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Abstract
PURPOSE Lack of health care providers' knowledge about the experience and needs of individuals with disabilities contribute to health care disparities experienced by people with disabilities. Using the Core Competencies on Disability for Health Care Education, this mixed methods study aimed to explore the extent the Core Competencies are addressed in medical education programs and the facilitators and barriers to expanding curricular integration. METHOD Mixed-methods design with an online survey and individual qualitative interviews was used. An online survey was distributed to U.S. medical schools. Semi-structured qualitative interviews were conducted via Zoom with five key informants. Survey data were analyzed using descriptive statistics. Qualitative data were analyzed using thematic analysis. RESULTS Fourteen medical schools responded to the survey. Many schools reported addressing most of the Core Competencies. The extent of disability competency training varied across medical programs with the majority showing limited opportunities for in depth understanding of disability. Most schools had some, although limited, engagement with people with disabilities. Having faculty champions was the most frequent facilitator and lack of time in the curriculum was the most significant barrier to integrating more learning activities. Qualitative interviews provided more insight on the influence of the curricular structure and time and the importance of faculty champion and resources. CONCLUSIONS Findings support the need for better integration of disability competency training woven throughout medical school curriculum to encourage in-depth understanding about disability. Formal inclusion of the Core Competencies into the Liaison Committee on Medical Education standards can help ensure that disability competency training does not rely on champions or resources.
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Affiliation(s)
- Danbi Lee
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
| | - Samantha W Pollack
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
| | - Tracy Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
| | - Bianca K Frogner
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
| | - Susan M Skillman
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
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Larson EH, Oster NV, Jopson AD, Andrilla CHA, Pollack SW, Patterson DG. Routes to Rural Readiness: Enhancing Clinical Training Experiences for Physician Assistants. J Physician Assist Educ 2023; 34:178-187. [PMID: 37467205 DOI: 10.1097/jpa.0000000000000514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
PURPOSE The purpose of this study was to describe practices and experiences of rurally oriented physician assistant (PA) training programs in providing rural clinical training to PA students. METHODS A survey of PA program directors (PDs) included questions about program characteristics, student and clinical preceptor (CP) recruitment in rural areas, and barriers to, and facilitators of, rural clinical training. Programs that considered rural training "very important" to their goals were identified. We interviewed PDs from rurally oriented programs about their rural clinical training and rural CPs about their experiences training PA students for rural practice. We identified key themes through content analysis. RESULTS Of 178 programs surveyed, 113 (63.5%) responded, 61 (54.0%) of which were rurally oriented and more likely than other programs to recruit rural students or those with rural practice interests and to address rural issues in didactic curriculum. The 13 PDs interviewed linked successful rural training to finding and supporting rural preceptors who enjoy teaching and helping students understand rural communities. The 13 rural CPs identified enthusiastic and rurally interested students as key elements to successful rural training. Interviewees identified systemic barriers to rural training, including student housing, decreased productivity, competition for training slots, and administrative burden. CONCLUSIONS Physician assistant students can be coached to capitalize on their rural clinical experiences. Knowing how to "jump in" to rotations and having genuine interest in the community are particularly important. Student housing, competition for training slots, and lack of financial incentives are major system-level challenges for sustaining and increasing the availability of PA rural clinical training.
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Affiliation(s)
- Eric H Larson
- Eric H. Larson, PhD, is a research professor emeritus, University of Washington School of Medicine, Seattle, Washington
- Natalia V. Oster, PhD, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Andrew Jopson, MPH, is a doctoral student, Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
- C. Holly A. Andrilla, MS, is a research scientist principal, University of Washington School of Medicine, Seattle, Washington
- Samantha W. Pollack, MHS, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Davis G. Patterson, PhD, is a research associate professor, University of Washington School of Medicine, Seattle, Washington
| | - Natalia V Oster
- Eric H. Larson, PhD, is a research professor emeritus, University of Washington School of Medicine, Seattle, Washington
- Natalia V. Oster, PhD, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Andrew Jopson, MPH, is a doctoral student, Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
- C. Holly A. Andrilla, MS, is a research scientist principal, University of Washington School of Medicine, Seattle, Washington
- Samantha W. Pollack, MHS, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Davis G. Patterson, PhD, is a research associate professor, University of Washington School of Medicine, Seattle, Washington
| | - Andrew D Jopson
- Eric H. Larson, PhD, is a research professor emeritus, University of Washington School of Medicine, Seattle, Washington
- Natalia V. Oster, PhD, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Andrew Jopson, MPH, is a doctoral student, Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
- C. Holly A. Andrilla, MS, is a research scientist principal, University of Washington School of Medicine, Seattle, Washington
- Samantha W. Pollack, MHS, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Davis G. Patterson, PhD, is a research associate professor, University of Washington School of Medicine, Seattle, Washington
| | - C Holly A Andrilla
- Eric H. Larson, PhD, is a research professor emeritus, University of Washington School of Medicine, Seattle, Washington
- Natalia V. Oster, PhD, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Andrew Jopson, MPH, is a doctoral student, Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
- C. Holly A. Andrilla, MS, is a research scientist principal, University of Washington School of Medicine, Seattle, Washington
- Samantha W. Pollack, MHS, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Davis G. Patterson, PhD, is a research associate professor, University of Washington School of Medicine, Seattle, Washington
| | - Samantha W Pollack
- Eric H. Larson, PhD, is a research professor emeritus, University of Washington School of Medicine, Seattle, Washington
- Natalia V. Oster, PhD, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Andrew Jopson, MPH, is a doctoral student, Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
- C. Holly A. Andrilla, MS, is a research scientist principal, University of Washington School of Medicine, Seattle, Washington
- Samantha W. Pollack, MHS, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Davis G. Patterson, PhD, is a research associate professor, University of Washington School of Medicine, Seattle, Washington
| | - Davis G Patterson
- Eric H. Larson, PhD, is a research professor emeritus, University of Washington School of Medicine, Seattle, Washington
- Natalia V. Oster, PhD, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Andrew Jopson, MPH, is a doctoral student, Department of Health Policy and Management, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
- C. Holly A. Andrilla, MS, is a research scientist principal, University of Washington School of Medicine, Seattle, Washington
- Samantha W. Pollack, MHS, is a research scientist, University of Washington School of Medicine, Seattle, Washington
- Davis G. Patterson, PhD, is a research associate professor, University of Washington School of Medicine, Seattle, Washington
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Pollack SW, Andrilla CHA, Peterson LE, Morgan ZJ, Longenecker R, Schmitz D, Evans D, Patterson DG. Rural Versus Urban Family Medicine Residency Scope of Training and Practice. Fam Med 2023; 55:162-170. [PMID: 36888670 PMCID: PMC10622018 DOI: 10.22454/fammed.2023.807915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Little is known about how rural and urban family medicine residencies compare in preparing physicians for practice. This study compared the perceptions of preparation for practice and actual postgraduation scope of practice (SOP) between rural and urban residency program graduates. METHODS We analyzed data on 6,483 early-career, board-certified physicians surveyed 2016-2018, 3 years after residency graduation, and 44,325 later-career board-certified physicians surveyed 2014-2018, every 7 to 10 years after initial certification. Bivariate comparisons and multivariate regressions of rural and urban residency graduates examined perceived preparedness and current practice in 30 areas and overall SOP using a validated scale, with separate models for early-career and later-career physicians. RESULTS In bivariate analyses, rural program graduates were more likely than urban program graduates to report being prepared for hospital-based care, casting, cardiac stress tests, and other skills, but less likely to be prepared in some gynecologic care and pharmacologic HIV/AIDS management. Both early- and later-career rural program graduates reported broader overall SOPs than their urban-program counterparts in bivariate analyses; in adjusted analyses this difference remained significant only for later-career physicians. CONCLUSIONS Compared with urban program graduates, rural graduates more often rated themselves prepared in several hospital care measures and less often in certain women's health measures. Controlling for multiple characteristics, only rurally trained, later-career physicians reported a broader SOP than their urban program counterparts. This study demonstrates the value of rural training and provides a baseline for research exploring longitudinal benefits of this training to rural communities and population health.
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Affiliation(s)
- Samantha W. Pollack
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
| | - C. Holly A. Andrilla
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
| | - Lars E. Peterson
- American Board of Family MedicineLexington, KY
- Family and Community Medicine, College of Medicine, University of KentuckyLexington, KY
| | | | | | - David Schmitz
- Department of Family and Community Medicine, School of Medicine and Health Sciences, University of North DakotaGrand Forks, ND
| | - David Evans
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
| | - Davis G. Patterson
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
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Peterson LE, Morgan ZJ, Andrilla CHA, Pollack SW, Longenecker R, Schmitz D, Evans DV, Patterson DG. Academic Achievement and Competency in Rural and Urban Family Medicine Residents. Fam Med 2023; 55:152-161. [PMID: 36888669 PMCID: PMC10622012 DOI: 10.22454/fammed.2023.656489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES The quality of training in rural family medicine (FM) residencies has been questioned. Our objective was to assess differences in academic performance between rural and urban FM residencies. METHODS We used American Board of Family Medicine (ABFM) data from 2016-2018 residency graduates. Medical knowledge was measured by the ABFM in-training examination (ITE) and Family Medicine Certification Examination (FMCE). The milestones included 22 items across six core competencies. We measured whether residents met expectations on each milestone at each assessment. Multilevel regression models determined associations between resident and residency characteristics milestones met at graduation, FMCE score, and failure. RESULTS Our final sample was 11,790 graduates. First-year ITE scores were similar between rural and urban residents. Rural residents passed their initial FMCE at a lower rate than urban residents (96.2% vs 98.9%) with the gap closing upon later attempts (98.8% vs 99.8%). Being in a rural program was not associated with a difference in FMCE score but was associated with higher odds of failure. Interactions between program type and year were not significant, indicating equal growth in knowledge. The proportions of rural vs urban residents who met all milestones and each of six core competencies were similar early in residency but diverged over time with fewer rural residents meeting all expectations. CONCLUSIONS We found small, but persistent differences in measures of academic performance between rural- and urban-trained FM residents. The implications of these findings in judging the quality of rural programs are much less clear and warrant further study, including their impact on rural patient outcomes and community health.
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Affiliation(s)
- Lars E. Peterson
- American Board of Family MedicineLexington, KY
- Family and Community Medicine, College of Medicine, University of KentuckyLexington, KY
| | | | - C. Holly A. Andrilla
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
| | - Samantha W. Pollack
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
| | - Randall Longenecker
- The RTT Collaborative and Ohio University Heritage College of Osteopathic MedicineAthens, OH
| | - David Schmitz
- Department of Family and Community Medicine, School of Medicine and Health Sciences, University of North DakotaGrand Forks, ND
| | - David V. Evans
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
| | - Davis G. Patterson
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
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Kaplan L, Pollack SW, Skillman SM, Patterson DG. Is being there enough? Postgraduate nurse practitioner residencies in rural primary care. J Rural Health 2022. [PMID: 36443985 DOI: 10.1111/jrh.12729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
PURPOSE Little research has been conducted on the outcomes of postgraduate nurse practitioner (NP) programs (referred to as residencies), particularly those located in rural communities. This study examined the purpose and characteristics of rural NP residencies that aim to promote the successful recruitment, transition, and retention of NPs in rural primary care practice. METHODS We compiled a list of rural NP residencies and verified the location of each clinic as rural if it met any of several federal definitions of rurality. We interviewed grant and project administrators, residency program directors, clinic personnel, and former and current NP residents using semistructured guides. FINDINGS Of 20 rural NP residencies identified, we interviewed 12 program directors or managers; 8 NPs; and 4 clinic personnel. All but 1 program was 12 months long. Three-quarters had federal funding. Each slowly increased residents' patient load and included didactic content and specialty rotations. We identified 2 different program models and 3 administrative models. Some NPs' intentionally chose rural practice, while others opted for a rural residency when unable to secure employment in an urban location. Most programs were new and not yet able to report on residents' subsequent employment locations. CONCLUSIONS It is premature to conclude definitively that rural NP residencies facilitate and promote NP connectedness to, and investment in, rural communities based on our investigation. Nonetheless, these programs are an option to encourage the recruitment and retention of NPs in rural practice, with further study needed to determine their long-term contribution to rural primary care practice.
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Affiliation(s)
- Louise Kaplan
- College of Nursing, Washington State University, Vancouver, Washington, USA
| | - Samantha W Pollack
- Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA.,Center for Health Workforce Studies, University of Washington, Seattle, Washington, USA
| | - Susan M Skillman
- Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA.,Center for Health Workforce Studies, University of Washington, Seattle, Washington, USA
| | - Davis G Patterson
- Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA.,Center for Health Workforce Studies, University of Washington, Seattle, Washington, USA
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Abstract
Phenomenon: Performance during the clinical phase of medical school is associated with membership in the Alpha Omega Alpha Honor Medical Society, competitiveness for highly selective residency specialties, and career advancement. Although race/ethnicity has been found to be associated with clinical grades during medical school, it remains unclear whether other factors such as performance on standardized tests account for racial/ethnic differences in clinical grades. Identifying the root causes of grading disparities during the clinical phase of medical school is important because of its long-term impacts on the career advancement of students of color. Approach: To evaluate the association between race/ethnicity and clinical grading, we examined Medical Student Performance Evaluation (MSPE) summary words (Outstanding, Excellent, Very Good, Good) and 3rd-year clerkship grades among medical students at the University of Washington School of Medicine. The analysis included data from July 2010 to June 2015. Medical students were categorized as White, underrepresented minorities (URM), and non-URM minorities. Associations between MSPE summary words and clerkship grades with race/ethnicity were assessed using ordinal logistic regression models. Findings: Students who identified as White or female, students who were younger in age, and students with higher United States Medical Licensing Examination Step 1 scores or final clerkship written exam scores consistently received higher final clerkship grades. Non-URM minority students were more likely than White students (Adjusted Odds Ratio = 0.53), confidence interval [0.36, 0.76], p = .001, to receive a lower category MSPE summary word in analyses adjusting for student demographics (age, gender, maternal education), year, and United States Medical Licensing Examination Step 1 scores. Similarly, in four of six required clerkships, grading disparities (p < .05) were found to favor White students over either URM or non-URM minority students. In all analyses, after accounting for all available confounding variables, grading disparities favored White students. Insights: This single institution study is among the first to document racial/ethnic disparities in MSPE summary words and clerkship grades while accounting for clinical clerkship final written examinations. A national focus on grading disparities in medical school is needed to understand the scope of this problem and to identify causes and possible remedies.
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Affiliation(s)
- Daniel Low
- Swedish Cherry Hill Family Medicine Residency, University of Washington School of Medicine, Seattle, Washington, WA, USA
| | - Samantha W Pollack
- Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Zachary C Liao
- Jackson Memorial Hospital, Internal Medicine Residency, University of Miami, Miami, FL, USA
| | - Ramoncita Maestas
- Student Affairs, University of Washington School of Medicine, Seattle, Washington, USA
| | - Larry E Kirven
- Wyoming WWAMI Program, University of Washington School of Medicine, Seattle, Washington, USA
| | - Anne M Eacker
- Kaiser Permanente School of Medicine, Pasadena, California, USA
| | - Leo S Morales
- Center for Health Equity, Diversity, and Inclusion, University of Washington School of Medicine, Seattle, Washington, USA
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