Joseph Hobbs

Impact of expanding use of health information technologies on medical student education in family medicine

The call for increased health care quality and access has facilitated the expanded use of health information technology (HIT) in the United States. In hospitals and physicians’ offices, HIT is most likely represented by the electronic health record (EHR) which, when fully deployed, provides

STFM unveils the National Family Medicine Clerkship Curriculum website.

STFM recently unveiled The National Family Medicine Clerkship Curriculum website. It outlines best practices for delivering and evaluating the core curriculum for 3rd-year family medicine clerkships and offers educational methods, assessment strategies, and resources for clerkship directors and medical school faculty. It also lets users see how colleagues are teaching and assessing specific competencies. The website can be accessed by STFM members at http://www.stfm.org/cci. “This resource is really an enhancement to the Family Medicine Clerkship Curriculum. It takes the “what” of the curriculum into mind and delivers users with the “how” of implementing the curriculum in their own departments,” said Katie Margo, MD, University of Pennsylvania. This website is actually the 2nd phase of the curriculum project. It gives clerkship directors and other medical school faculty the tools to implement the National Family Medicine Curriculum. The curriculum defined the core content of a family medicine clerkship and established the goals and objectives; defined principles; listed core conditions for acute presentations, chronic illnesses, and prevention visits; and addressed the role of family medicine. The National Family Medicine Clerkship Curriculum was created for several purposes. A national standard for the clerkship curriculum helps curriculum committees gain a better understanding of the time needed to accomplish the clerkship goals and objectives. Defining the content gives a framework for development of educational resources, such as fmCASES, which can be shared across institutions. Standardized core content helps our representatives who are working with the NBME on the subject examination in family medicine. The National Family Medicine Clerkship Curriculum was designed for clerkship directors and faculty members engaged in 3rd-year medical student education. The content is organized into 4 sections: curriculum competencies and content, clerkship director roles and resources, educational methods, and assessment strategies. The curriculum competencies and content is the work of the first task force, organized to be web friendly. The clerkship director roles and resources outlines the different roles expected of a clerkship director, highlights best bet resources for clerkship directors, and provides some information on fellowships. The educational methods section contains information on 8 common methods: experiential learning, small-group sessions, simulation/standardized patients, skill development sessions, case-based learning, self-study, reflection, and products/projects. For each educational methods topic, there is background information, key questions with short evidence-based responses, best practices, and references. Assessment strategies provide a wealth of information organized into student assessment and evaluation, program evaluation and improvement, faculty development for educational evaluation, and developing an educational research program. The National Family Medicine Clerkship Curriculum website partnered with the STFM Resource Library (http://www.fmdrl.org) to provide peer reviewed curricular pieces that match objectives of the national curriculum. These can be accessed through the clerkship curriculum website. The family medicine Clerkship Curriculum Implementation (CCI) task force solicited curricular pieces that matched objectives in the principles of family medicine section. “Real-world examples of curricula can provide visionary yet practical ways to improve a clerkship,” said Alexander Chess-man, MD, Medical University of South Carolina. The CCI task force focused on the principles section because these objectives are often the most difficult to address and the content addressing these objectives changes less frequently than content addressing many clinical topics. Family medicine educators submitted materials that included all items needed to replicate the curricular experience in another institution. After peer review, 6 submissions were chosen and are currently present on the website. At the time of this writing, these submissions have between 15 and 163 hits each. In the future, additional calls for submissions will occur. This section will develop over time to provide clerkship directors and faculty members with peer reviewed resources that are directly tied to specific objectives of the national family medicine clerkship. The STFM Education Committee has the responsibility for the maintenance and upkeep of the website. This initiative will undergo assessment to ensure that it currently meets and continues to meet the needs of the family medicine clerkship directors and medical student education faculty. The assessment will initially include measurements of website use and national curriculum implementation. The first data review, completed 3 weeks after launch, revealed high use: the website had 2,638 hits with 1,901 unique page views. The Education Committee also holds the responsibility for envisioning and creating version 2.0. In the future, the website may provide more online interaction, networking, or mentoring; serve as a hub for identifying colleagues to collaborate on multi-institutional educational research; or even provide opportunities for CME credit, particularly around assessment. This initiative, developed by STFM, was also supported by the STFM Foundation. This curriculum has also been endorsed by the AAFP and the other Council of Academic Family Medicine organizations: ADFM, AFMRD, and NAPCRG.

Family Medicine Clerkship, Tracks, and Faculty Support for Family Medicine Education in Departments of Family Medicine: An Update

Departments of Family Medicine, while experiencing financial resource diminution, are simultaneously called upon to expand their primary care bases and teaching programs, while building and testing medical homes with a goal of advancing to fiscal independence. These rapid changes, while posing unique opportunities, have the potential to diminish and de-prioritize student education as practice transformation occurs.

White Privilege in Health Care: Following Recognition With Action

I have observed the implications of white privilege from the standpoint of one who does not possess it. This experience leads me to believe that the essay “White Privilege in a White Coat: How Racism Shaped My Medical Education”[1][1] describes one of many places to start on the path of self-

COMMUNITY FACULTY: CAUGHT BETWEEN THE DEAN’S OFFICE, ACADEMIC HEALTH CENTERS, DEPARTMENTS AND THE FISCAL REALITIES OF PRIMARY CARE

Many departments of family medicine are at the threshold of a possible new beginning in undergraduate medical education—a beginning that will provide medical school leaders new opportunities to address anticipated physician workforce shortages and “right-balance” physician specialty and geographic distribution using innovations in curriculum and national testing standards to achieve these changes. This new beginning will usher in expansion of medical schools’ class size as well as the establishment of new medical campuses and schools. This increase in medical school class size will require academic departments of family medicine to expand and reinforce the distributed community-based (and largely volunteer) physician faculty. These community practices provide learning opportunities for students in family medicine clerkships and often “Introduction to Clinical Medicine” courses. Many of the current family medicine community faculty teaching sites already experience “learner-saturation” not only from family medicine clerkship students, but with students from PA, Nursing, Osteopathic, and international schools competing for community clinical teaching placements. Academic departments of family medicine are challenged to maintain and now likely rapidly expand this decentralized model of clinical education. These proposed expansions raise several questions. First, can clinical teaching volunteerism support the magnitude of planned medical school expansion? Second, once voluntary teaching capacity of community faculty is exceeded, can additional capacity be financed with departmental resources? And finally, if departmental resources are inadequate, are medical schools prepared to further support the teaching involvement and necessary educational resources for community faculty? These are questions that many departments are facing or will be facing very soon. The educational model that was first established by family medicine and now used by other primary care departments rests on the tenuous volunteerism of community faculty at a time when primary care practice resources are stressed and volunteerism often is expected by leaders of medical schools and legislators who support these initiatives. Amid medical school expansion, family medicine educators also strive to standardize the community-based learning experience, to conduct meaningful evaluations and to embrace learning within practices that meet the expectations of a patient-centered medical home. The creation of this practice environment is a challenging undertaking for all clinical venues. The requirement of this new practice concept in community-based learning sites will likely decrease access to existing and new community teaching opportunities. We must also ask whether we should expect all community-based teaching sites to accomplish what academic family medicine practices have not yet consistently done. These challenges set the stage for a new model of community-based learning: community faculty potentially compensated for teaching who are members of a learning community in partnership with the academic department and for whom the departments serve as political and educational advocates, quality improvement assistants and providers of continuing medical education. In this new model of community-based learning, the presence of students could potentially be “value-added” for community and academic practices. Value is provided by facilitation of: Performance in Practice Modules as required for maintenance of certification, meaningful “bubble-up” research ideas by community faculty, academic appointments and benefits, and vigorous advocacy with payors and legislators for the appropriate fiscal advancement of primary care and enhanced reimbursement for practices embracing concepts of the patient-centered medical homes and teaching students. It is now time to collect and share best practices that advance the partnership between academic departments of family medicine and community faculty. Collectively we may be able to answer the following critical questions that may be necessary for departments to appropriately respond to this new academic challenge. What are the most successful incentives? What are the best models for faculty development? How can we enhance the learning experiences of community faculty? What is required to facilitate meaningful promotion and advancement for community faculty? How do we select and maintain community faculty committed to the institution’s educational mission? New models of family medicine department/community partnerships will produce educational innovations that include greater identification of appropriate community faculty as equal academic colleagues worthy of additional investments from the department and schools of medicine. Consider the quantitative impact of integrating the estimated 10,000 community faculty (extrapolating from a query of ADFM members in 2004 concerning the number of community faculty) into our departments as partners in the mission of advancing the future of our discipline. Sharing best practices related to relationships with our distributed community faculty across the country will facilitate the development of appropriate responses to the unique opportunities afforded by the changing medical school environment.