Despite increased awareness of persistent healthcare disparities, integrating health equity education into medical residency curricula needs urgent expansion. The Accreditation Council for Graduate Medical Education (ACGME) mandates addressing healthcare disparities and social determinants of health, but implementation remains insufficient due to pervasive barriers. To explore residency faculty perspectives at one institution surrounding implementing a health equity curriculum within their programs. Between November 2022 and April 2023, qualitative interviews and focus groups were conducted with residency faculty participants (n = 13) from a large academic medical institution. Participants were recruited via an internal email list directory of program directors. Semi-structured sessions explored faculty perspectives on health equity curriculum implementation. Data analysis utilized template analysis and thematic coding. Faculty perceived barriers included limited time for teaching health equity, challenges in prioritizing health equity content within the curriculum, lack of formal training and expertise, discomfort in leading discussions, and institutional barriers such as resource allocation and lack of buy-in. Findings underscored the need for institutionally supported faculty development and protected learning time for health equity education. Despite participant recruitment and representation limitations, the study provides valuable insights for addressing curricular challenges. This study highlights critical areas for improving health equity curriculum implementation in graduate medical education. Addressing these faculty barriers can enhance resident competency in identifying and addressing healthcare disparities. The study received approval from the Thomas Jefferson Institutional Review Board (IRB #22E.762).

OBJECTIVES:Organizations recommend providing confidential adolescent health care to reduce the consequences of high-risk health behaviors such as substance use, unhealthy eating patterns, and high-risk sexual behaviors. Family physicians are uniquely positioned to provide confidential counseling and care to this vulnerable population but must be trained to provide such care. This study describes the impact of formal and informal training on the knowledge of and comfort level in providing confidential adolescent healthcare among a sample of US Family Medicine residents. METHODS:Electronic surveys were distributed to all Family Medicine residents throughout the United States. We used descriptive statistics and χ2 analysis where appropriate to determine the association between resident-reported receipt of training, confidence, and frequency in providing confidential adolescent health care. RESULTS:A total of 714 Family Medicine residents completed the survey. The majority reported no formal training in residency (50.3%). The receipt of formal and informal training in both medical school and residency was associated with a greater degree of comfort in providing confidential adolescent care and a higher likelihood of providing confidential time alone. Those reporting formal training were more likely to always provide confidential care (P = 0.001). CONCLUSIONS:Training focused on confidential adolescent health care in medical school or residency was associated with a greater degree of comfort and a higher likelihood of providing confidential adolescent health care.

Departments of family medicine are centered around the tripartite mission of education, research, and clinical care. Historically, these three missions have been balanced and interdependent; however, changes in the funding and structures of health systems have resulted in shrinking education and research missions and an increased emphasis on clinical care. In the wake of waning state and federal contributions to primary care research, many departments of family medicine have adopted a private practice approach. This approach is centered on generating revenue for the institution, incentivizing physicians to remain clinically focused through productivity and intense attention to volume targets. As a department’s focus shifts to the clinical care mission, education and research are increasingly neglected and underresourced. Meanwhile, the administrative burden of electronic health records (EHRs) has further encroached on time previously allocated to research, with the EHR burden disproportionately affecting the primary care workforce. To counteract mission competition in departments of family medicine and to recover the vital missions of education and scholarship, devising a clear plan for reclaiming and sustaining a tripartite mission is important. Advocating for increased primary care research funding, enhancing EHRs, balancing clinical and education metrics, and supporting primary care research, especially for groups underrepresented in medicine, are interventions to help fully support education and research missions and to recover and sustain mission balance in departments of family medicine.

Differential rewarding of work and experience has been a longtime feature of academic medicine, resulting in a series of academic disparities. These disparities have been collectively called a cultural or minority "tax," and, when considered beyond academic medicine, exist across all departments, colleges, and schools of institutions of higher learning-from health sciences to disciplines located on university campuses outside of medicine and health. A shared language can provide opportunities for those who champion this work to pool resources for larger impacts across the institution. This article aims to catalog the terms used across academic medicine disciplines to establish a common language describing the inequities experienced by Black, Latinx, American Indian/Alaska Native and Native Hawaiian/Other Pacific Islander, Women, and other underrepresented people as well as queer, disabled, and other historically marginalized or excluded groups. These ideas are specific to academic medicine in the United States, although many can be used in academic medicine in other countries. The terms were selected by a team of experts in equity, diversity, and inclusion, (EDI) who are considered national thought leaders in EDI and collectively have over 100 years of scholarship and experience in this area.

BACKGROUND AND OBJECTIVES: While there is increased attention to underrepresented in medicine (URiM) faculty and students, little is known about what they value in faculty development experiences. METHODS: We performed a URiM-focused. 3-day family medicine faculty development program and then collected program evaluation forms. The program evaluations had open-ended questions and a reflection on the activity. We used inductive open coding using NVivo software. We analyzed open-ended responses and reflections, and identified themes. RESULTS: Seven participants provided reflections on the workshop and responses to the evaluation forms. Analysis revealed four major themes in the learners' responses and reflections: (1) personalizing learning, (2) impacting career trajectories, (3) clarifying the writing process, and (4) creating a safe place, with frequencies of 28.2%, 26.7%, 23.6%, and 20.9%, respectively. CONCLUSIONS: Although this faculty development experience was designed to teach writing skills to URiM junior faculty, their collective responses indicate that they found value beyond the skills taught and appreciated the approach taken in this activity.

The COVID-19 pandemic resulted in rapid telemedicine implementation. This study aimed to identify mean differences in telehealth maternity care provided by perceived patient acceptability and clinician satisfaction, and to determine the association between acceptability, satisfaction, and perceived anticipation of long-term telehealth utilization in family medicine maternity care. Data from the 2020 Council of Academic Family Medicine Educational Research Alliance general membership survey of family medicine educators and practicing clinicians were analyzed. Respondents who reported providing maternity care in the 12 months preceding the survey were included (N = 290). Descriptive statistics were calculated. ANOVA was used to determine the mean difference in percent maternity care provided by reported clinician satisfaction and perceived patient acceptability. Logistic regression models were fit to determine associations between perceived telehealth satisfaction and acceptability with long-term use. The sample was 67 percent female, 85 percent white, mean age of 45 years (SE = .63). 51 percent reported total prenatal visits decreased since pandemic onset. Greater agreement with perceived patient telehealth acceptability (OR = 3.73 , 95 percent CI 1.09, 12.71) and clinician telehealth satisfaction (OR = 3.72 , 95 percent CI 1.40, 9.86) was significantly associated with anticipated long-term usage. Perceived patient telehealth acceptance and clinician satisfaction were significantly higher among clinicians providing more telehealth and positively associated with anticipated long-term use.

Objectives The diversity of the US physician workforce lags significantly behind the population, and the disparities in academic medicine are even greater, with underrepresented in medicine (URM) physicians accounting for only 6.8% of all US medical school faculty. We describe a "for URM by URM" pilot approach to faculty development for junior URM Family Medicine physicians that targets unique challenges faced by URM faculty. Methods A year-long fellowship was created for junior URM academic clinician faculty with funding through the Society of Teachers of Family Medicine Project Fund. Seven junior faculty applied and were accepted to participate in the fellowship, which included conference calls and an in-person workshop covering topics related to writing and career advancement. Results The workshop included a mix of prepared programming on how to move from idea to project to manuscript, as well as time for spontaneous mentorship and manuscript collaboration. Key themes that emerged included how to address the high cost of the minority tax, the need for individual passion as a pathway to success, and how to overcome imposter syndrome as a hindrance to writing. Conclusions The "for URM by URM" approach for faculty development to promote writing skills and scholarship for junior URM Family Medicine physicians can address challenges faced by URM faculty. By using a framework that includes the mentors' lived experiences and creates a psychological safe space, we can address concerns often overlooked in traditional skills-based faculty development programs.

We read with great interest the paper by Bliss et al on the University of Utah Health Sciences Learning, Engagement, Achievement, and Progress (HS-LEAP) program's provision of longitudinal support and mentorship for underrepresented in medicine (URM) students. 1 The authors reported less than half of accepted students completed the program and suggested the attrition may be partially due to student specific deficits.In addition to student deficiency concerns, the leaky pipeline of diversity-focused programs also represents the need for academic institutions in general to take an inward look to determine how systems and processes should change to improve URM student retention and promote their advancement.The problem isn't always with the URM student.Students included as underrepresented in medicine were American Indian/Alaska Native, Black, Latinx, Pacific Islander, Southeast or Refugee Asians, and those from lower socioeconomic and rural backgrounds.The Association of American Medical Colleges does not provide recommendations for the implementation of pipeline programs, and as such, there are no requirements to address the societal bias and racism that contribute to low numbers of underrepresented minorities in medicine. 2 It is important for pipeline programs to address racism, isolation, low institutional expectations and privilege systems as they impact the success of URM learners. 3 Working from a skills-based only model, or a learner deficiency only model, is to deny the fact that race and racism make up part of a URM learner's identity and life experiences, and impact how the learner learns.Academic leaders must dismantle institutional systems and policies that advantage some learners and disadvantage others.For example, concerns about bias have been raised in medical school admissions and the Alpha Omega Alpha honors society. 4Academic leaders must promote equity for URM learners and ensure an academic environment that is inclusive and enriching.They must provide funding for URM-specific programing, and advocate for campus-wide policies that support this group. 5 We commend Dr Bliss and colleagues for their meaningful work in this longitudinal pipeline program and the successes they share despite challenges reported with attrition.The continued success of pipeline programs depends not only on learner ability, but also the academic environment in which the learner is placed.This letter is a call to action for all academic institutions with pipeline programs to look at their academic environments to dismantle systems of racism and privilege that impact the academic success of URM learners.The time is now.

We are living in unprecedented times. While the world is grappling with COVID-19, we find the horrors of racism looming equally large as we, yet again, confront lurid deaths in the center of the news cycle of Black and brown people from police bias and brutality. Those of us who have been championing anti-racism and justice work and bearing the burden of the "minority tax" have been overwhelmed by sudden asks from our well-intentioned White colleagues of how to best respond. In the tone of the Netflix series, "Dear White People," we further emphasize that we are not alone in trying to reach out to you, our White colleagues and leaders. Please hear our story and heed our call to action.

There have been ongoing efforts to increase the presence of underrepresented minorities in medicine (URMM), including faculty development initiatives, mentoring programs and outreach efforts. However, URMM faculty face unique challenges that are crucial for academic institutions and leaders to recognize in order to improve retention of this group and allow for meaningful advancement in the field. This paper introduces the concept of gate blocking, defined as what happens to minority faculty as a result of the consequences of the minority tax and systems designed to advantage some and disadvantage others. In addition to defining gate blocking, the authors make recommendations to address this concern in academic medicine and promote the advancement and retention of URMM faculty.

BACKGROUND AND OBJECTIVES The population surrounding an urban federally qualified health center (FQHC) in Philadelphia has poorer health than Philadelphia overall. Community residents identified aerobics and dance classes as very important services or programs that an FQHC might provide. We sought to measure the impact of participation in a resident physician-led, patient-centered fitness and nutrition class on participants' attitudes, knowledge, and self-efficacy regarding their health. METHODS An urban line dancing class and brief healthy eating intervention for adults was held at a YMCA adjacent to a residency-affiliated FQHC weekly for 8 weeks. Pre/postsurveys were administered to assess attitudes and confidence toward physical activity and healthy lifestyles. RESULTS Participants' self-assessment of health and levels of physical activity improved. Confidence in performing everyday activities, doing regular exercise and exercising without making symptoms worse increased. A significant decrease in participants' physical activity gratification was observed. Participants' confidence improved in reading food labels for health, but confidence in eating a balanced diet did not improve. CONCLUSIONS A resident-led fitness and nutrition class, tailored to perceived community needs, generated significant interest and sustained participation. This pilot study furthered development of community infrastructure addressing health, nutrition, and overall fitness, and the results reflect opportunities and challenges of engaging communities in physical fitness.

A man presented with a rash over much of his body that had steadily spread over one year. The rash covered his limbs, including his palms and soles, and his ears.

BACKGROUND AND OBJECTIVES:Elevated blood lead levels have well-described detrimental effects to growth and development in children, yet screening rates remain low. We sought to determine if a reminder within the electronic health record (EHR) could change provider behavior and improve blood lead level (BLL) screening test ordering rates in an urban academic family medicine practice.METHODS:Baseline BLL test ordering rates were calculated for children ages 9-72 months. An update adding reminders to screen was made to the electronic note template used during pediatric well and sick visits at the practice. Data from the 10-week periods both before and after the change was made were compared through a retrospective chart review.RESULTS:A total of 210 children were seen during the pre-intervention period. Forty-eight percent (n=101) had already been screened. Of the 109 eligible for screening, 23 had tests ordered, and 18 of those had tests completed. Eighty-four children were eligible for screening in the post-intervention period. Forty-one of those children had tests ordered, and 15 had tests completed. Provider ordering rates increased from 21% of eligible patients to 49%. Test completion rates only increased from 17% to 18%.CONCLUSIONS:An electronic note-based reminder system significantly improves provider ordering rates of BLL tests. Researchers are currently investigating how the use of point-of-care BLL sample collection can improve test completion rates and therefore increase the frequency of successful screening.

Women with gestational diabetes (GDM) have a fivefold higher risk of developing type 2 diabetes (T2DM). Furthermore, Hispanic and African-American women are disproportionately affected by GDM, but their views on prevention of T2DM after gestational diabetes are largely unknown. We conducted semi-structured interviews with 23 women (8 Hispanic, 8 African-American, 7 non-Hispanic White) from two academic clinics in Chicago, IL. Interview questions elicited perspectives on prevention of T2DM; the interview protocol was developed based on the Health Belief Model. Two investigators applied template analysis to identify emergent themes. Women conceptualized risk for T2DM based on family history, health behaviors, and personal history of GDM. A subgroup of women expressed uncertainty about how GDM influences risk for T2DM. Women who described a strong link between GDM and T2DM often viewed the diagnosis as a cue to action for behavior change. T2DM was widely viewed as a severe condition, and desire to avoid T2DM was an important motivator for behavior change. Children represented both a key motivator and critical barrier to behavior change. Women viewed preventive care as important to alert them to potential health concerns. Identified themes were congruent across racial/ethnic groups. Diagnosis with GDM presents a potent opportunity for engaging women in behavior change. To fully harness the potential influence of this diagnosis, healthcare providers should more clearly link the diagnosis of GDM with risk for future T2DM, leverage women’s focus on their children to motivate behavior change, and provide support with behavior change during healthcare visits in the postpartum period and beyond.