Practice Adjustments Made by Family Physicians During the COVID-19 Pandemic.

Introduction: COVID-19 pandemic-related health care disruptions necessitated rapid adaptation among family physicians to safely meet patient needs while protecting themselves and their staff. On April 1, 2020, the American Board of Family Medicine (ABFM) introduced a COVID Performance Improvement (PI) activity for physicians to report on and receive Family Medicine certification credit for practice adjustments they made during the early stages of the pandemic. We aimed to understand the types of interventions implemented, and lessons physicians learned from the efforts.

Preparing Faculty to Incorporate Health Systems Science into the Clinical Learning Environment: Factors Associated with Sustained Outcomes.

This study assesses participants' perceptions of long-term impacts of the Teachers of Quality Academy, a medical school faculty development program designed to prepare faculty to both practice and teach health system science. A previously published 1-year evaluation of the first cohort of 27 participants showed improved perceived skills, with positive career and health system impacts. In this 5-year evaluation, a mixed-methods design included a questionnaire followed by semistructured interviews to assess perceived long-term impacts on participants.

The Clinic is The Curriculum: Can Attention to the Clinical Learning Environment Enhance Improvement in Health Care Delivery and Outcomes?

Actualization of knowledge and skills learned in medical education is required for medical students and residents to adopt effective clinical patterns and behaviors into their lives as practicing physicians. In addition, the imprinting of clinical behaviors that these trainees incorporate from the observations they make in the clinical learning environment in which they train has been well established to have a substantial and long-lasting impact on their approaches to care in subsequent practice settings. While much attention is paid to the formal curriculum for students and residents, supported by the need to meet requirements for accreditation, it is less common to witness explicit discussions and planning about the role that the clinical learning environment plays in the ultimate outcomes of educational efforts.

Imprinting on Clinical Rotations: Multisite Survey of High- and Low-Value Medical Student Behaviors and Relationship with Healthcare Intensity.

Background: Physician behaviors are important to high-value care, and the learning environment medical students encounter on clinical clerkships may imprint their developing practice patterns.

Objectives: To explore potential imprinting on clinical rotations by (a) describing high- and low-value behaviors among medical students and (b) examining relationships with regional healthcare intensity (HCI).

Design: Multisite cross-sectional survey PARTICIPANTS: Third- and fourth-year students at nine US medical schools MAIN MEASURES: Survey items measured high-value (n = 10) and low-value (n = 9) student behaviors.

Attitudes toward cost-conscious care among U.S. physicians and medical students: analysis of national cross-sectional survey data by age and stage of training.

Background: The success of initiatives intended to increase the value of health care depends, in part, on the degree to which cost-conscious care is endorsed by current and future physicians. This study aimed to first analyze attitudes of U.S.

Developing Tomorrow's Leaders: A Medical Student Distinction Track in Health System Transformation and Leadership.

Problem: Calls for medical education reform focus on preparing physicians to meet the challenges of today's complex health care system. Despite implementing curricula focused on health systems science (HSS), including quality improvement (QI), patient safety, team-based care, and population health, a significant gap remains in training students to meet the system's evolving needs.

Approach: Brody School of Medicine redesigned its curriculum to prepare leaders to effect health system change.

Value-Added Activities in Medical Education: A Multisite Survey of First- and Second-Year Medical Students' Perceptions and Factors Influencing Their Potential Engagement.

Purpose: To describe attitudes of first- and second-year U.S. medical students toward value-added medical education, assess their self-reported desire to participate in value-added activities, and identify potentially modifiable factors influencing their engagement.

Triple Aim Is Triply Tough: Can You Focus on Three Things at Once?

Background And Objectives: The I3 POP Collaborative sought to improve health of patients attending North Carolina, South Carolina, and Virginia primary care teaching practices using the triple aim framework of better quality, appropriate utilization, and enhanced patient experience. We examined change in triple aim measures over 3 years, and identified correlates of improvement.

Methods: Twenty-nine teaching practices representing 23 residency programs participated.

Workplace Factors Associated With Burnout of Family Physicians.

This study examines physician burnout using data from American Board of Family Medicine application questionaires.

Prevalence of Burnout in Board Certified Family Physicians.

Physician burnout has become a critical issue in a rapidly changing health care environment and is reported to be increasing. However, little is known about the prevalence of this problem among board-certified family physicians. Using an abbreviated burnout survey, we found a lower prevalence of this problem than has been previously reported.

The Teachers of Quality Academy: A Learning Community Approach to Preparing Faculty to Teach Health Systems Science.

Problem: Although efforts to integrate health systems science (HSS) topics, such as patient safety, quality improvement (QI), interprofessionalism, and population health, into health professions curricula are increasing, the rate of change has been slow.

Approach: The Teachers of Quality Academy (TQA), Brody School of Medicine at East Carolina University, was established in January 2014 with the dual goal of preparing faculty to lead frontline clinical transformation while becoming proficient in the pedagogy and curriculum design necessary to prepare students in HSS competencies. The TQA included the completion of the Institute for Healthcare Improvement Open School Basic Certificate in Quality and Safety; participation in six 2-day learning sessions on key HSS topics; completion of a QI project; and participation in three online graduate courses.

Role Modeling and Regional Health Care Intensity: U.S. Medical Student Attitudes Toward and Experiences With Cost-Conscious Care.

Purpose: To examine medical student attitudes toward cost-conscious care and whether regional health care intensity is associated with reported exposure to physician role-modeling behaviors related to cost-conscious care.

Method: Students at 10 U.S.

Transforming Medical Education is the Key to Meeting North Carolina's Physician Workforce Needs.

To meet the needs of the population of North Carolina, an epic transformation is under way in health care. This transformation requires that we find new ways to educate and train physicians and other health care professionals. In this commentary, we propose that the success of the Brody School of Medicine in preparing a primary care physician workforce can serve as a model for meeting the state's future physician workforce needs.

Meeting North Carolina's health care needs through interprofessional education and practice.

To meet the future health care needs of North Carolinians, health professions students must learn how to work together as part of an interdisciplinary team. This commentary describes how interprofessional education and team-based care can decrease the number of adverse events, improve health care delivery, and support consistent outcomes.

"PDSA-ADHD": a newly reported syndrome.

We present a satirical case report of a new syndrome, called "plan do study act-attention deficit hyperactivity disorder," or PDSA-ADHD. This syndrome is associated with the implementation of multiple simultaneous plan-do-study-act cycles as a quality improvement approach in a health care setting. This case represents a clinical warning sign of quality improvement impairment and suggests a new variant of organizational attention deficit disorder.

The effect of a carve-out advanced access scheduling system on no-show rates.

Background And Objectives: The relationship between advanced access scheduling and no-show rates in academic settings is unclear. The purpose of this analysis is to assess the effect of moving to a carve-out model of an advanced access scheduling system on no-show rates in an academic practice.

Methods: A multivariable logistic regression with repeated measures analysis of patient visits was used to assess the relationship between the time to third-next available appointment and no-show rates.

Rural-urban differences in depression prevalence: implications for family medicine.

Background And Objectives: Rural populations experience more adverse living circumstances than urban populations, but the evidence regarding the prevalence of mental health disorders in rural areas is contradictory. We examined the prevalence of depression in rural versus urban areas.

Methods: We performed a cross-sectional study using the 1999 National Health Interview Survey (NHIS).

Use of ED diagnosis to determine medical necessity of EMS transports.

Objective: To examine interrater agreement for classifying emergency medical services transports as medically unnecessary using emergency department diagnosis as the sole determining factor.

Methods: Three emergency physicians and two family medicine physicians classified 913 International Classification of Diseases, Ninth Revision (ICD-9) codes as medically necessary, unnecessary, or uncertain. Overall agreement, interrater agreement, and agreement within 17 major disease categories were measured using kappa statistics in SAS.

Medically unnecessary emergency medical services (EMS) transports among children ages 0 to 17 years.

Objectives: Estimate the prevalence of medically unnecessary Emergency Medical Services (EMS) transports among children.

Methods: We linked EMS and emergency department (ED) billing records for all EMS-to-hospital transports of children originating in three counties in South Carolina between January 1, 2001 and March 31, 2003. EMS responses resulting in no transport, transports to destinations other than the ED, or multiple trips for the same child in a single day could not be linked to ED data and were excluded.

Update: health insurance and utilization of care among rural adolescents.

Context: Adolescence is critical for the development of adult health habits. Disparities between rural and urban adolescents and between minority and white youth can have life-long consequences.

Purpose: To compare health insurance coverage and ambulatory care contacts between rural minority adolescents and white and urban adolescents.