Alexander W. Chessman

Applying Theory to Assess Cultural Competency

Abstract Using a theoretical cultural competency model, the effectiveness of a cultural competency learning assignment was examined to determine: 1) students’ cultural competency levels as reflected through the assignment, and 2) the effectiveness of the assignment as a cultural competency learning activity. Third-year family medicine clerkship students completed a required project to research and reflect upon a patient’s “cultural belief.” Applying a model of cultural competence development, a content analysis of written project reports determined what level of cultural competence was expressed by students’ reflections. Results indicated16% of students were at “no insight”, 18% at “minimal emphasis” and 66% at “acceptance.” While many students expressed an “acceptance” competence level, not all students expressed the desired level of acceptance about the role of cultural beliefs in medical care. Application of a cultural competency theory to assess learners permits educators to frame performance changes within the context of competency achievement and determine if desired levels of competency have been achieved.

Medical students' abilities to take an occupational history : Use of the WHACS mnemonic

This study examined medical students’ use of the WHACS mnemonic during an occupational history objective structured clinical examination station. Students’ performance on the 10 content-specific station items was calculated. Factor analysis of the items was conducted, and student demographic and academic characteristics associated with performance on the station were examined. A total of 205 students completed the station. The mean number of correct responses was 5 (SD, 1.6). Students performed well on some items and less well on others. Factor analysis supported the WHACS framework. There were no significant associations with student demographic or academic characteristics. Students were aware of the particular features of an occupational history but were deficient in other areas; this awareness was not related to demographic or academic characteristics. The WHACS mnemonic could be an effective tool to teach occupational history–taking skills.

Faculty Development for Medical School Community-based Faculty: A Council of Academic Family Medicine Educational Research Alliance Study Exploring Institutional Requirements and Challenges

Purpose Community-based faculty play a large role in training medical students nationwide and require faculty development. The authors hypothesized that positive relationships exist between clerkships paying preceptors and requiring faculty development, and between protected clerkship directors’ time and delivering face-to-face preceptor training, as well as with the number or length of community-based preceptor visits. Through under standing the quantity, delivery methods, barriers, and institutional support for faculty development provided to community-based preceptors teaching in family medicine clerkships, best practices can be developed. Method Data from the 2015 Council of Academic Family Medicine’s Educational Research Alliance survey of Family Medicine Clerkship Directors were analyzed. The cross-sectional survey of clerkship directors is distributed annually to institutional representatives of U.S. and Canadian accredited medical schools. Survey questions focused on the requirements, delivery methods, barriers, and institutional support available for providing faculty development to community-based preceptors. Results Paying community-based preceptors was positively correlated with requiring faculty development in family medicine clerkships. The greatest barrier to providing faculty development was community-based preceptor time availability; however, face-to-face methods remain the most common delivery strategy. Many family medicine clerkship directors perform informal or no needs assessment in developing faculty development topics for community-based faculty. Conclusions Providing payment to community preceptors may allow schools to enhance faculty development program activities and effectiveness. Medical schools could benefit from constructing a formal curriculum for faculty development, including formal preceptor needs assessment and program evaluation. Clerkship directors may consider recruiting and retaining community-based faculty by employing innovative faculty development delivery methods.

The role of Balint group training in the professional and personal development of family medicine residents

This paper presents a study based on the participation of PGY2 and PGY3 family medicine residents in Balint seminars that occurred twice monthly for 24 months. Balint groups were cofacilitated by leader pairs experienced with the Balint method. Prior to residency graduation, 18 of 19 eligible resident physicians (94.5%) completed 30- to 60-min semistructured interviews conducted by a research assistant. Resident physicians were told that these individual interviews concerned “…how we teach communication in residency.” The deidentified transcripts from these interviews formed the raw data that were coded for positive (n = 9) and negative (n = 3) valence themes by four faculty coders utilizing an iterative process based on grounded theory. The consensus positive themes included several elements that have previously been discussed in published literature concerning the nature of Balint groups (e.g., being the doctor that the patient needs, reflection, empathy, blind spots, bonding, venting, acceptance, perspective taking, and developing appreciation for individual experiences). The negative themes pointed to ways of possibly improving future Balint offerings in the residency setting (repetitive, uneasiness, uncertain impact). These findings appear to have consistency with seminal writings of both Michael and Enid Balint regarding the complex nature of intrapsychic and interpersonal skills required to effectively manage troubling doctor–patient relationships. The implications of findings for medical education (curriculum) development as well as future research efforts are discussed.

Creating a Centralized Infrastructure to Facilitate Medical Education Research

PURPOSE Building research capacity and increasing scholarly productivity are identified needs of the specialty of family medicine. The Accreditation Council for Graduate Medical Education (ACGME) has increased the scholarly requirements for residency programs, placing even more pressure on faculty to be productive in the scholarly realm. The Council of Academic Family Medicine Educational Research Alliance (CERA) was created by volunteer members of the specialty with shared interests in overcoming barriers and increasing scholarly production. METHODS CERA has developed the infrastructure and expertise to regularly conduct omnibus surveys of key family medicine educational leaders. Proposals are centrally collected and competitively chosen. The omnibus survey process includes collaboration with experienced mentors, centralized institutional review board clearance, pilot testing, and centralized data collection. The survey results are disseminated back to research teams for presentation and publication of the findings. RESULTS To date, over 115 research teams have had their projects included in CERA omnibus surveys. Projects have been led by research teams from across the country and with a wide variety of research experience. This collaborative work has resulted in more than 75 scientific presentations and over 55 peer-reviewed papers in the medical literature. The raw data are now available online and serve as a repository for future secondary analysis and as an educational resource. CONCLUSIONS The CERA infrastructure has allowed a large number of research teams to conduct meaningful scholarship at a fraction of the typical cost in terms of time and energy. CERA has expanded family medicine research by removing barriers for teams with limited experience or resources.

Review: Acetaminophen reduces acute migraine pain in adults

Source Citation Derry S, Moore RA, McQuay HJ. Paracetamol (acetaminophen) with or without an antiemetic for acute migraine headaches in adults. Cochrane Database Syst Rev. 2010;(11):CD008040. 21069700

Review: Evidence for the effectiveness of prophylactic drugs for tension-type headache in adults is limited

Source Citation Verhagen AP, Damen L, Berger MY, Passchier J, Koes BW. Lack of benefit for prophylactic drugs of tension-type headache in adults: a systematic review. Fam Pract. 2010;27:151-65. 200...