Entice With Procedures, Inspire With Primary Care: A Preclerkship Pipeline Course

Background and Objectives

The growing demand for primary care clinicians in the United States continues to outstrip their dwindling supply. Many allopathic medical schools, including Stanford University School of Medicine, are not adequately meeting this shortage. We sought to develop a preclerkship elective to increase the visibility and desirability of primary care at our institution.

Methods

A novel 9-week preclerkship elective titled "Primary Care Defined: Perspectives and Procedures," was designed as a series of procedural workshops followed by interactive sessions with local primary care clinicians. A total of 36 medical and physician assistant students were enrolled. We administered a questionnaire pre- and postcourse to evaluate the impact of the elective on learner interest and attitudes toward primary care.

Results

Twenty-four enrolled and 10 nonenrolled learners completed the questionnaire both pre- and postcourse. A one-way analysis of covariance controlling for gender, program (medical doctor versus physician assistant), and precourse responses demonstrated that enrollees had a significantly increased interest in primary care compared to nonenrollees after the course (F _1,32=9.22, P=.005). Enrollees also more positively rated their attitudes toward compensation, scope of practice, and job fulfillment than nonenrollees. Both groups had high levels of agreement on statements concerning patient-physician interactions and the importance of primary care to the health care system.

Conclusion

The design and content of this elective offers a framework for other institutions looking to promote the value of primary care specialties, particularly family medicine. Creating opportunities for experiential learning and early student-faculty engagement may encourage preclerkship learners to consider a career in primary care.

Impact of a Family Medicine Minor Procedure Service on Cost of Care for a Health Plan

BACKGROUND AND OBJECTIVES

Academic medical centers (AMC) are among some of the most expensive places to provide care. One way to cut costs is by decreasing unnecessary referrals to specialists for procedures that can be provided by well-trained primary care physicians. Our goal is to measure the financial impact of an office-based minor procedure service driven entirely by family physicians.

METHODS

We examined claims data for procedures performed on patients insured under our AMC's home-grown accountable care organization-style health plan (Stanford Health Care Alliance [SHCA]). Descriptive statistics was used to compare the volume and cost of procedures performed by family medicine (FM) versus specialty care (SC). We preformed a subanalysis of SC procedures to explore the degree to which consultation and facility fees increased costs for SC. We used mathematical modeling to estimate the impact on cost of care if procedures were shifted from SC to FM and to calculate a return on investment (ROI).

RESULTS

Our data set examined 6,974 outpatient procedures performed on SHCA patients from 2016-2018 at a cost of $5,263,720 to SHCA. FM performed 6% of procedures at an average cost of $236 per procedure, while SC performed 94% of procedures at an average cost of $787 per procedure. FM saved money for all 12 types of skin, musculoskeletal, and reproductive procedures assessed; the average saved per procedure was $551. This represents a 70% cost savings. ROI was 2.33; for every $1 spent on FM procedures, SHCA saved $2.33.

CONCLUSION

A family medicine minor procedure service significantly lowered health spending at our AMC.

Qualities of Resident Teachers Valued by Medical Students

BACKGROUND AND OBJECTIVES

Medical students often see residents as the most important teachers on the wards. However, there is a relative lack of data on the qualities that medical students value in their resident teachers. We conducted a qualitative study to determine the teaching behaviors that medical students value in their resident teachers.

METHODS

Over a 1-year period, 28 medical students completed 115 open-ended written reflections about their educational experiences with residents at a single, university-affiliated, community-based family medicine residency program in San Jose, CA. Qualitative data were analyzed using the constant comparative method associated with grounded theory. Ten recurring themes were identified after triangulation with published literature.

RESULTS

When given the opportunity to make open-ended written reflections about the teaching abilities of their resident teachers, medical students most often commented on topics relevant to a "safe learning environment." More than one in four reflections were associated with this theme, and all were characterized as positive, suggesting that the ability to set a safe learning environment is a quality that medical students value in their resident teachers. In contrast, the least frequently occurring theme was "knowledge," suggesting that residents' fund of knowledge may not be as important as other qualities in the eyes of medical students.

CONCLUSIONS

Our study adds to a growing body of literature suggesting that, from the medical students' perspective, a resident's fund of medical knowledge may not be as important as his/her ability to establish a supportive, safe, and nonthreatening environment to learn and practice medicine.

Galvanizing medical students in the administration of influenza vaccines: the Stanford Flu Crew

Many national organizations call for medical students to receive more public health education in medical school. Nonetheless, limited evidence exists about successful servicelearning programs that administer preventive health services in nonclinical settings. The Flu Crew program, started in 2001 at the Stanford University School of Medicine, provides preclinical medical students with opportunities to administer influenza immunizations in the local community. Medical students consider Flu Crew to be an important part of their medical education that cannot be learned in the classroom. Through delivering vaccines to where people live, eat, work, and pray, Flu Crew teaches medical students about patient care, preventive medicine, and population health needs. Additionally, Flu Crew allows students to work with several partners in the community in order to understand how various stakeholders improve the delivery of population health services. Flu Crew teaches students how to address common vaccination myths and provides insights into implementing public health interventions. This article describes the Stanford Flu Crew curriculum, outlines the planning needed to organize immunization events, shares findings from medical students' attitudes about population health, highlights the program's outcomes, and summarizes the lessons learned. This article suggests that Flu Crew is an example of one viable service-learning modality that supports influenza vaccinations in nonclinical settings while simultaneously benefiting future clinicians.