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Background and Objectives: Identifying underperforming residents and helping them become fully competent physicians is an important faculty responsibility. The process to identify and remediate these learners varies greatly between programs. The objective of this study was to evaluate the remediation landscape in family medicine residency programs by investigating resident remediation characteristics, tools to improve the process, and remediation challenges., Methods: This study analyzed responses from the Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of family medicine program directors in 2017. Survey questions included topics on faculty remediation training, remediation prevalence, tools for remediation, and barriers to remediation., Results: Two hundred sixty-seven of 503 program directors completed our survey (53% response rate). Most residency programs (245/264, 93%) had at least one resident undergoing remediation in the last 3 years. A majority (242/265, 91%) of residents undergoing remediation were successful within 12 months. The three most important tools to improve remediation were an accessible remediation toolkit (50%), formal remediation recommendations from national family medicine organizations (20%), and on-site faculty development and training (19%). The top-two challenges to the remediation process were a lack of documented evaluations to trigger remediation and a lack of faculty knowledge and skills with effective remediation strategies., Conclusions: Residents needing remediation are common, but most were successfully remediated within 12 months. Program directors wanted access to a standardized toolkit to help guide the remediation process.

Background and Objectives: The clinical pharmacist's role within family medicine residency programs (FMRPs) is well established. However, there is limited information regarding perceptions of program directors (PDs) about clinical pharmacy educators. The study objectives were (1) to estimate the prevalence of clinical pharmacists within FMRPs and (2) to determine barriers and motivations for incorporation of clinical pharmacists as educators., Methods: The Council of Academic Family Medicine Educational Research Alliance (CERA) distributed an electronic survey to PDs. Questions addressed formalized pharmacotherapy education, clinical pharmacists in educator roles, and barriers and benefits of clinical pharmacists in FMRPs., Results: The overall response rate was 50% (224/451). Seventy-six percent (170/224) of the responding PDs reported that clinical pharmacists provide pharmacotherapy education in their FMRPs, and 57% (97/170) consider clinical pharmacists as faculty members. In programs with clinical pharmacists, 72% (83/116) of PDs reported having a systematic approach for teaching pharmacotherapy versus 22% (21/95) in programs without. In programs without clinical pharmacists, the top barrier to incorporation was limited ability to bill for clinical services 48% (43/89) versus 29% (32/112) in programs with clinical pharmacists. In both programs with and without clinical pharmacists, the top benefit of having clinical pharmacists was providing a collaborative approach to pharmacotherapy education for residents (35% and 36%, respectively)., Conclusions: Less than half of FMRPs incorporate clinical pharmacists as faculty members. Despite providing collaborative approaches to pharmacotherapy education, their limited ability to bill for services is a major barrier.

Background and Objectives: As the number of people living with HIV steadily increases, severe shortages in the HIV provider workforce in the United States are projected. With an increased emphasis on HIV education during residency, family physicians could play a major role in meeting this need., Methods: A nationwide survey of family medicine residency program directors (PDs) was conducted to determine their attitudes toward training residents in HIV care., Results: Of 440, 224 (51%) PDs responded to the electronic survey. Teaching HIV care was a high priority for 20% of PDs. Twenty percent of PDs reported residents in their program were providing care to at least five HIV-infected patients. Twenty-five percent of PDs felt that their graduates had the skills to be HIV care providers. Fewer than 25% of PDs reported having a formal HIV curriculum or faculty with adequate HIV expertise. The most favored approaches to strengthen the HIV curriculum by PDs were: (1) a half-day mini-course (30%) and (2) developing a faculty member's expertise in HIV care (17%). A total of 79% of directors saw a need to modify their existing curriculum., Conclusions: Despite growing numbers of HIV-infected patients, only 25% of family medicine PDs felt that their graduates were adequately trained in HIV primary care, and most saw a need to modify their HIV curricula. Family medicine residency training programs have an important opportunity to develop residency curricula and increase faculty competence to train the next generation of clinicians in HIV care.

Background and Objectives: Direct observation (DO) is considered to be an effective way to evaluate patient care. This study assesses if weekly direct observation with formal feedback (DO-FF) increases (1) clinical skills and (2) comfort with patient care skills (CWPCS) during the first 12 weeks of internship., Methods: A single-blinded, stratified, randomized controlled trial (RCT) with allocation concealment incorporating interns at a community hospital family medicine residency program was performed. Interns (n=14) were stratified by the predicted number of calls in a 2:1 ratio of intervention: control group. The intervention group received DO-FF four times/month on inpatient history and physicals (H&Ps) by a family medicine senior resident or fellow. To assess skills, all interns were videotaped doing H&Ps at the beginning, middle, and end of the study. These were scored by two independent, blinded physicians using a validated tool. For self-assessment, all interns took a patient care comfort survey (PCCS) at baseline, 6 weeks, and 12 weeks. Analysis was done via intention to treat., Results: At 6 weeks, interns who received weekly DO-FF had greater CWPCS on 32 of 35 questions. Eight were significantly different: (1) discussing end of life issues, (2) chest X ray interpretation, management of (3) congestive heart failure, (4) chronic obstructive pulmonary disease, (5) diabetes mellitus, (6) diabetic ketoacidosis, (7) stroke, and (8) venous thromboembolism/pulmonary embolism. In all but three questions, differences resolved by 12 weeks. Video data were not significantly different between groups., Conclusions: In certain aspects of patient care, DO-FF improved intern CWPCS at 6 weeks. There was no difference in the video assessments of clinical skills between the treatment groups. These results need to be further explored. However, this study showed that a well-designed RCT is feasible for educational research questions.

Background and Objectives: Publication of clinical research in peer-reviewed journals is an important measure of scholarly productivity. This study determined the quantity and quality of original clinical research published by family physicians., Methods: We surveyed clinical research papers published in the year 2000 in four leading family medicine research journals and research originating in a family practice institution but published in 16 non-family medicine journals. All were selected on the basis of relevance to family physicians and "impact factor." The relevance and validity of papers was assessed using previously established criteria., Results: The survey of family medicine journals revealed a total of 170 original research articles. Ninety eight were from academic family practice programs, and the remaining 72 were from other medical specialties or health care institutions. Most of the papers were cross-sectional surveys. There were seven qualitative studies, six randomized controlled trials, and no systematic reviews from family practice programs in these journals. Eight of the articles were from practice-based research networks. A total of 79 articles were considered relevant or highly relevant, and 22 of these were also considered valid (Patient-oriented Evidence That Matters or POEMs). The survey of 16 non-family medicine journals revealed 37 clinical research papers: 16 surveys, nine prospective cohort studies, seven randomized controlled trials, three systematic reviews/meta-analysis, one qualitative study, and one case-control study. There were nine "highly relevant" papers--seven could be classified as POEMs., Conclusions: Most clinical family medicine research uses less-rigorous study designs, such as the cross-sectional survey. The majority of papers do not meet established criteria for relevance and validity. There are no standards or comparable studies to compare these results to prior years or to other disciplines.

Background and Objectives: Prior published family medicine faculty satisfaction survey results were performed in 1975, 1984, and 1989. The current survey identified specific factors that contribute to family medicine faculty satisfaction and career decision making., Methods: We mailed a self-administered questionnaire to a proportionate random sample of family medicine faculty of residency programs identified by a pre-survey of programs. The eight-page survey explored 60 professional, scheduling, compensation, and regional factors as they related to overall satisfaction and career plans. The survey also explored 59 similar factors related to the initial decision to enter academic family medicine., Results: Of 383 respondents (59.2% response rate), 93% felt satisfied overall with their faculty roles. Eighty-six percent felt appreciated in their current program, and 94% reported a positive sense of professional challenge. Satisfaction, appreciation, and challenge were strongly intercorrelated and were also positively related to whether the faculty surveyed planned to stay in their current position. The opportunity to mentor residents, the ability to keep more up to date with medical information, and income level stood out as being the most significant of all the factors in predicting overall satisfaction., Conclusions: The faculty surveyed indicated high levels of satisfaction, feeling appreciated, and professional challenge. The results of this cross-sectional survey identify factors most related to satisfaction and the initial decision to enter academic family medicine.

Background: The prevalence of obesity in adolescence is increasing. This study determined whether a lack of nutrition knowledge is correlated with obesity in adolescents., Methods: We distributed a survey at three high schools to 292 9th-through 12th-grade students. The questionnaire examined the students' nutrition knowledge, food-related behaviors, and food preferences. The students' body mass indices (BMI) were calculated from self-reported weights and heights. Obesity was defined as a BMI greater than the 85th percentile, using criteria from the National Health and Nutrition Examination Survey II., Results: Of 292 students contacted, 289 returned the survey. The population had a prevalence of obesity of 26%. There were no significant differences in nutrition knowledge between the obese and non-obese students with the exception that obese students were better able to identify high-fiber foods. In addition, obese students were more likely to report infrequent meals with their family. Otherwise, there were no significant differences in nutrition behaviors or food preferences., Conclusions: Overall nutrition knowledge did not differ between obese and non-obese adolescents.

Background and Objectives: This descriptive study sought information on the types of clinical practice arrangements and the nature of clinical responsibilities of full-time physician faculty in family practice residency programs., Methods: A four-page, 37-item, self-administered questionnaire was sent to a 20% proportionate, systematic randomly sampled group of family practice faculty. Simple descriptive statistics were used for demographic and clinical practice data. Clinical practice characteristics were compared by the three most frequent clinical practice arrangements (private practice, on-site practice, and off-site practice) to determine differences., Results: The majority of respondents were white, board-certified males. Most faculty saw patients two (26.9%) or three (27.7%) half days per week and between 6-10 (47.5%) and 11-15 (41.1%) patients per session. The most frequent clinical practice arrangements were having faculty see patients in their own private practice (5.3%), as part of the faculty practice in the residency program's health center (72.9%), and as part of the faculty practice remote from the residency program's health center (11.7%). There were no differences among the three arrangements with respect to clinical sessions per week, taking call at night to back up the resident on call, seeing patients outside of regularly scheduled office hours, making house calls, following patients in the nursing home, or offering pregnancy care., Conclusions: Further research is needed to determine the advantages and disadvantages of different clinical practice arrangements for the clinical skills and role-modeling ability of family physician faculty.

Background: Prescription-writing skills are often overlooked in resident education. The present study evaluates a method of improving prescription-writing skills over a 2-year period., Methods: This was a prospective, nonblinded, nonrandomized trial of an educational method to improve prescription-writing abilities of a class of 12 family practice residents. The intervention included evaluation and feedback of prescription writing by a clinical pharmacist using copies of prescriptions written over a 2-year period and applying previously defined criteria for determining prescription-writing errors., Results: The baseline prescription-writing error rate was 14.4%. Over the 2-year intervention, prescription-writing errors by all residents decreased to 6.0% (P = .0002). Error rates decreased 58% from the baseline during the last 6 months of the intervention (P = .001)., Conclusions: Continuous evaluation and feedback improved prescription-writing skills and improved communication with pharmacists and patients.