Individual and organizational factors associated with public health workforce competencies to advance health equity.

Little is known about how to develop public health workforce capacity for health equity work. We explored associations of individual and organizational characteristics of local public health departments (LHDs) with competencies essential for advancing health equity. Data included responses of 29,751 staff from 742 LHDs in 48 states to the 2021 Public Health Workforce Interests and Needs Survey, plus LHD characteristics and county demographics.

Changes in Diversity, Equity, and Inclusion Activities of Family Medicine Departments.

Background And Objectives: Institutional racism causes worse health outcomes for patients of racial/ethnic minority groups via limited access to health care, disparities in quality of care delivered, and lack of physician diversity. Increased attention to racism in 2020 led many medical institutions to examine their diversity, equity, and inclusion (DEI) efforts. In the context of increased national attention to health equity, this study sought to investigate the current status of DEI infrastructure by evaluating leadership and support related to DEI in family medicine departments in 2020 and 2021.

Low birthweight rate differences associated with distinct perinatal staffing mixes at federally funded health centers.

Health centers (sometimes referred to as "federally qualified health centers") can play an important role in addressing perinatal inequities. However, there is limited information on how different staffing models in health centers contribute to perinatal outcomes, including the availability of certified nurse midwives (CNMs). Using 2011-2021 Uniform Data System files, we examined 4 staffing models in 1385 health centers: those with no CNMs or obstetricians-gynecologists (OBs) ("non-CNM/OB"), CNM-only, OB-only, and both CNMs and OBs ("CNM/OB").

Recruitment of Residents to Rural Programs: Early Outcomes From Cohort 1 of the Rural Residency Planning and Development Grants Program.

To address rural physician workforce shortages, the Health Resources and Services Administration funded multiple Rural Residency Planning and Development (RRPD) awards, beginning in 2019, to develop rural residency programs in needed specialties. To describe early resident recruitment outcomes of the RRPD grants program. A cross-sectional survey of program directors or administrators of these 25 new rural residency training programs across the United States was administered at RRPD award conclusion in 2022.

Examining the Sustainability of Core Capacity and Evidence-Based Interventions for FIT-Based CRC Screening: California Colorectal Cancer Control Program.

Objectives: We examined the extent to which funded satellite clinics could sustain the California Colon Cancer Control Program (C4P) strategies implemented in health systems to increase uptake of the fecal immunochemical test (FIT) or immunochemical fecal occult blood test (iFOBT) for colorectal cancer (CRC) screening in the absence of future C4P funds.

Introduction: Seven health systems consisting of 38 satellite clinics participated in C4P to examine the sustainability of the program in the absence future Centers for Disease Control and Prevention (CDC) funding.

Methods: Quantitative and qualitative methods with a close and open-ended survey approach, and a prospective cohort design were used to examine the sustainability of the C4P in health systems.

Expanding the opioid use disorder medication treatment workforce in rural communities through the RCORP initiative.

Purpose: The Rural Communities Opioid Response Program (RCORP) was funded to help rural communities improve prevention, treatment, and recovery services for Opioid Use Disorder (OUD), including increasing the supply of clinicians with a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine, which was required before 2023. This research investigates the impact of RCORP funding on the supply of DEA-waivered clinicians in rural communities.

Methods: We used 2017-2022 DEA lists of waivered clinicians to assign clinicians to US counties.

Burnout, Exhaustion, Experiences of Discrimination, and Stress Among Underrepresented and First-Generation College Students in Graduate Health Profession Education.

Objectives: Mental health disorders are increasing among health profession students. Compounding this, students from underrepresented backgrounds may face additional stressors and challenges. The aims of this study were to: (1) assess the extent to which burnout, exhaustion, experiences of discrimination, and stress exist among students in dentistry, nursing, occupational therapy, pharmacy, and physical therapist professional education programs; (2) determine if there are significant differences by key demographic characteristics (those who are first-generation college students [FGCSs], a member of an underrepresented minority [URM] group, or both); and (3) highlight strategies and solutions to alleviate these challenges identified by students.

Routes to Rural Readiness: Enhancing Clinical Training Experiences for Physician Assistants.

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.

Assessing the Feasibility of Rural Residency Training for Licensed Naturopathic Physicians in the Northwest: A Qualitative Study.

Objectives: Naturopathic physicians (ND) are uniquely situated to address areas of unmet health care need as primary care providers (PCPs). In several states, NDs have a broad scope of practice and are licensed as independent practitioners regardless of residency training. However, with a larger role in the health care system, the need for post-graduate medical training becomes more important for clinical success and patient safety.

Understanding and Overcoming Barriers to Rural Obstetric Training for Family Physicians.

Background And Objectives: Family physicians are the most common health professional providing rural obstetric (OB) care, but the number of family physicians practicing OB is declining. To address rural/urban disparities in parental and child health, family medicine must provide robust OB training to prepare family physicians to care for parent-newborn dyads in rural communities. This mixed-methods study aimed to inform policy and practice solutions.

Competencies, Training Needs, and Turnover Among Rural Compared With Urban Local Public Health Practitioners: 2021 Public Health Workforce Interests and Needs Survey.

To compare rural versus urban local public health workforce competencies and training needs, COVID-19 impact, and turnover risk. Using the 2021 Public Health Workforce Interest and Needs Survey, we examined the association between local public health agency rural versus urban location in the United States (n = 29 751) and individual local public health staff reports of skill proficiencies, training needs, turnover risk, experiences of bullying due to work as a public health professional, and posttraumatic stress disorder symptoms attributable to COVID-19. Rural staff had higher odds than urban staff of reporting proficiencies in community engagement, cross-sectoral partnerships, and systems and strategic thinking as well as training needs in data-based decision-making and in diversity, equity, and inclusion.

Growing a rural family physician workforce: The contributions of rural background and rural place of residency training.

Objective: To determine the distinct influences of rural background and rural residency training on rural practice choice among family physicians.

Data Sources And Study Setting: We used a subset of The RTT Collaborative rural residency list and longitudinal data on family physicians from the American Board of Family Medicine National Graduate Survey (NGS; three cohorts, 2016-2018) and American Medical College Application Service (AMCAS).

Study Design: We conducted a logistic regression, computing predictive marginals to assess associations of background and residency location with physician practice location 3 years post-residency.

A Match Made in Rural: Interpreting Match Rates and Exploring Best Practices.

Background And Objectives: Although rural family medicine residency programs are effective in placing trainees into rural practice, many struggle to recruit students. Lacking other public measures, students may use residency match rates as a proxy for program quality and value. This study documents match rate trends and explores the relationship between match rates and program characteristics, including quality measures and recruitment strategies.

The Workforce Needed to Address Population Health.

Policy Points Although a single definition of the population health workforce does not yet exist, this workforce needs to have the skills and competencies to address the social determinants of health, to understand intersectionality, and to coordinate and work in concert with an array of skilled providers in social and health care to address multiple health drivers. On-the-job training programs and employer support are needed for the current health workforce to gain skills and competencies to address population health. Funding and leadership combined are critical for developing the population health workforce with the goal of supporting a broad set of workers beyond health and social care to include, for example, those in urban planning, law enforcement, or transportation professions to address population health.

Integrating Immigrant Health Professionals into the U.S. Healthcare Workforce: Barriers and Solutions.

Internationally educated immigrant healthcare workers face skill underutilization working in lower-skilled healthcare jobs or outside healthcare. This study explored barriers to and solutions for integrating immigrant health professionals. Content analysis identifying key themes from semi-structured qualitative interviews with representatives from Welcome Back Centers (WBCs) and partner organizations.

Association of psychiatric consultant characteristics with clinical outcomes of collaborative care for depression.

Context: Adult depression treatment in primary care is improved by integrated behavioral health such as the Collaborative Care Model (CoCM) but outcomes vary across health centers. Objective: Identify CoCM team factors associated with variation in clinical outcomes. Study Design: Correlative study of survey with linked clinical data from routine care.

Rural Versus Urban Family Medicine Residency Scope of Training and Practice.

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.

Academic Achievement and Competency in Rural and Urban Family Medicine Residents.

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.

The Current State of Antiracism Curricula in Undergraduate and Graduate Medical Education: A Qualitative Study of US Academic Health Centers.

Purpose: We undertook a study to evaluate the current state of pedagogy on antiracism, including barriers to implementation and strengths of existing curricula, in undergraduate medical education (UME) and graduate medical education (GME) programs in US academic health centers.

Methods: We conducted a cross-sectional study with an exploratory qualitative approach using semistructured interviews. Participants were leaders of UME and GME programs at 5 institutions participating in the Academic Units for Primary Care Training and Enhancement program and 6 affiliated sites from November 2021 to April 2022.

Building Rural Primary Care Research by Connecting Rural Programs.

Both research and medical education make substantial contributions to rural primary care and health. An inaugural Scholarly Intensive for Rural Programs was conducted in January 2022 to connect rural programs within a community of practice focused on promoting scholarly activity and research in rural primary health care, education, and training. Participant evaluations confirmed that key learning objectives were met, including stimulating scholarly activity in rural health professions education programs, providing a forum for faculty and student professional development, and growing a community of practice that supports education and training in rural communities.

Measuring the Impact of the COVID-19 Pandemic on Health Behaviors and Health Care Utilization in Rural and Urban Patients with Cancer and Cancer Survivors.

Healthcare access and health behaviors differ between those living in urban and rural communities and contribute to inequitable cancer health outcomes. The COVID-19 pandemic led to significant disruptions in daily life and healthcare delivery. This cross-sectional survey aimed to measure the impact of the COVID-19 pandemic on the health behaviors of cancer patients and survivors, comparing outcomes for urban and rural respondents.

Positive yet problematic: Lived experiences of racial and ethnic minority medical students during rural and urban underserved clinical rotations.

Purpose Of Study: Medical students who identify as Black, Indigenous, and People of Color (BIPOC) regularly experience mistreatment and discrimination. This study sought to understand these student experiences during rotations in rural and urban underserved community teaching sites.

Methods: Self-identified BIPOC medical students who completed the University of Washington School of Medicine's Rural Underserved Opportunities Program from 2019 through 2021 were invited to participate in a 60- to 90-minute focus group discussion via Zoom.

Is being there enough? Postgraduate nurse practitioner residencies in rural primary care.

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.

Can Family Medicine's Counterculture History Help Shape an Anti-Racist Future?

Family medicine prides itself on community engagement and has embraced its counterculture roots. After the racial and social reckoning of 2020, including the COVID-19 pandemic and the Black Lives Matters movement, family medicine, as a specialty, must embrace anti-racism as a core value to meet community needs. This article reflects on the foundational tenets of family medicine's origin.

Brief online implicit bias education increases bias awareness among clinical teaching faculty.

Problem And Purpose: Healthcare provider implicit bias influences the learning environment and patient care. Bias awareness is one of the key elements to be included in implicit bias education. Research on education enhancing bias awareness is limited.