Introduction:Family medicine (FM) residents spend hours working in the electronic health record (EHR). We implemented a multifaceted training program to improve their ability to utilize the EHR. This study analyzed Epic Signal data to assess the impact of that training on their proficiency and efficiency in the system. Methods:We performed a retrospective cohort study using 3 years of monthly data exported from Epic's Signal database for residents in our FM program and programs of internal medicine, obstetrics and gynecology, and pediatrics within our organization. The EHR training program was implemented in FM (and not the other residencies) incrementally across this time frame. We analyzed trends in Epic's proprietary Provider Efficiency Profile Score ("efficiency") and Proficiency Score ("proficiency") for differences in these scores. Results:FM residents demonstrated improved proficiency in EHR use over time compared to the other residencies. No significant changes in efficiency were seen for any group. Conclusion:Epic Signal data provides a tool to study curricular impacts. An EHR training program enhanced FM residents' proficiency but did not improve efficiency.
Introduction:Continuous glucose monitoring (CGM) has become an essential tool in managing diabetes, offering real-time insights that improve patient engagement, decision-making, and clinical outcomes. Despite its benefits, CGM is underutilized in primary care due to perceived complexity and time constraints. This study aimed to enhance health care professionals' understanding of and confidence in prescribing CGM technology through two multidisciplinary, hands-on workshops. Methods:A total of 51 participants, including family medicine residents, faculty, clinical staff, and pharmacists, attended hands-on workshops and wore a CGM for 10-14 days. We analyzed prescribing patterns using EHR data to compare CGM orders placed before and after the workshops. Additionally, we evaluated pre- and postworkshop surveys' changes in participants' comfort, knowledge, and likelihood of recommending CGMs to patients. Results:Results showed a 31% improvement in participants' prescribing patterns of CGMs after holding the workshops. Qualitative feedback highlighted insights into device usability, blood sugar patterns, and patient counseling. Conclusion:This study demonstrates the value of experiential learning in improving health care providers' competence with diabetes technologies. Future research should explore the long-term impact of such training on clinical practice and patient outcomes.
Background:The University of Washington School of Medicine (UWSOM) and other medical schools utilize a distributed medical education (DME) model to train medical students in real-world community settings. An inherent challenge in this model is maintaining high-quality teaching across large geographic areas and clinical settings. This study compares student perceptions of rural and nonrural preceptor teaching in the UWSOM-required clerkships. Methods:Our study analyzed 41,684 medical student evaluations of preceptors from six required clerkships and over 4 clerkship school years. Using the Rural-Urban Commuting Area definitions, we categorized individual evaluations as either "rural" or "nonrural". We used Welch's unpaired t tests and descriptive statistics to compare rural and nonrural evaluation results. Results:The evaluation data showed high ratings of preceptor teaching across all nine teaching evaluation categories for both rural and nonrural preceptors, with mean scores of 5.5 or higher on a 6-point Likert scale. Rural preceptors slightly outperformed their nonrural counterparts in seven out of nine teaching categories, including three categories reaching statistical significance. Conclusions:Results suggest that Liaison Committee on Medical Education standards for comparable educational experiences are being met across distributed sites. We recommend a thematic analysis of student evaluation comments to contextualize the findings reported in our study.
Background and Objectives:As the opioid epidemic continues in the United States, neonatal opioid withdrawal syndrome (NOWS) prevalence is rising. Research has shown positive outcomes from protocols to assess and treat infants with NOWS. A medical student preclinical elective was created to teach students about NOWS, substance use disorders (SUDs), social services, and trauma-informed care. This involved didactics, hospital volunteer experience, and reflection essays. Our study aimed to determine the impact of the course on medical student attitudes and beliefs toward people with SUDs. Methods:Enrolled preclinical medical students completed a pre- and postcourse survey, an adapted 22 question version of the Drug and Drug Problems Perceptions Questionnaire (DDPPQ). We analyzed results through a Wilcoxon signed ranked test and we performed a thematic analysis on students' reflective essays. Results:Twenty students completed the course during the study, with a 95% survey response rate. Survey results showed a statistically significant change between pre- and postcourse responses for seven of the 22 questions, showing positive changes in self-perceived knowledge, respect, and ability to find help. Reflective essays identified major themes of professional identity formation, interdisciplinary values, patient/family perspectives, empathy, and increased knowledge and confidence. Conclusions:Implementing an elective that combines didactics and volunteer experiences can improve medical students' self-reported perceptions of people with SUD and interest in primary care and addiction medicine, a key to continued handling of the opioid epidemic.
Introduction:Poster displays are commonly used to present scholarly activity. Most current research evaluates posters' visual appeal. Isolated studies looking at knowledge transfer have evaluated standalone posters. The innovation of BetterPoster highlighted the idea that design may be as important as poster content for knowledge transfer. The objective of this study was to evaluate the difference in knowledge transfer between poster designs. Methods:We randomized participants to two different poster designs (48 viewed a traditional poster design; 46 viewed the BetterPoster model). We obtained baseline knowledge via anonymous 5-question pretest. Participants viewed their assigned poster then completed a 10-question posttest. Eight questions tested general medicine knowledge about the topic and two questions tested the case's scholarly question and conclusion. We used a full factorial model analysis of covariance (ANCOVA) to analyze test scores between the two posters for the 10-question posttest and the 2-question subset. Results:A total of 94 participants recruited at a family medicine conference completed the study. We conducted a full factorial model ANCOVA of the 10-item posttest summed score, which was not found to be significant. A similar analysis on the two posttest learning point items showed that participants viewing the BetterPoster scored significantly higher, (F [1, 91]=8.00, P=.006). Conclusion:Our study was designed to move past evaluating visual appeal of poster design to effectiveness of knowledge transfer. We found that poster design did not impact knowledge transfer of the general case topic; however, it did improve knowledge related to key concepts of the case.
Introduction:CERA, the Council of Academic Family Medicine (CAFM) Educational Research Alliance, is a collaboration between four family medicine organizations that conduct omnibus surveys of different academic family medicine groups. This paper describes the methodology of the 2025 Clerkship Director (CD) Survey and demographic results of respondents. Methods:Four topics for the annual CD survey were selected via peer review after a call for proposals in early 2025. The survey was sent to clerkship directors via email from June 3, 2025 to July 11, 2025. The demographics of the sampling frame vs sample were compared with χ2 tests to determine if they were representative. Results:One hundred eighty surveys were sent out; after receiving updated clerkship information, the final 2025 pool size was 174 survey recipients (161 in the United States and 13 in Canada). Although there are 43 DO schools in the US, the CD list maintained by STFM lacks these CDs. One hundred CDs responded for a response rate of 57.47%. We compared demographic data of the sampling frame with the sample. There were no significant differences in location, gender, or race/ethnicity. There was a significant difference in underrepresented in medicine status and being a physician. Discussion:2025 CD Survey respondents are representative of CDs. Few CAFM organization members submit to this survey and DO schools have not historically been included so are not represented. Targeted outreach to DO schools to identify their CD is planned prior to the launch of the 2026 CD survey.
Background and Objectives:Clinical preceptors serve a vital role in medical education. Recruiting and retaining clinical preceptors, especially in family medicine, is a growing challenge for US medical schools. This study aimed to investigate the incentives and barriers family physicians at the University of Colorado School of Medicine (CUSOM) face when deciding to serve as clinical preceptors, and to explain why these physicians become, remain, and/or stop serving as preceptors. Method:A cross-sectional survey was distributed to 376 family physicians associated with CUSOM who were active clinical teachers, had been clinical teachers in the past, or were associated with practices that historically had taken medical student learners, with a 60.6% response rate. We calculated descriptive statistics for single-choice, closed-ended survey questions. For the open-ended questions, we adopted a thematic analysis. Results:The results revealed that intrinsic motivators, such as a love for teaching (76.6%), a sense of duty to the profession (67.8%), and relationships with students (58.5%) were the primary reasons that preceptors chose to teach clinically. Conversely, time (an extrinsic factor), was the largest barrier to teaching that current (80.0%) and potential (51.3%) preceptors faced. Conclusions:Our results indicate that family physicians largely balance intrinsic motivators against extrinsic barriers when deciding whether to clinically precept medical students. While a longitudinal integrated clerkship model can amplify the impact of these intrinsic motivators, addressing the preceptor shortage may require focus on the motivators that preceptors report as most meaningful and minimizing the impact of the time burden of teaching.
Introduction:Family medicine contributes less scholarship and receives much less grant money than other specialties. Understanding when and how this disparity begins is a key step in addressing the gap in family medicine scholarship. Methods:We analyzed data from the National Resident Matching Program's (NRMP's) Charting Outcomes in the Match (2016-2024) to compare family medicine applicants with applicants to other specialties (ie, internal medicine, pediatrics, and all specialties combined). We examined the mean number of research experiences and the number of presentations and publications applicants had completed prior to starting residency. Additionally, we analyzed NRMP surveys to evaluate the weight applicants placed on institutional research support when choosing a residency program and the weight program directors placed on applicants' research experience. Results:Family medicine applicants consistently reported fewer research experiences and presentations/publications than applicants to internal medicine, pediatrics, and all specialties combined. Osteopathic applicants showed the lowest research participation across all specialties we compared. Among other specialties, family medicine applicants placed less importance on programs' research support, and family medicine residency program directors were less likely to consider research involvement when selecting applicants. Conclusions:Our results suggest that family medicine's underrepresentation in research begins during the residency application process or sooner. Increased involvement in family medicine research among medical students should be a key component of strategies for bridging the research gap.
Introduction:In regions characterized by limited access to pharmacies-commonly referred to as pharmacy deserts-medication adherence tends to be lower, particularly among underserved and vulnerable populations. Similarly, food deserts denote areas with constrained access to nutritious food options, thereby exacerbating food and nutrition insecurity. While both heavily influence health outcomes, a paucity of literature explores the intersection between pharmacy deserts and food deserts. Methods:We combined two data sets: (a) community/retail pharmacy brand and location data, and (b) the Food Access data set. A scatterplot was created using the transformed values of pharmacies per 1,000 population and Food Access as the x and y coordinates, respectively. The scatterplot was divided into nine parts based on the 33rd and 67th percentile values of both variables, categorized as a combination of low, median, and high pharmacy and food access. For further analysis, we categorized zip codes with limited access by median income ratio, poverty level, and diversity. Results:Overall, approximately one-third of all zip codes exhibited low pharmacy access, and another third demonstrated low food access. About 20% of zip codes experienced both low pharmacy and low food access. As the pharmacy access increased, food access also increased, suggesting that zip codes with greater pharmacy access tend to have disproportionately higher food access, consistent with an exponential-type relationship. Low pharmacy and food access were predominantly in zip codes with higher poverty rates and diversity. Conclusions:Limited access to both pharmacies and nutritious food options places an added burden on vulnerable populations, contributing to challenges in managing chronic diseases and maintaining overall health. This limited accessibility highlights the need for targeted interventions that address these dual resource shortages.
Introduction:Securing peer reviewers for scholarly manuscripts is essential to journal operations but has become increasingly challenging. Previous PRiMER data suggested that reviewer responsiveness has been declining, and we examined whether this decline persisted over time. Methods:We conducted a retrospective secondary analysis of reviewer invitation outcomes for all research manuscripts submitted to PRiMER from 2017 to July 31, 2025. Only invitations for research briefs (n=2,951) across 459 manuscripts were analyzed. Data were extracted from the ScholarOne editorial database. χ2 tests compared acceptance rates over time. Fixed-effect binary logistic regression controlled for individual reviewer behavior to assess linear trends in invitation acceptance and review completion rates. Results:Invitation acceptance peaked at 56.14% in 2020, then declined to 35.71% in 2024 and 38.58% in 2025-the lowest since journal inception. Logistic regression revealed a significant negative annual trend (OR=0.656, P<.001). Review completion rates declined from 89.31% in 2021 to 76.19% in 2025 (OR=0.707, P<.001). Late review rates ranged from 11.97% (2021) to 18.09% (2018) with no significant time trend. Conclusion:Reviewer responsiveness to PRiMER invitations has continued to decline, both in accepting invitations and completing reviews. If similar patterns exist across journals, innovative strategies to recruit, engage, and incentivize reviewers will be necessary to sustain peer review in its current form.
Introduction: Physicians’ biased attitudes toward people who use drugs (PWUD) can impact the care they deliver. Despite recommendations from national organizations, treatment of substance use disorders and harm reduction are often absent from medical school curricula. This absence may influence how medical students, as future physicians, perceive PWUD and therefore, impact the care they provide. Our study aimed to assess medical students’ attitudes and, to a lesser extent, knowledge and self-confidence regarding substance use and harm reduction by identifying factors associated with positive beliefs about PWUD and students’ self-confidence in managing their care. Methods: We emailed an optional, anonymous Qualtrics survey of multiple-choice and Likert-type questions to all students at Florida International University’s Herbert Wertheim College of Medicine (FIU HWCOM). The survey included demographics, prior exposure to PWUD, attitudes regarding drug acceptability, and substance use treatment. Results: Of 496 medical students who received the survey, 172 (34.7%) responded to all questions. The primary outcome was attitudes, while secondary outcomes were knowledge and self-confidence. Clinical students reported significantly more positive attitudes toward PWUD compared with preclinical students. Similarly, students with personal or professional experience with PWUD had more positive attitudes and reported increased knowledge about substance use and treatment. Conclusion: Our findings show that exposure to PWUD may positively impact medical students’ attitudes and knowledge in caring for patients with substance use disorders. However, gaps in knowledge and self-confidence persist, particularly in preclinical years. Introducing harm reduction and substance use topics earlier in the curriculum may address knowledge gaps, shift attitudes, and ultimately equip students to provide equitable care.
Introduction:The Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA) is a collaboration of family medicine education organizations that supports medical educational survey research. CERA regularly conducts surveys of department chairs, clerkship directors, residency program directors, and other members of academic family medicine organizations. This article describes the methodology and demographic results of the spring 2025 CERA Residency Program Director Survey. Methods:CERA received 18 module proposals in response to its call for submissions. After a competitive peer-review process, five proposals were accepted and included in the spring 2025 CERA Residency Program Director Survey. The survey included questions from these five research teams as well as standard demographic questions. The sample included all family medicine residency program directors identified through the CAFM member database and previous CERA surveys. CERA administered the survey from April 22, 2025 through May 23, 2025. Results:Of 726 eligible program directors, 321 responded, resulting in a 44.2% response rate. The demographics of survey respondents did not significantly differ by gender, race/ethnicity, or self-identification as underrepresented in medicine compared to the sample of potential respondents. Conclusions:This paper describes the methods and generalizability of the spring 2025 CERA Residency Program Director Survey. The demographics between survey respondents and potential respondents were not statistically significantly.
Introduction:Over the last three match cycles (2023, 2024, and 2025), a coordinated effort has led family medicine residency applicants to apply to fewer programs, resulting, on average, in 21% fewer US applications for programs to review. Whether this decline is a cause for celebration or concern is unclear. How has the reduction affected the number of applicants programs considered desirable? Methods:For the past 3 years, the Oregon Health & Science University (OHSU) Family Medicine Residency Program (FMRP) has consistently used a two-faculty review process to decide which applicants are invited to interview. We conducted a χ2 test of independence to assess the relationship between the application year and the percentage of applicants invited to interview in the first round. Results:Using 2023 as a baseline, the OHSU FMRP received 15.2% and 33.7% fewer applicants in the 2024 and 2025 match cycles, respectively. Concurrently, 33.7% of applicants in 2024 and 36.4% of applicants in the 2025 match were offered an interview in the first wave of interviews, which is higher than in 2023. Conclusions:These data indicate that although the number of applicants decreased over the last three match cycles, applicant quality has remained consistent. A broader analysis is needed to understand the impact on programs and the factors influencing applicants' choice of programs in the era of virtual interviews and program signaling.
Faculty career advisors (FCAs) are crucial in guiding medical students toward successful National Resident Matching Program outcomes in family medicine. Our specialty is experiencing an evolving landscape, characterized by an increase in postgraduate year-1 positions, shifts in applicant demographics, rising application numbers, and the recent implementation of program signaling and geographic preference setting. This professional development perspective offers FCAs strategies to navigate these complexities beyond Strolling Through the Match and other related materials. Key areas addressed include defining program fit for individual applicants, determining an optimal range of application numbers, and providing tailored advice for diverse student situations including "high-performing," "midrange," "at-risk," dual-specialty, and couples-matching candidates. We explore current insights on navigating virtual versus in-person interviews, strategically utilizing program signals, and successfully managing the Supplemental Offer and Acceptance Program. Our guidance aims to equip FCAs, students, and key stakeholders with practical, anecdotal, and evidence-informed approaches to support all students applying to family medicine in achieving optimal match results.
Background:The quality of and access to care by lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender diverse (LGBTQIA+) patients is often compromised by physician knowledge deficits, bias, and inadequate training in LGBTQIA+ health. Emergency medicine physicians must be prepared to care for LGBTQIA+ patients, but there is a lack of standardized training in LGBTQIA+ health across emergency medicine residencies. We sought to assess current practices and perform a needs assessment of LGBTQIA+ health teaching across a sample of emergency medicine residencies. Methods:Residents from five geographically diverse emergency medicine residencies in the United States were invited to complete an online Qualtrics survey between April 2024 and June 2024. The survey included questions regarding the scope of LGBTQIA+ health exposure in residency as well as delivery preferences to improve LGBTQIA+ health teaching within residency curricula. Results:One hundred residents across the five programs participated in the survey (37% response rate). Most residents reported some exposure to gender-affirming language practices and LGBTQIA+ health disparities. Topics with the least reported coverage were pediatric considerations, legal considerations, and taking an organ inventory. Overall, participants were more comfortable performing clinical care for sexual minority patients than gender minority patients. Suggestions for improving LGBTQIA+ health education emphasized the necessity of incorporating LGBTQIA+ health into the core curriculum and including LGBTQIA+ community members and patients into curricular design and delivery. Conclusions:The results of this study can guide future educational assessment and curricular development efforts to improve LGBTQIA+ health content delivery during emergency medicine residency training.
