, as well as to disseminate findings to impact local practice and policy. Reliance on funding from high-income countries may limit projects of higher priority in LMIC, and ‘brain drain’ may reduce available research support; however, we provide recommendations on how to deal with these tensions.
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Affiliation(s)
- David Ponka
- Besrour Centre for Global Family Medicine, College of Family Physicians of Canada, Mississauga, Ontario, Canada .,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Megan Coffman
- Robert Graham Center Policy Studies in Family Medicine and Primary Care, Washington DC, District of Columbia, USA
| | | | - Richard D W Fortier
- General Practice, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand.,Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Amanda Howe
- Primary Care, University of East Anglia Norwich Medical School, Norwich, Norfolk, UK
| | - Michael Kidd
- Department of Family and Community Medicine, University of Toronto, Canada and Southgate Institute for Health, Toronto, Ontario, Canada
| | - Robert P Lennon
- Family and Community Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Jeremiah K A Madaki
- Family Medicine, University of Jos, Jos, Plateau, Nigeria.,Family Medicine, Jos University Teaching Hospital, Jos, Plateau, Nigeria
| | - Bob Mash
- Family and Emergency Medicine, Stellenbosch University, Cape Town, South Africa.,Stellenbosch University, Cape Town, South Africa
| | - Sherina Mohd Sidik
- Psychiatry, Universiti Putra Malaysia Faculty of Medicine and Health Sciences, Serdang, Selangor, Malaysia
| | - Chris van Weel
- Department Primary and Community Care, Radboud Universiteit Nijmegen, Nijmegen, The Netherlands.,Department of Health Services Research and Policy, Australian National University, Acton, Australian Capital Territory, Australia
| | - Kristina Zawaly
- Family Medicine, McGill University, Montreal, Quebec, Canada.,General Practice and Primary Health Care, The University of Auckland, Auckland, New Zealand
| | - Felicity Goodyear-Smith
- General Practice, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
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Liaw W, Bazemore AW, Ewigman B, Turin TC, McCorry D, Petterson S, Dovey SM. Advancing bibliometric assessment of research productivity: an analysis of US Departments of Family Medicine. J Prim Health Care 2021; 12:149-158. [PMID: 32594982 DOI: 10.1071/hc19098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 02/24/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Measurement of family medicine research productivity has lacked the replicable methodology needed to document progress. AIM In this study, we compared three methods: (1) faculty-to-publications; (2) publications-to-faculty; and (3) department-reported publications. METHODS In this cross-sectional analysis, publications in peer-reviewed, indexed journals for faculty in 13 US family medicine departments in 2015 were assessed. In the faculty-to-publications method, department websites to identify faculty and Web of Science to identify publications were used. For the publications-to-faculty method, PubMed's author affiliation field were used to identify publications, which were linked to faculty members. In the department-reported method, chairs provided lists of faculty and their publications. For each method, descriptive statistics to compare faculty and publication counts were calculated. RESULTS Overall, 750 faculty members with 1052 unique publications, using all three methods combined as the reference standard, were identified. The department-reported method revealed 878 publications (84%), compared to 616 (59%) for the faculty-to-publications method and 412 (39%) for the publication-to-faculty method. Across all departments, 32% of faculty had any publications, and the mean number of publications per faculty was 1.4 (mean of 4.4 per faculty among those who had published). Assistant Professors, Associate Professors, Professors and Chairs accounted for 92% of all publications. DISCUSSION Online searches capture a fraction of publications, but also capture publications missed through self-report. The ideal methodology includes all three. Tracking publications is important for quantifying the return on our discipline's research investment.
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Affiliation(s)
- Winston Liaw
- Robert Graham Center, Policy Studies in Family Medicine and Primary Care, Washington DC, USA; and Department of Health Systems and Population Health Sciences, University of Houston, College of Medicine, Houston, TX 77204, USA; and Corresponding author.
| | - Andrew W Bazemore
- American Board of Family Medicine in Lexington, Kentucky, USA; and Center for Professionalism and Value in Health Care in Washington, DC, USA
| | - Bernard Ewigman
- Department of Family Medicine, University of Chicago & NorthShore University Health System, Chicago, IL 60637, USA
| | | | - Daniel McCorry
- Reid Hospital and Health Care Services, Richmond, Indiana, USA
| | - Stephen Petterson
- Robert Graham Center, Policy Studies in Family Medicine and Primary Care, Washington DC, USA
| | - Susan M Dovey
- Royal New Zealand College of General Practitioners, Wellington, New Zealand
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Mullen R, Weidner A, Liaw W, Mainous AG, Hester CM, Goodyear-Smith F, Nease D, Schneider D, Ewigman B. Family medicine research capacity in the USA. Fam Pract 2021; 38:187-189. [PMID: 33159206 DOI: 10.1093/fampra/cmaa119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rebecca Mullen
- Department of Family Medicine, University of Colorado, Denver, CO, USA
| | - Amanda Weidner
- Association of Department of Family Medicine, Leawood, KS, USA.,Family Medicine Residency Network, University of Washington School of Medicine, Seattle, WA, USA
| | - Winston Liaw
- Department of Health Systems and Population Health Sciences, University of Houston College of Medicine, Houston, TX, USA
| | - Arch G Mainous
- Department of Community Health and Family Medicine and Department of Health Services Research, Management and Policy University of Florida, Gainesville, FL, USA
| | | | - Felicity Goodyear-Smith
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Donald Nease
- Department of Family Medicine, University of Colorado, Denver, CO, USA
| | - David Schneider
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bernard Ewigman
- NorthShore University HealthSystem, Department of Family Medicine, University of Chicago, Chicago, IL, USA
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Rollins LK. Enhancing your scholarship as a family medicine junior faculty member. Fam Med Community Health 2020; 8:fmch-2020-000426. [PMID: 32859643 PMCID: PMC7462150 DOI: 10.1136/fmch-2020-000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Family medicine faculty are often expected to produce some form of scholarship as members of academic departments. However, this can be challenging given a range of contextual factors, including limited research capacity in many departments, increased competition for funding and individual challenges around balancing multiple roles, unclear expectations and lack of mentorship, to name a few. The purpose of this reflection is to discuss seven content areas that might be addressed by faculty in order to promote scholarship, particularly among junior faculty. These include: 1) knowing your academic track and its associated expectations by rank, as well as the scholarship expectations within your department; 2) considering your personal goals, interests, professional development needs and the relationship between meaningful work and burnout; 3) starting small and building towards a niche content area; 4) finding collaborators and the benefits of collaboration; 5) seeking alignment between your scholarship and work that you already are performing; 6) educating yourself about available outlets for scholarship and 7) seeking mentorship.
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Affiliation(s)
- Lisa K Rollins
- Department of Family Medicine, University of Virginia, Charlottesville, Virginia, USA
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Slattengren AH, Finstad D, Pitt MB. Personal Manuscript Acceptance Rates: Metrics for Self-assessment in Scholarship. PRIMER : PEER-REVIEW REPORTS IN MEDICAL EDUCATION RESEARCH 2020; 3:25. [PMID: 32537596 DOI: 10.22454/primer.2019.834349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction There is no established baseline for how frequently clinical researchers personally encounter manuscript rejection, making it difficult for faculty to put their own evolving experience in context. The purpose of this study was to determine the feasibility of obtaining personal acceptance per submission (APS) and acceptance per manuscript (APM) rates for individual faculty members. Methods We performed a cross-section survey pilot study of clinical faculty members of two departments (family medicine and pediatrics), in one academic health center in the academic year 2017-2018. The survey asked participants to report the number of attempted submissions required per journal article they have had accepted in the prior 2 years as well as any submissions that did not lead to publication. Results Sixty-eight of 136 eligible faculty (50%) completed the questionnaire. Academic clinicians in the sample eventually published 80% of the manuscripts submitted, with 39% of papers rejected per submission attempt. Associate professors had the highest APS (0.71) and APM (0.88). Conclusions In this pilot, we demonstrated the feasibility of retrospectively collecting data that could identify baseline manuscript acceptance rates and were able to generate department averages and rank specific averages for manuscript acceptance and rejection. We confirmed that rejection is common among academic clinicians. The APS and APM can be used by academic clinicians to track their own progress from day one of their publishing careers as a method of self-assessment, rather than having to wait for citations to accumulate.
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Affiliation(s)
- Andrew H Slattengren
- Department of Family Medicine and Community Health, University of Minnesota, North Memorial Family Medicine Residency
| | - Deborah Finstad
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | - Michael B Pitt
- Department of Pediatrics, University of Minnesota, Minneapolis, MN
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Abstract
Although the generation of new knowledge through research is a hallmark of medical specialties, research was a low priority in family practice when it was established in 1969. Today, when a base of knowledge is crucial to the ability to lead health care change, the early relationship between family practice and research continues to influence the specialty. An examination of archival and secondary materials finds that the priority placed on research during family practice's early years was shaped by internal and external factors, including, (1) family physicians' desire to differentiate themselves from the prevailing specialty environment; (2) lack of a clear identity in family practice; (3) the non-laboratory nature of family medicine research; (4) reliance on information from other specialties; and, (5) a focus on establishing an academic presence. The low level of attention given to research during the early years of family practice has had lasting implications, as the specialty seeks to transform practice while continuing to struggle to achieve academic acceptance. A strong culture of generalist knowledge is crucial in assuring family medicine's future and strengthening its ability to improve the health of individuals, families, and communities.
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Seehusen DA, Mainous AG, Chessman AW. Creating a Centralized Infrastructure to Facilitate Medical Education Research. Ann Fam Med 2018; 16:257-260. [PMID: 29760031 PMCID: PMC5951256 DOI: 10.1370/afm.2228] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/01/2017] [Accepted: 11/29/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Building research capacity and increasing scholarly productivity are identified needs of the specialty of family medicine. The Accreditation Council for Graduate Medical Education (ACGME) has increased the scholarly requirements for residency programs, placing even more pressure on faculty to be productive in the scholarly realm. The Council of Academic Family Medicine Educational Research Alliance (CERA) was created by volunteer members of the specialty with shared interests in overcoming barriers and increasing scholarly production. METHODS CERA has developed the infrastructure and expertise to regularly conduct omnibus surveys of key family medicine educational leaders. Proposals are centrally collected and competitively chosen. The omnibus survey process includes collaboration with experienced mentors, centralized institutional review board clearance, pilot testing, and centralized data collection. The survey results are disseminated back to research teams for presentation and publication of the findings. RESULTS To date, over 115 research teams have had their projects included in CERA omnibus surveys. Projects have been led by research teams from across the country and with a wide variety of research experience. This collaborative work has resulted in more than 75 scientific presentations and over 55 peer-reviewed papers in the medical literature. The raw data are now available online and serve as a repository for future secondary analysis and as an educational resource. CONCLUSIONS The CERA infrastructure has allowed a large number of research teams to conduct meaningful scholarship at a fraction of the typical cost in terms of time and energy. CERA has expanded family medicine research by removing barriers for teams with limited experience or resources.
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Affiliation(s)
| | - Arch G Mainous
- Department of Health Services Research, Management & Policy, University of Florida, Gainesville, Florida.,Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
| | - Alexander W Chessman
- Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina
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Bowman MA, Lucan SC, Rosenthal TC, Mainous AG, James PA. Family Medicine Research in the United States From the late 1960s Into the Future. Fam Med 2017; 49:289-295. [PMID: 28414408 PMCID: PMC5407380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
When the new field of family medicine research began a half century ago, multiple individuals and organizations emphasized that research was a key mission. Since the field's inception, there have been notable research successes for which family medicine organizations, researchers, and leaders-assisted by federal and state governments and private foundations-can take credit. Research is a requirement for family medicine residency programs but not individual residents, and multiple family medicine departments offer research training in various forms for learners at all levels, including research fellowships. Family physicians have developed practice-based research networks (PBRNs) to conduct investigations and generate new knowledge. The field of family medicine has seen the creation of new journals to support the publication of research relevant to practicing family physicians. Nonetheless, in spite of much growth and many successes, family physicians and their research have been underrepresented in research funding. Clinical presentations in family medicine are often complex, poorly-differentiated, and exist as one of several patient complaints and diagnoses, and are not well-covered by the narrow basic-science and specialty research that defines most of the biomedical research enterprise. Overall health in the United States would benefit from a more robust research participation and greater support for family medicine research.
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Affiliation(s)
- Marjorie A Bowman
- Departments of Family Medicine and Population and Public Health Sciences, Boonshoft School of Medicine
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