James M. Cooke

Institution-Specific Factors Associated With Family Medicine Residency Match Rates

ABSTRACT Phenomenon: Existing research provides little specific evidence regarding the association between public and private medical school curricular settings and the proportion of medical students matching into family medicine careers. Institutional differences have been inadequately investigated, as students who match into family medicine are often consolidated into the umbrella of primary care along with those matching in internal medicine and pediatrics. However, understanding medical school contexts in relation to career choice is critical toward designing targeted strategies to address the projected shortage of family physicians. This study examines factors associated with family medicine residency match rates and the extent to which such factors differ across medical school settings. Approach: We combined data from a survey of 123 departments of family medicine with graduate placement rates reported to the American Academy of Family Physicians over a 2-year period. Chi-square/Fishers Exact texts, t tests, and linear regression analyses were used to identify factors significantly associated with average match rate percentages. Findings: The resulting data set included 85% of the U.S. medical schools with Departments of Family Medicine that reported 2011 and 2012 residency match rates in family medicine. Match rates in family medicine were higher among graduates of public than private medical schools—11% versus 7%, respectively, t(92) = 4.00, p < .001. Using a linear regression model and controlling for institutional type, the results indicated 2% higher match rates among schools with smaller annual clerkship enrollments (p = .03), 3% higher match rates among schools with clerkships lasting more than 3 to 4 weeks (p = .003), 3% higher match rates at schools with at least 1 family medicine faculty member in a senior leadership role (p = .04), and 8% lower match rates at private medical schools offering community medicine electives (p < .001, R2 = .48), F(6, 64) = 9.95, p < .001. Three additional factors were less strongly related and varied by institutional type—informal mentoring, ambulatory primary care learning experiences, and institutional research focus. Insights: Educational opportunities associated with higher match rates in family medicine differ across private and public medical schools. Future research is needed to identify the qualitative aspects of educational programming that contribute to differences in match rates across institutional contexts. Results of this study should prove useful in mitigating physician shortages, particularly in primary care fields such as family medicine.

An approach to value-based simulator selection: The creation and evaluation of the simulator value index tool

Background. Currently there is no reliable, standardized mechanism to support health care professionals during the evaluation of and procurement processes for simulators. A tool founded on best practices could facilitate simulator purchase processes. Methods. In a 3‐phase process, we identified top factors considered during the simulator purchase process through expert consensus (n = 127), created the Simulator Value Index (SVI) tool, evaluated targeted validity evidence, and evaluated the practical value of this SVI. A web‐based survey was sent to simulation professionals. Participants (n = 79) used the SVI and provided feedback. We evaluated the practical value of 4 tool variations by calculating their sensitivity to predict a preferred simulator. Results. Seventeen top factors were identified and ranked. The top 2 were technical stability/reliability of the simulator and customer service, with no practical differences in rank across institution or stakeholder role. Full SVI variations predicted successfully the preferred simulator with good (87%) sensitivity, whereas the sensitivity of variations in cost and customer service and cost and technical stability decreased (≤54%). The majority (73%) of participants agreed that the SVI was helpful at guiding simulator purchase decisions, and 88% agreed the SVI tool would help facilitate discussion with peers and leadership. Conclusion. Our findings indicate the SVI supports the process of simulator purchase using a standardized framework. Sensitivity of the tool improved when factors extend beyond traditionally targeted factors. We propose the tool will facilitate discussion amongst simulation professionals dealing with simulation, provide essential information for finance and procurement professionals, and improve the long‐term value of simulation solutions. Limitations and application of the tool are discussed.

The Use of Simulation in Continuing Professional Development: A Comparison of Family Physicians’ Awareness in Mersin and in Ann-Arbor

Introduction: With the intent to promote using simulation in Continued Professional Development (CPD) in Turkey, we examined Turkish Family Medicines (FM) in Mersin and United States FMs in Ann-Arbor attitudes toward simulation and resources used in CPD programs to identify preferred teaching methods and subject areas that might benefit from the use of simulation for training. Method: A survey-based needs assessment was disseminated via email to FM Associations in Mersin (MAHDER) and in Ann-Arbor (AFMRD). Participants completed the 2-part survey that included demographics and 10 items across three domains (reasons for CPD, preferred resources, learning modalities) rated on 5-point rating scales (5=highest). Top factors and rating differences across participants’ country, gender, stage in career, were evaluated using a many-facet Rasch model. Results: Two-hundred, seventy-three FMs completed the survey. Top reason for participation in CPD was “Willingness to try new things” for both FMs in Mersin and Ann-Arbor. FMs in Mersin indicated “Simulation-based training” had higher importance as a learning modality than FMs in Ann-Arbor, but reported less use of simulation for CPD. Other detailed findings and their implications are discussed. Conclusions: Findings suggest that FMs in Mersin feel that simulation is an important educational modality for CPD but it is not widely employed. This suggests that there are opportunities for the development of novel, simulation-based CPD curricula targeted to FM physicians in Mersin. with potential expansion to other developing countries. Giris: Turkiye’de, Surekli Mesleki Gelisim (SMG) de simulasyon kullanimini tesvik etmek amaciyla, Turkiye’nin Mersin ilindeki aile hekimleri ile Amerika’nin Ann-Arbor bolgesindeki aile hekimlerinin egitimlerinde simulasyon kullaniminin, hangi egitim metodlarinda ve konu alanlarinda fayda saglayabilecegini belirlemek icin SMG programlarinda simulasyon ve kaynak kullanim aliskanliklari arastirildi. Yontem: Mersin (MAHDER) ve Ann-Arbor (AFMRD) aile hekimleri derneklerine mail yoluyla degerlendirme anketleri gonderildi. Katilimcilarin tamamladiklari anket, demografik verileri ve uc alani kapsayan (SMG sebepleri, tercih edilen kaynaklar, ogrenim modaliteleri) 5 lik skalada degerlendirilen (5= en yuksek) 10 soruluk 2 kisimdan olusmustu. Katilimcilarin ulke, cinsiyet, ve kariyerlerine gore temel faktorler ve puanlama farkliliklari many-facet Rasch teknigi kullanilarak degerlendirildi. Bulgular: 273 aile hekimi anketi tamamladi. Mersin ve Ann-Arbor daki aile hekimlerinin herikisi icin de, SMG’ye katilimda en onemli faktor “yeni seyleri denemeye isteklilik’’ idi. “Simulasyon temelli egitimi’’ bir ogrenme sekli olarak, Mersin’deki aile hekimleri, “Ann-Arbor’’ daki aile hekimlerine gore daha onemli bulduklarini, ancak SMG’de daha az kullandiklarini belirttiler. Diger sonuclar ve uygulamalar tartisildi. Sonuc: Bu bulgular, Mersin’deki aile hekimlerinin SMG’de simulasyon kullaniminin onemli bir egitim sekli oldugunun farkinda olduklarini ancak yaygin olarak kullanmadiklarini gostermistir. Bu durum Mersin’deki ve diger gelismekte olan ulkelerdeki aile hekimlerine yonelik yeni, simulasyona dayali SMG mufredatinin gelistirilmesi icin firsatlar oldugunu onermektedir.

Using Simulation-Based Education to Improve Residents’ Clinical Decision Making Skills in Developing Countries

Background: Recently, a significant increase occured in the use of medical simulation technology for teaching and assessment. Improved patient safety during medical education has driven simulation-based education (SBE), particularly in resident education. Although many countries have integrated SBE into their undergraduate programs, some developing countries, including Turkey, have been slow to apply SBE into their graduate programs. We propose a review of existing examples of SBE used which may promote the implementation of similar curricula in developing countries. Methods: To derive a representative sample of relevant curricula, we performed a web-based literature review using the search terms “simulation” and (“ graduate, resident”) and (“clinical decision-making” or ‘‘clinical reasoning”) and “training’’. Results: Of the 83 original articles, ten resulting articles were relevant to SBE used to support residents’ clinical decision-making in six clinical areas. We summarize the ten curricula and discuss them in the context of three primary considerations (course administration, content development, and assessment program evaluation) so they may be applied in similar graduate curricula in Turkey and others. Conclusions: It is obvious that simulation-based education offers benefits. In particular, graduate-level training programs used to support clinical decision-making are critical to the development of competent physicians around the world.

Simulation in Family Medicine

Family medicine trainees must master an ever-growing body of knowledge and clinical competencies in order to prepare for practice in the rapidly changing primary care work environment. Because patient demographics and the medical conditions encountered by trainees vary within and across family medicine programs, it is often difficult for educators to maintain consistency in the provision of clinical training experiences. Simulation, although relatively new to family medicine education, offers a mechanism by which greater consistency can be achieved and holds the potential to enhance training in many aspects of patient care including procedural, inpatient, and outpatient skill development. This chapter provides an overview of the current state of the science and art of simulator use in the field of family medicine. Discussion begins with a review of simulator use in medical school and residency training curricula, professional certifications, and continuing medical education. Application of simulation to clinical competency assessment is also explored. The chapter concludes with a discussion of the potential challenges to successful implementation and the anticipated benefits of extended simulator use within the family medicine training environment.