Training Residents to Work in a Patient-Centered Medical Home: What Are the Outcomes?

Residents’ Perception of the Educational Program “Family Medicine” in Kazakhstan: A Focus Group Study

Целью данного исследования было: восприятие обучения, мнение резидентов, обучающихся по программе «Семейная медицина», и определение потребности резидентов программы «Семейная медицина».   Методы . В этом качественном исследовании были проведены четыре полуторачасовых фокус-группы с 24 ординаторами, обучаемыми по программе резидентуры по семейной медицине Западно-Казахстанского университета, и результаты были проанализированы с использованием тематического анализа. Результаты. Анализ появления пяти тем и 14 вопросов подтем, которые были классифицированы по областям для обсуждения в фокус-группах: восприятие особенности ФМ, Мотивация доходов, Преимущества и внешний вид категории товаров, Жалобы и проблемы, пожелания по просмотру программ, идеальное значение имеют. Выводы. Это исследование выявления наличия жителей, которые ранее не учитывались в достаточной мере. Компетенции и содержание программы будут изменены в соответствии с назначением резидентов.

Factors Associated with a Career in Primary Care Medicine: Continuity Clinic Experience Matters

BACKGROUND

Due to concerns of inadequate primary care access, national agencies like the Health Resources and Services Administration (HRSA) support primary care (PC) residencies. Recent research demonstrates that up to 35% of PC alumni lost interest in PC during residency. These alumni who lost interest noted that their continuity clinic experience influenced their career choice. The purpose of this study was to identify the specific aspects of PC residency experience that influenced career choice.

METHODS

We conducted a cross-sectional electronic survey of a PC internal medicine alumni cohort (2000-2015) from a large, academic residency. Our primary predictor was PC career and our primary outcome was influential factors on career choice. We performed chi-squared or Fisher's exact tests for categorical variables and t tests for continuous variables.

RESULTS

Of the 317 PC alumni in the last 15 years, 305 were contacted. One hundred seventy-two (56%) responded with 94 (55%) reporting current careers in PC and 78 (45%) in non-PC fields. Ninety-four percent of respondents expressed interest prior to residency, while only 68% remained interested at the conclusion of residency. Sixty-one percent of PC alumni rated the overall clinic experience as the most influential factor towards their ultimate career choice. The patient-physician relationship was the most frequently endorsed positively influential factor in career choice in both groups (95% of PC alumni, 76% non-PC). There was no difference among all alumni in common frustrations of clinic including clerical duties, encounter documentation, or visit length. Similarly, resident debt did not differ between groups.

CONCLUSIONS

Strong interpersonal relationships with patients and clinic mentors were associated with a PC career. These factors may compensate for the reported frustrations of clinic. Enhancing patient and mentor relationships may increase the retention of PC residents in ambulatory careers and may help address the current and projected shortage of primary care physicians.

The Development of a Video Intervention to Improve Senior Medical Students' Performance on Outpatient Telephone Encounters: a Delphi Analysis and Randomized Controlled Trial

Introduction

Postgraduate trainees address outpatient telephone calls (OTCs) with little prior training. This study determines the skills necessary for OTCs and examines whether a video intervention improves medical students' performance on simulated OTCs.

Materials and Methods

We utilized a Delphi technique to determine skills needed for OTCs and created a 9-min video teaching these skills. Senior medical students were randomized to Intervention (viewed video) and Control (did not view video) groups. Students were assessed pre-/post-intervention on simulated OTCs. The primary outcome was the between-group difference in improvement.

Results

The Delphi yielded 34 important skills with the highest focus on communication (n = 13) and triage (n = 6). Seventy-two students completed assessments (Control, n = 41; Intervention, n = 31). The score (mean ± SD) improved 4.3% in the Control group (62.3 ± 14.3% to 66.6 ± 25.0%) and 12.2% in the Intervention group (60.7 ± 15.2% to 72.9 ± 20.4%, p = 0.15). The effect size measured by Cohen's d was 0.55, considered effective (> 0.33) for an educational intervention.

Conclusions

This project fills a gap in OTC training. The use of the Delphi technique, intervention development based on the results, and evaluation of efficacy is a process that could be reproduced for other educational gaps.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-021-01331-w.