Leslie A. Wimsatt

A Team-Based Approach to Providing Asthma Action Plans

Background: National guidelines for treatment of asthma include recommendations for providing written asthma action plans (AAPs) to improve outcomes through patient self-management. However, AAP completion rates remain limited in practice. Methods: We developed a team-based approach for the delivery of care to asthma patients in a primary care setting that involved integration of an electronic clinical quality management system and provision of written AAPs by registered nurses. Results: The percentage of patients with AAPs increased after implementation of clinical reminders and nurse-led provision of written AAPs. Conclusion: Proper training, use of an electronic clinical reminder system, and enhanced engagement of registered nurses can improve AAP completion rates in a team-based primary care setting.

Predictors of Depression Stigma in Medical Students: Potential Targets for Prevention and Education.

INTRODUCTION Suicide rates are higher among U.S. physicians than the general population. Untreated depression is a major risk factor, yet depression stigma presents a barrier to treatment. This study aims to identify early career indications of stigma among physicians-in-training and to inform the design of stigma-reduction programs. METHODS A cross-sectional student survey administered at a large, Midwestern medical school in fall 2009 included measures of depression symptoms, attitudes toward mental health, and potential sources of depression stigma. Principal components factor analysis and linear regression were used to examine stigma factors associated with depression in medical students. RESULTS The response rate was 65.7%, with 14.7% students reporting a previous depression diagnosis. Most students indicated that, if depressed, they would feel embarrassed if classmates knew. Many believed that revealing depression could negatively affect professional advancement. Factor analyses revealed three underlying stigma constructs: personal weakness, public devaluation, and social/professional discrimination. Students associating personal weakness with depression perceived medication as less efficacious and the academic environment as more competitive. Those endorsing public stigma viewed medication and counseling as less efficacious and associated depression with an inability to cope. Race, gender, and diagnosis of past/current depression also related to beliefs about stigma. Depression measures most strongly predicted stigma associated with personal weakness and social/professional discrimination. CONCLUSIONS Recommendations for decreasing stigma among physicians-in-training include consideration of workplace perceptions, depression etiology, treatment efficacy, and personal attributes in the design of stigma reduction programs that could facilitate help-seeking behavior among physicians throughout their career.

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.

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.