Patient Perspectives of Rural Kansas Maternity Care

Introduction

Pregnant women in rural areas face a unique set of challenges due to geographic maldistribution of obstetric services. The perspectives of rural Kansas women were sought regarding experience of birth and satisfaction with maternity care.

Methods

Medical student research assistants facilitated discussion groups and structured interviews in rural Kansas communities distributed throughout the state with women who had an uncomplicated delivery in the last 24 months. Participants were recruited via convenience sampling from clinic medical records and appointments over a two-to-three-week period. Guiding questions were used to facilitate discussion. Survey instruments were used to gather information about satisfaction with maternity care. Data for qualitative and quantitative analysis was aggregated using Rural Urban Commuting Area (RUCA) codes.

Results

Fourteen groups with 47 total participants completed the survey and discussion. Participants came from large rural, small rural, and isolated areas in Kansas as described by RUCA Code Four Category Classification. Survey results indicated that satisfaction with maternity care in participants' home county was significantly higher in small rural and isolated compared to large Rural RUCAs. Qualitative analysis results showed positive experiences related to doctor characteristics, relationship with doctor, doctor's involvement with care, alternative labor options, and distance convenience. Negative experiences were related to doctor bedside manner, doctor not there until delivery, and staff related complaints.

Conclusions

Kansas women in small rural and isolated RUCA codes appeared to be more satisfied with care.

Co-creating opportunities to incorporate cessation for electronic nicotine delivery systems in family medicine - a qualitative program evaluation

Background

The number of Americans who use tobacco has decreased in the twenty-first century, but electronic nicotine delivery systems (ENDS) have increased the complexity of treating tobacco dependence. The experiences of 18 family medicine practices were explored and opportunities to improve ENDS cessation were co-created in this study.

Methods

Eighteen family medicine practices were enrolled into an implementation project to incorporate ENDS cessation into their practice. The participants’ experiences were explored throughout the project using an iterative qualitative approach. The research team provided technical assistance. Semi-structured group interviews and focus groups were held with participants at the beginning, middle, and end of the project to explore participants’ experiences. The collective knowledge and experiences of participants, expert consultants and the research team were fused together to co-create opportunities to improve ENDS cessation.

Results

Nine opportunities to improve ENDS cessation were identified in three larger categories. The first category was leading change. This included: creating a vision for change to establish buy-in from key stakeholders and educate health care professionals to improve their confidence to address ENDS. The second category was creating processes. This included: establishing criteria for screening and quality improvement for ENDS cessation; being specific when asking about ENDS; creating electronic health record systems to support incorporating ENDS cessation; using chart audits if electronic health records cannot support incorporating ENDS into tobacco cessation; and assigning roles and responsibilities to members of the clinical care team. The third category was assisting patients who use ENDS. This included: educating patients and their parents/caregivers about ENDS and their potential harms, avoiding dual use, and developing a plan to quit.

Conclusions

This study highlights challenges and opportunities for incorporating ENDS cessation into family medicine. The opportunities outlined here provide a practical approach which is rooted in the experiences of family physicians and their clinical care teams working to improve how they address ENDS and based on peer reviewed literature and expert input. Improving how ENDS are addressed in family medicine will require more than clinical expertise. It will also require leadership skills and the ability to create process improvements.

Trial registration

Not applicable

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01520-x.

Becoming a coach: experiences of faculty educators learning to coach medical students

BACKGROUND

Despite the growth of coaching in medical education, many questions remain about the process of becoming a coach for medical students. We sought to understand the process through which faculty acclimated to this new role, and what benefits and challenges they experienced.

METHODS

A multi-phase qualitative focus group study was conducted with 20 faculty at one medical school in the United States during the initial year coaching was implemented. Focus group transcripts were analyzed using the constant comparative approach to inductively identify themes from the data.

RESULTS

Four main benefits were reported by faculty: student guidance, identifying student issues early, helping students develop work-life balance, and fostering clinician connectivity, which was seen as benefitting both students and faculty. The two main challenges were uncertainty regarding how adaptive the coaching sessions should be, and difficulty engaging in some of the roles simultaneously, like mentoring and supervision.

CONCLUSIONS

Schools that develop academic medical student coaching programs should design faculty support around coaching and recognize that the process of becoming a coach may not be or feel straightforward for faculty. Overall, faculty found coaching to be rewarding despite challenges they experienced.

The Impact of Communication Strategies on Faculty Members' Readiness for Curricular Change

Curricular change is the "new normal" for medical schools. Assessing faculty readiness, perceptions about the necessity and urgency of change, and confidence in the capacity of the organization to successfully implement the process, have been identified as essential to managing the curricular change process. We used The Medical School's Organizational Readiness for Curriculum Change Questionnaire (MORC) to assess and monitor faculty readiness for change. This 53-item survey uses a 5-point Likert scale to assess 3 factors. This project focused on the seven-item Communication subscale in order to guide the strategy for informing and involving faculty in the curricular change process. The MORC was distributed electronically to full-time faculty in December 2014 (pre-change), August 2016 (mid-change), and September 2017 (post-change). Respondents reported significantly increasing support and positive attitudes about curricular change, supporting the hypothesis that the communication strategies informed by MORC findings had a positive impact on faculty members' perceptions of the process. As the leading faculty concerns reported in the MORC shifted from the merits of change to practical concerns about implementation, we adapted communications to address their priorities. The MORC proved useful in capturing quantitative data on faculty perceptions of curricular change but its value was limited by low response rates and unrepresentative samples. Scientists, full professors and tenure track faculty members were overrepresented in survey respondents. Survey lengths were identified as limiting participation. Our experience supports the development of a shorter version of MORC to retain validity and reliability while potentially increasing response rate.

Medical Student Perspectives of Active Learning: A Focus Group Study

Phenomenon: Medical student perspectives were sought about active learning, including concerns, challenges, perceived advantages and disadvantages, and appropriate role in the educational process.

APPROACH

Focus groups were conducted with students from all years and campuses of a large U.S. state medical school.

FINDINGS

Students had considerable experience with active learning prior to medical school and conveyed accurate understanding of the concept and its major strategies. They appreciated the potential of active learning to deepen and broaden learning and its value for long-term professional development but had significant concerns about the efficiency of the process, the clarity of expectations provided, and the importance of receiving preparatory materials. Most significantly, active learning experiences were perceived as disconnected from grading and even as impeding preparation for school and national examinations. Insights: Medical students understand the concepts of active learning and have considerable experience in several formats prior to medical school. They are generally supportive of active learning concepts but frustrated by perceived inefficiencies and lack of contribution to the urgencies of achieving optimal grades and passing United States Medical Licensing Examinations, especially Step 1.

On the Origins of Perceptions: Student Perceptions of Active Learning and Their Implications for Educational Reform

This Conversation Starters article presents a selected research abstract from the 2016 Association of American Medical Colleges Central Region Group on Educational Affairs annual spring meeting. The abstract is paired with the integrative commentary of three experts who shared their thoughts stimulated by the study. These thoughts highlight the value of exploring what drives student perceptions of active learning in order to reform medical education.