Resident Remediation in Family Medicine Residency Programs: A CERA Survey of Program Directors.

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.

Point-of-Care Ultrasound in Family Medicine Residencies 5-Year Update: A CERA Study.

Background And Objectives: In 2014, family medicine residency programs began to integrate point-of-care ultrasound (POCUS) into training, although very few had an established POCUS curriculum. This study aimed to evaluate the resources, barriers, and scope of POCUS training in family medicine residencies 5 years after its inception.

Methods: Questions regarding current training and use of POCUS were included in the 2019 Council of Academic Family Medicine Educational Research Alliance (CERA) survey of family medicine residency program directors, and results compared to similar questions on the 2014 CERA survey.

Integrated care coordination by an interprofessional team reduces emergency department visits and hospitalisations at an academic health centre.

People with chronic behavioural and physical health conditions have higher healthcare costs and mortality rates than patients with chronic physical conditions alone. As a result, there has been promotion of integrated care for this group. It is important to train primary care residents to practice in integrated models of care with interprofessional teams and to evaluate the effectiveness of integrated care models to promote high-quality care for this at-risk group.

Comparison of patient preferences for fecal immunochemical test or colonoscopy using the analytic hierarchy process.

Background: In average-risk individuals aged 50 to 75 years, there is no difference in life-years gained when comparing colonoscopy every 10 years vs. annual fecal immunochemical testing (FIT) for colorectal cancer screening. Little is known about the preferences of patients when they have experienced both tests.

Management of skin and soft tissue infections in community practice before and after implementing a "best practice" approach: an Iowa Research Network (IRENE) intervention study.

Context: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a major pathogen among skin and soft tissue infections (SSTIs). Most CA-MRSA infections are managed initially on an outpatient basis. It is critical that primary care clinicians recognize and appropriately treat patients suspected of having such infections.

Primary care clinicians' perspectives on management of skin and soft tissue infections: an Iowa Research Network study.

Unlabelled: An estimated 95,000 people developed methicillin-resistant Staphylococcus aureus (MRSA) infections during 2005 of which 14% were community-associated and 85% were hospital or other health setting associated, and 19,000 Americans died from these infections that year.

Purpose: To explore health care providers' perspectives on management of skin and soft tissue infections to gain a better understanding of the problems faced by busy providers in primary care settings.

Methods: Focus group meetings were held at 9 family physician offices in the Iowa Research Network.

Does structured audit and feedback improve the accuracy of residents' CPT E&M coding of clinic visits?

Background And Objectives: Family physicians frequently err when applying Current Procedural Terminology (CPT) evaluation and management (E&M) codes to their office visits, but there are few published prospective studies on educational interventions to improve coding.

Methods: Over a 6-year intervention period, 429 resident patient notes from return clinic visits were recoded by a faculty member with coding expertise. Feedback on coding accuracy and annual educational coding workshops were provided to the residents.

Using systematically observed clinical encounters (SOCEs) to assess medical students' skills in clinical settings.

Introduction: The Objective Structured Clinical Examination (OSCE) is widely used to assess the clinical performance of medical students. However, concerns related to cost, availability, and validity, have led educators to investigate alternatives to the OSCE. Some alternatives involve assessing students while they provide care to patients - the mini-CEX (mini-Clinical Evaluation Exercise) and the Long Case are examples.

Physician and pharmacist collaboration to improve blood pressure control.

Background: Studies have demonstrated that blood pressure (BP) control can be improved when clinical pharmacists assist with patient management. The objective of this study was to evaluate if a physician and pharmacist collaborative model in community-based medical offices could improve BP control.

Methods: This was a prospective, cluster randomized, controlled clinical trial with clinics randomized to a control group (n = 3) or to an intervention group (n = 3).

Trained lay observers can reliably assess medical students' communication skills.

Context: Our project investigated whether trained lay observers can reliably assess the communication skills of medical students by observing their patient encounters in an out-patient clinic.

Methods: During a paediatrics clerkship, trained lay observers (standardised observers [SOs]) assessed the communication skills of Year 3 medical students while the students interviewed patients. These observers accompanied students into examination rooms in an out-patient clinic and completed a 15-item communication skills checklist during the encounter.

Fertility awareness-based methods: another option for family planning.

Modern fertility awareness-based methods (FABMs) of family planning have been offered as alternative methods of family planning. Billings Ovulation Method, the Creighton Model, and the Symptothermal Method are the more widely used FABMs and can be more narrowly defined as natural family planning. The first 2 methods are based on the examination of cervical secretions to assess fertility.

Influence of patient characteristics on success of ambulatory blood pressure monitoring.

Study Objective: To examine the influence of specific patient characteristics on the success of ambulatory blood pressure monitoring (ABPM).

Design: Retrospective analysis.

Setting: University-affiliated family care center.

How well does a shortened time interval characterize results of a full ambulatory blood pressure monitoring session?

Ambulatory blood pressure monitoring (ABPM) is useful in evaluating cardiovascular risk but requires significant time. The authors examined how closely shortened time intervals correlate with the systolic blood pressure (BP) determined from a full 24-hour ABPM session in 1004 ABPM recordings. After excluding the first hour, Pearson correlations performed for the mean systolic BP of the subsequent 3-, 5-, and 7-hour periods (4, 6, and 8 hours total) with the entire, and remainder of the session, demonstrated greatest improvement in correlation when the session is increased from 4 to 6 hours.

A cluster randomized trial to evaluate physician/pharmacist collaboration to improve blood pressure control.

This was a prospective, cluster randomized controlled trial in patients with uncontrolled hypertension aged 21 to 85 years (mean, 61 years). Pharmacists made recommendations to physicians for patients in the intervention clinics (n=101) but not patients in the control clinics (n=78). The mean adjusted difference in systolic blood pressure (BP) between the control and intervention groups was 8.

A study of Two Clinical Performance Scores: Assessing the Psychometric Characteristics of a Combined Score Derived from Clinical Evaluation Forms and OSCEs.

Background/Purpose - It is important to improve the quality of clinical skill assessments. In addition to using the OSCE, the clinical skills of medical students are assessed with clinical evaluation forms (CEFs). The purpose of this study is to examine the psychometric characteristics of an OSCE/CEF composite score.

The reliability of summative judgements based on objective structured clinical examination cases distributed across the clinical year.

Context: Objective structured clinical examinations (OSCEs) can be used for formative and summative evaluation. We sought to determine the generalisability of students' summary scores aggregated from formative OSCE cases distributed across 5 clerkships during Year 3 of medical school.

Methods: Five major clerkships held OSCEs with 2-4 cases each during their rotations.

The influence of irrelevant anchors on the judgments and choices of doctors and patients.

Background: Little research has examined how anchor numbers affect choice, despite several decades of research showing that judgments typically and robustly assimilate toward irrelevant anchors.

Methods: In one experiment, HIV-positive patients (N = 99) judged the chances that sexual partners would become infected with HIV after sex using a defective condom and then indicated their choices of remedial action. In a second experiment, Iowa physicians (N =191) rated the chances that hypothetical patients had a pulmonary embolism and then formulated a treatment plan.

Explicit and implicit evaluation of physician adherence to hypertension guidelines.

This study evaluated physician adherence to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) hypertension guidelines in 6 community-based clinics. Explicit review of retrospective medical record data for patients with uncontrolled hypertension measured guideline adherence using 22 criteria. Mean overall guideline adherence was 53.

Email teleconsultations: well formulated clinical referrals reduce the need for clinic consultation.

We examined how well primary-care physicians formulated their clinical referrals when asking for help with patient-related clinical problems using an email-based teleconsultation service. Over 100 family physicians made use of the service. The specialists were medical school faculty members.

Comparative antihypertensive effects of hydrochlorothiazide and chlorthalidone on ambulatory and office blood pressure.

Low-dose thiazide-type diuretics are recommended as initial therapy for most hypertensive patients. Chlorthalidone has significantly reduced stroke and cardiovascular end points in several landmark trials; however, hydrochlorothiazide remains favored in practice. Most clinicians assume that the drugs are interchangeable, but their antihypertensive effects at lower doses have not been directly compared.

The limited effect of screening for depressive symptoms with the PHQ-9 in rural family practices.

Context: Previous studies have found that routine screening for depression does not improve patient outcome unless it is combined with case management. However, these studies were conducted before the widespread use of SSRIs or in settings other than traditional primary care.

Purpose: This study investigated whether screening for depressive symptoms improves outcomes for depressed patients seen in rural fee-for-service primary care offices.

Association of amoxicillin use during early childhood with developmental tooth enamel defects.

Background: It has been speculated that amoxicillin use could be associated with dental enamel defects.

Objective: To assess the association between dental fluorosis, one of the most common developmental tooth enamel defects, and amoxicillin use during early childhood.

Design, Setting, And Participants: As participants in the Iowa Fluoride Study, subjects were followed up from birth to 32 months using questionnaires every 3 to 4 months to gather information on fluoride intake and amoxicillin use.