Family Medicine in Times of War.

Wars and conflicts appear to be a fact of life for populations across the globe, often in places where family medicine functions as the backbone of the health care system. In these situations, family physicians are frequently called on to serve in expanded roles and are witnesses to the enormous mental and physical suffering of individuals, families, communities, and populations. This article examines the lessons family medicine can learn from current wars and other terrible conflagrations.

Competing Narratives of Hospital Closure: A Case Study of Memorial Hospital of Rhode Island.

Background: Hospital closures have become commonplace in the United States but remain controversial. Memorial Hospital of Rhode Island was a 294-bed hospital in a disadvantaged community that closed in 2018 amid falling patient volume and rising costs.

Methods: Immersion/crystallization method of qualitative analysis was employed in reviewing semi-structured interviews, public testimony, and public documents.

Storylines of family medicine I: framing family medicine - history, values and perspectives.

is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'I: framing family medicine-history, values, and perspectives', the authors address the following themes: 'Notes on , 'Family medicine-the generalist specialty', 'Family medicine's achievements-a assessment', 'Family medicine's next 50 years-toward filling our glasses', 'Four enduring truths of family medicine', 'Names matter', 'Family medicine at its core' and 'The ecology of medical care.' May readers find much food for thought in these essays.

Primary Care Access for All: A Roadmap for Addressing the Primary Care Crisis in Rhode Island.

Background: Primary care in Rhode Island is in crisis. The dearth of primary care providers is already affecting access to services and the situation is likely to worsen unless major steps are taken. There are inadequate numbers of trainees in primary care medical residencies, nurse practitioner (NP) and physician assistant (PA) training programs who plan to practice primary care in our state.

Using medical storytelling to communicate problems and solutions in the low back pain conundrum: an evidence-based tale of twins.

Objectives: Low back pain (LBP) is the number one cause of disability world-wide. It is also the most expensive area in healthcare. Patient-centered innovations are needed.

Health systems science education: The new post-Flexner professionalism for the 21st century.

The foundations of medical education have drawn from the Flexner Report to prepare students for practice for over a century. These recommendations relied, however, upon a limited set of competencies and a relatively narrow view of the physician's role. There have been increasing calls and recommendations to expand those competencies and the professional identity of the physician to better meet the current and future needs of patients, health systems, and society.

PCMH in a College Setting: A Brown Primary Care Transformation Initiative.

While the PCMH is the primary care model of choice for many healthcare systems, it is a relatively new area for college communities. The college health setting provides an important and challenging primary care platform because of developmental milestones that young adults face at this time of their lives. The Brown Primary Care Transformation Initiative (BPCTI) facilitated PCMH practice transformation efforts within a university center from 2013-2015.

Comparative case studies in integrated care implementation from across the globe: a quest for action.

Background: Integrated care is the coordination of general and behavioral health and is a highly promising and practical approach to improving healthcare delivery and patient outcomes. While there is growing interest and investment in integrated care implementation internationally, there are no formal guidelines for integrated care implementation applicable to diverse healthcare systems. Furthermore, there is a complex interplay of factors at multiple levels of influence that are necessary for successful implementation of integrated care in health systems.

A Behavioral Health Survey of Primary Care Integration in Rhode Island.

Background: Integrating behavioral and primary care practices improves quality of care, but limited data exists regarding the extent or attributes of such integration. We conducted a baseline evaluation of the level and characteristics of integrated practices in Rhode Island.

Methods: The Rhode Island Department of Health 2015 Statewide Health Inventory Behavioral Health Survey was sent to behavioral health clinics and outpatient psychiatry and psychology practices.

What matters in patient-centered medical home transformation: Whole system evaluation outcomes of the Brown Primary Care Transformation Initiative.

Objectives: Patient-centered medical home transformation initiatives for enhancing team-based, patient-centered primary care are widespread in the United States. However, there remain large gaps in our understanding of these efforts. This article reports findings from a contextual, whole system evaluation study of a transformation intervention at eight primary care teaching practice sites in Rhode Island.

Contrasting Incoming Medical Students' Attitudes Dual Degree vs Traditional Tracks.

Background And Objectives: The Warren Alpert Medical School of Brown University (AMS) recently implemented a novel dual degree MD-ScM program in primary care and population medicine (PC-PM) that enrolls up to 24 of its nearly 144 yearly matriculants. The overarching goal of this track is to train medical students to become physician leaders who focus on issues in population medicine within primary care.

Methods: We conducted a baseline assessment of the students enrolled in this parallel track in comparison to our traditional students to identify characteristics of and group differences between students in the PC-PM program and traditional students.

Curricular Transformation: The Case Against Global Change.

In this Commentary, the authors make the case for medical schools to pursue more circumscribed solutions to curricular redesign for undergraduate medical education rather than whole system changes-at least as first steps and perhaps as ultimate solutions. Although they focus primarily on the experience at the Warren Alpert Medical School of Brown University (AMS), they believe that the insights gleaned from their experiences are generalizable to other innovations and other medical schools. The authors describe the implementation of the Primary Care-Population Medicine track at AMS as a working example of implementing circumscribed rather than global change, and they discuss the advantages and disadvantages of such an approach to curriculum transformation.

Priority Areas and Potential Solutions for Successful Integration and Sustainment of Health Systems Science in Undergraduate Medical Education.

Educators, policy makers, and health systems leaders are calling for significant reform of undergraduate medical education (UME) and graduate medical education (GME) programs to meet the evolving needs of the health care system. Nationally, several schools have initiated innovative curricula in both classroom and workplace learning experiences to promote education in health systems science (HSS), which includes topics such as value-based care, health system improvement, and population and public health. However, the successful implementation of HSS curricula across schools is challenged by issues of curriculum design, assessment, culture, and accreditation, among others.

Health Systems Science Curricula in Undergraduate Medical Education: Identifying and Defining a Potential Curricular Framework.

Purpose: The authors performed a review of 30 Accelerating Change in Medical Education full grant submissions and an analysis of the health systems science (HSS)-related curricula at the 11 grant recipient schools to develop a potential comprehensive HSS curricular framework with domains and subcategories.

Method: In phase 1, to identify domains, grant submissions were analyzed and coded using constant comparative analysis. In phase 2, a detailed review of all existing and planned syllabi and curriculum documents at the grantee schools was performed, and content in the core curricular domains was coded into subcategories.

Partnering With Patients, Families, and Communities.

Collaborating with patients, families, and communities is a core principle of family medicine. However, the health care system in the United States has grown increasingly complex, fragmented, and difficult to navigate. This system, focused on disease-specific care delivered by specialists, often treats patients as the objects of care rather than as partners in care.

Envisioning a New Health Care System for America.

Between August 2013 and April 2014, eight family medicine organizations convened to develop a strategic plan and communication strategy for how our discipline might partner with patients and communities to build a new foundation for American health care. An outline of this initiative, Family Medicine for America's Health (FMAHealth), was formally announced to the public in October 2014. The purpose of this paper and the five papers to follow is to describe the guiding principles of FMAHealth in greater detail.

Advancing the Integration of Population Medicine into Medical Curricula at The Warren Alpert Medical School of Brown University: A New Master's Degree Program.

Additional knowledge, attitudes and skills are required for the next generation of medical students as they expand the traditional focus on individual patients to include population-based health and scholarly investigation. The Warren Alpert Medical School of Brown University (AMS) is initiating a master's degree program as a key component of the new Primary Care-Population Medicine program at AMS leading to both a Doctorate in Medicine (MD) and Master of Science in Population Medicine (ScM) degrees in four years. The ScM is composed of a series of nine courses, integrated into the four-year MD curriculum, as well as a thesis.