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BACKGROUND: Deficiencies in communication among healthcare professionals, recognized by medical educators and healthcare institutions, can negatively impact medical education and clinical practice. Analyzing teacher-resident communication difficulties shed light on this issue and propose practical strategies for its mitigation. OBJECTIVE: To identify common communication challenges between teacher and residents during Family Medicine residency and to analyze their impact on interactions with peers, the work team, and patients. DESIGN: Qualitative study, the critical incident technique was used to collect information of interest. PARTICIPANTS: Seventy teachers, and fifty third-year residents from the Mexican Republic described critical incidents related to their communication experiences during Family Medicine residency. RESULTS: 192 critical incidents were collected (several participants reported more than one incident), comprising 127 reports from teachers, and 65 from residents. Four themes were identified: 1) asymmetric communication, 2) assertive communication, 3) organizational communication, and 4) effective communication. The main challenges identified were abuse of power in communication, lack of communication skills, and the absence of institutional communication channels. These issues significantly impacted learning, work environment, interpersonal relationships, and medical care. CONCLUSION: This study highlights communication issues within Family Medicine residency in Mexico. The issues detected hindered learning and effective collaboration and negatively impacted the work environment, interpersonal relationships, and the quality of medical care. These findings underscore the urgent need to reorient the medical specialty curriculum towards an approach that includes communication skills.

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La distribución inequitativa del talento humano en salud afecta la capacidad de los sistemas de ofrecer servicios esenciales. En la provincia de Córdoba, el primer nivel de atención es responsabilidad de los municipios, pero el nivel provincial procura sostener la rectoría y ser garante del derecho a la salud. En ese marco, se desarrolló un programa para reducir las brechas en la distribución de médicos: el Plan Cordobés de Médicos del Interior. Acompañando ese plan se ejecutó un convenio específico con la Universidad Nacional de Córdoba para garantizar la formación en la especialidad de Medicina Familiar y General. Ingresaron al programa 170 personas, y hoy contamos con 98 médicos en formación o seguimiento. En este artículo damos cuenta de la experiencia docente, los desafíos y dificultades que supuso afrontar una formación en lugares de práctica variados, y con el aporte de las tecnologías de la información y comunicación. Esperamos que la experiencia sirva para transmitir los aprendizajes de nuestra práctica (AU)

The inequitable distribution of human talent in health affects the capacity of systems to offer essential services. In the province of Córdoba, the primary level of care is the responsibility of municipalities, but the provincial level aims to maintain leadership and guarantee the right to health. Within this framework, a program was developed to reduce gaps in the distribution of physicians: the Cordobés Plan for Interior Physicians. Accompanying this plan, a specific agreement was executed with the National University of Córdoba to ensure training in the specialty of Family and General Medicine. 170 individuals entered the program, and today we have 98 physicians in training or under supervision. In this article, we give an account of the teaching experience, the challenges, and difficulties involved in facing training in various practice settings, along with the contribution of information and communication technologies. We hope that this experience serves to transmit the lessons learned from our practice (AU)

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BACKGROUND AND OBJECTIVES: Burnout is prevalent among clinicians and faculty. We sought to understand the impact of a recognition program designed to reduce burnout and affect engagement and job satisfaction in a large academic family medicine department. METHODS: A recognition program was created in which three clinicians and faculty from the department were randomly selected each month to be recognized ("awardees"). Each awardee was asked to honor a person who had supported them (a "hidden hero" [HH]). Clinicians and faculty not recognized or selected as an HH were considered "bystanders." Interviews were completed with 12 awardees, 12 HHs, and 12 bystanders for a total of 36 interviews. We used content analysis to qualitatively evaluate the program. RESULTS: Assessment of the "We Are" Recognition Program resulted in the categories of impact (subcategories: process positives, process negatives, and fairness of program) and HHs (subcategories: teamwork and awareness of the program). We conducted interviews on a rolling basis and made iterative changes to the program based on feedback. CONCLUSIONS: This recognition program helped create a sense of value for clinicians and faculty in a large, geographically dispersed department. It represents a model that would be easy to replicate, requires no special training or significant financial investment, and can be implemented in a virtual format.

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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.

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OBJECTIVES: Primary health care (PHC) is essential for a well-functioning health system. Although PHC has been shown to have adverse effects on health outcomes, many barriers prevent adequate access, including a shortage of primary care physicians. In New Mexico, 32 of 33 counties are designed as primary care health professional shortage areas, and the state has a lower-than-average primary care provider density compared with other states. This study explored the predictors of job placement among New Mexican Family Medicine residents. METHODS: A retrospective cohort study design was used, which included a subset of data from The University of New Mexico (UNM) Family Medicine Residency Alumni Database and hard copy personnel files. The study's population consisted of the 260 graduates from the UNM Family Medicine Residency Program between 1998 and 2019. Analysis included simple and multiple logistic regression. RESULTS: Results indicated that, consistently, approximately two-thirds of first practices are in New Mexico, whereas the percentage with a current practice in New Mexico decreases over time. Those born in New Mexico or who attended the UNM School of Medicine were more likely to have their first and current practice in New Mexico. CONCLUSIONS: The results of this study provide further evidence that the relationship between place of birth and place of medical training are determining factors for both place of first and current practice. These results can inform practice, policy, and future research to address the pressing need for PHC in underserved and rural communities.

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Background: Communication in the health field is essential, since it depends on it that the physician has complete and accurate information to carry out the fulfillment of his functions. The relationship with the medical staff leads the patient to feel listened to and cared for, in order to understand their state of health. Objective: To know the perception of patients about the communicative competence of family physicians during the consult at the Family Medicine Unit No. 27. Material and methods: Descriptive and cross-sectional study that identifies patients who attended Family Medicine Unit No. 27 in Tijuana in September 2021. The Communication Assessment Tool was applied to participants to measure the perception of communicative competence of doctors. The responses obtained were collected and analyzed with descriptive statistics. Results: 200 patients who met selection criteria were studied, made up of patients on morning and afternoon shifts equally. 54.6% of the studied population considers the communicative competence of family doctors to be excellent. Conclusions: The communicative competence in the family physicians of the studied unit had a better result than others studies of several countries; however, it has areas of opportunity to optimize this competence, since medical knowledge must include the area of communication and interpersonal relationships.

Introducción: la comunicación en el ámbito de la salud es fundamental, pues de ella depende que el médico cuente con información completa y precisa para realizar el cumplimiento de sus funciones. La vinculación con el personal médico conlleva al paciente a sentirse escuchado y atendido, a fin de que se comprenda su estado de salud. Objetivo: conocer la percepción de los pacientes acerca de la competencia comunicativa de los médicos familiares durante la consulta en la Unidad de Medicina Familiar No. 27. Material y métodos: estudio descriptivo y transversal en el que se identifica a pacientes que acudieron a la Unidad de Medicina Familiar No. 27 de Tijuana en septiembre de 2021. Se aplicó el instrumento Communication Assessment Tool a participantes para medir la percepción de la competencia comunicativa de los médicos. Se recolectaron las respuestas obtenidas y se analizaron con estadística descriptiva. Resultados: se estudiaron 200 pacientes que cumplieron criterios de selección, conformados por pacientes de turno matutino y vespertino equitativamente. El 54.6% de la población estudiada considera excelente la competencia comunicativa de los médicos familiares. Conclusiones: la competencia comunicativa en los médicos familiares de la unidad estudiada tuvo un mejor resultado que el de varios países; sin embargo, cuenta con áreas de oportunidad para optimizarla, ya que el conocimiento médico debe incluir el rubro de de comunicación y relaciones interpersonales.

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OBJECTIVE: To describe the sociodemographic profile and analyze the migratory characteristics of the members of the Residency Programs in Family Medicine in 2020 in Brazil. METHODS: The study follows a cross-sectional observational design of a quantitative nature from the perspective of the members of the Residency Programs in Family Medicine. Questionnaires adapted for each participating group were developed, applied through an online platform. RESULTS: Most participants are female and white. Most supervisors and preceptors were residents of Residency Programs in Family Medicine, however, there are some who are not specialists in the field. Most participants are based in capitals or metropolitan regions. In relation to retention, 41.1% of supervisors and 73.1% of preceptors are affiliated to a program in the same municipality where they lived. For most resident physicians, the place of residence coincides with the place of birth and/or graduation (57.4%), and 48.5% are in the same place of graduation. CONCLUSIONS: The research reinforces the need for policies to promote the migration of residents to Residency Programs in Family Medicine outside capital cities and metropolitan regions, as well as encouraging the retention of graduates trained outside large urban centers so that they can contribute to distribution and provision of doctors where they are still needed.

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Introducción: La figura del tutor tiene vital importancia en la formación del especialista de Medicina General Integral. Objetivo: Valorar los antecedentes de la función del tutor en la formación del especialista de MGI en Cuba. Métodos: Se realizó un análisis documental, a partir de una búsqueda de literatura relevante sobre el tema de enero de 2019 a enero de 2020. Se utilizaron los buscadores de información científica Pubmed, Scielo y Google Académico. Se evaluaron artículos de revisión, de investigación y páginas web que tenían menos de 10 años de publicados, en idioma español, portugués e inglés, y que hicieran referencia al tema de estudio a través del título. Fueron excluidos los artículos que no cumplieron con estas condiciones. Esto permitió el estudio de 83 referencias bibliográficas, de las cuales 34 se citaron en el presente artículo. Conclusiones: La labor del tutor en la formación del especialista de Medicina General Integral constituye un eje primordial para la formación de los residentes como regulador de la estrategia y ritmo del sistema de enseñanza y aprendizaje, acorde al contexto histórico en el que se han desarrollado y evolucionado los diferentes planes de estudio de la especialidad(AU)

Introduction: The tutor's role is of vital importance in the training of the specialist in family and community medicine. Objective: To assess the background about the tutor's role in the training of the specialist in family and community medicine in Cuba. Method: A document analysis was carried out, based on a search of relevant literature about the subject from January 2019 to January 2020. The scientific information search engines Pubmed, Scielo and Google Scholar were used. Review articles, research articles and web pages were assessed, of the were published within the last ten years old, in Spanish, Portuguese and English, and that made reference to the topic of study through the title. Articles that did not meet these conditions were excluded. These criteria allowed the study of 83 bibliographic references, of which 34 were cited in the present article. Conclusions: The tutor's work is a cornerstone in the training of the specialist in family and community medicine, as far as it is a regulator of the strategy and rhythm of the teaching and learning system, according to the historical context in which the different programs of studies for the specialty have been developed and evolved(AU)

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OBJECTIVE: To measure the effect that residency training in family medicine (RTFM) has on continuity and coordination of care. DESIGN: Observational cohort study using electronic health records. SETTING: Rio de Janeiro, Brazil, public primary care system. PARTICIPANTS: 504 940 patients, 633 generalists (physicians without RTFM) and 204 family physicians (FP-doctors with 2 years of RTFM) from one health district between January 2015 and December 2018. INTERVENTION: Two years of RTFM. MAIN OUTCOME MEASURES: Relative risks of patients being referred to secondary care for outpatient consultations and diagnostics tests; and having a follow-up medical consultation in primary care within 3 and 6 months after being referred. RESULTS: We examined 2 414 508 medical consultations and 284 754 referrals to secondary care. FPs were less likely to request ambulatory care services (including surgical specialties), but were more likely to request ophthalmology, physiotherapy, rehabilitationand surgical evaluations for their patients. Patients referred to secondary care by FPs were more likely to have a follow-up visit in primary care for almost every service requested. If all medical consultations were performed by FPs, a 37.6% (95% CI 32.4% to 42.4%) increased demand for rehabilitation services would be noticed. Oppositely, 1532 (95% CI 1458 to 1602) fewer requests for dermatology would happen every year. CONCLUSIONS: RTFM improves coordination and continuity of care by making FPs more competent to retain those health conditions that can be properly managed in primary care and making FPs more competent to detect health conditions that require specific biomedical technologies and skills, increasing the demand for those services. Besides, it increases the chances of patients having follow-up visits in primary care. Policy-makers in low-income and middle-income countries must consider investing in RTFM to make primary care systems more comprehensive, with better coordination and continuity of care.

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A new graduate medical education program in family medicine is urgently needed now. We propose an innovative plan to develop community-based, community-owned family medicine residency programs. The plan is founded on five guiding principles in which residencies will (1) transition to independent, community-owned organizations; (2) sustain comprehensiveness and generalism; (3) emphasize collaborative learning and interprofessional education; (4) develop local educators with national guidance; and (5) share resources, responsibilities, and learning. We describe actionable steps to begin the process of transforming residencies and strengthening primary care. As community-based and locally-run organizations, residencies will gain self-determination in how time is allocated, budgets are spent, and teams function. Building on the momentum of the National Academy of Medicine's 2021 primary care implementation plan and recommendations by family medicine organization leaders, we propose a Decade of Family Medicine Residency Transformation. We encourage individuals and organizations spanning disciplines, health care systems, and communities, to join forces to reimagine and recreate the preparation of outstanding personal physicians dedicated to individual and community health and well-being.

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ABSTRACT OBJECTIVE To describe the sociodemographic profile and analyze the migratory characteristics of the members of the Residency Programs in Family Medicine in 2020 in Brazil. METHODS The study follows a cross-sectional observational design of a quantitative nature from the perspective of the members of the Residency Programs in Family Medicine. Questionnaires adapted for each participating group were developed, applied through an online platform. RESULTS Most participants are female and white. Most supervisors and preceptors were residents of Residency Programs in Family Medicine, however, there are some who are not specialists in the field. Most participants are based in capitals or metropolitan regions. In relation to retention, 41.1% of supervisors and 73.1% of preceptors are affiliated to a program in the same municipality where they lived. For most resident physicians, the place of residence coincides with the place of birth and/or graduation (57.4%), and 48.5% are in the same place of graduation. CONCLUSIONS The research reinforces the need for policies to promote the migration of residents to Residency Programs in Family Medicine outside capital cities and metropolitan regions, as well as encouraging the retention of graduates trained outside large urban centers so that they can contribute to distribution and provision of doctors where they are still needed.

RESUMO OBJETIVO Caracterizar o perfil sociodemográfico e analisar as características migratórias dos integrantes dos Programas de Residência em Medicina de Família e Comunidade em 2020 no Brasil. MÉTODOS O estudo segue um delineamento observacional transversal de natureza quantitativa a partir da perspectiva dos integrantes dos Programas de Residência em Medicina de Família e Comunidade. Foram desenvolvidos questionários adaptados para cada grupo participante, aplicados por meio de plataforma on-line. RESULTADOS A maioria dos participantes é do sexo feminino e de cor branca. A maioria dos supervisores e preceptores foi residente de Programas de Residência em Medicina de Família e Comunidade, contudo, há alguns que não são especialistas na área. A maior parte dos participantes está vinculada às capitais ou regiões metropolitanas. Em relação à fixação, 41,1% dos supervisores e 73,1% dos preceptores estão vinculados a um programa no mesmo município onde foram residentes. Para a maioria dos médicos residentes, o local da residência coincide com o local de nascimento e/ou graduação (57,4%), sendo que 48,5% estão no mesmo local de graduação. CONCLUSÕES A pesquisa reforça a necessidade de políticas de promoção da migração de residentes para Programas de Residência em Medicina de Família e Comunidade fora das capitais e regiões metropolitanas, bem como estimula a fixação dos egressos formados fora dos grandes centros urbanos para que eles possam contribuir com a distribuição e com o provimento de médicos onde ainda é necessário.

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Introducción: Estudios realizados en los últimos años señalan dificultades en torno al componente investigativo del programa de formación del médico general integral destacando la inadecuada utilización de la Estadística por parte de sus especialistas en estrecha relación con insuficiencias que tienen lugar durante su formación. Objetivo: Proponer algunas consideraciones didácticas para dar solución a las inconsistencias que presenta la formación de la dimensión investigativa de los especialistas en medicina general integral en relación a la utilización de la Estadística. Material y Métodos: Revisión documental de artículos y trabajos referentes al estado actual del uso de la Estadística en la actividad científica de médicos generales integrales y su relación con insuficiencias durante la formación de la dimensión investigativa de estos especialistas. Las fuentes de información consultadas fueron accedidas a través de diferentes buscadores y bases de datos, entre ellas SciELO, Google Académico, Medline y Pubmed. Resultados y discusión: Los trabajos analizados demuestran que el proceso de formación de la dimensión investigativa de los especialistas de medicina general integral manifiesta insuficiencias durante la aplicación de la Estadística, determinado por una inadecuada instrumentación de sus contenidos en el programa docente. Conclusiones: Existe una instrumentación inadecuada de la Estadística en el programa docente para el desarrollo de la dimensión investigativa de los especialistas de medicina general integral. Se sugieren algunas consideraciones didácticas para la instrumentación de la Estadística en la formación del médico general integral(AU)

Introduction: Studies carried out in recent years indicate difficulties around the investigative component of the comprehensive general practitioner training program, highlighting the inadequate use of Statistics by its specialists in close relation to shortcomings that occur during their training. Objective: To propose some didactic considerations to solve the inconsistencies presented by the training of the investigative dimension of specialists in comprehensive general medicine in relation to the use of Statistics. Material and Methods: Documentary review of articles and works referring to the current state of the use of Statistics in the scientific activity of comprehensive general practitioners and its relationship with deficiencies during the training of the investigative dimension of these specialists. The sources of information consulted were accessed through different search engines and databases, including SciELO, Google Academic, Medline and Pubmed. Results and Discussion: The analyzed works show that the process of formation of the investigative dimension of the specialists of integral general medicine shows insufficiencies during the application of the Statistics, determined by an inadequate instrumentation of its contents in the teaching program. Conclusions: There is an inadequate instrumentation of Statistics in the teaching program for the development of the investigative dimension of specialists in general comprehensive medicine. Some didactic considerations are suggested for the instrumentation of Statistics in the training of the comprehensive general practitioner(AU)

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BACKGROUND: There is a need for evidence that residency training in family medicine can benefit the care of patients in primary care in low- and middle-income countries. We tested the hypothesis that two years of residency training in family medicine enables doctors to better detect chronic health conditions while requesting fewer laboratory tests and providing more follow-up visits. METHODS: We performed a retrospective longitudinal observational analysis of medical consultations from 2013 to 2018 in primary care in Rio de Janeiro, comparing doctors without residency training in family medicine (Generalists) versus family physicians (FPs). Multivariate multilevel binomial regression models estimated the risks of patients being diagnosed for a list of 31 chronic health conditions, having a follow-up visit for these conditions, and having laboratory tests ordered from a list of 30 exams. RESULTS: 569.289 patients had 2.908.864 medical consultations performed by 734 generalists and 231 FPs. Patients seen by FPs were at a higher risk of being detected for most of the chronic health conditions, at a lower risk of having any of the 30 laboratory tests requested, and at a higher risk of having a follow-up visit in primary care. CONCLUSIONS: Residency training in family medicine can make physicians more skilled to work in primary care. Policymakers must prioritize investments in capacity building of healthcare workforce to make primary care truly comprehensive.

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BACKGROUND AND OBJECTIVES: The 2011 Alliance for Clinical Education panel recommended the development of a specialty-specific curriculum for all subinternships (sub-Is). A 2019 CERA survey found that 58% of family medicine clerkship directors agreed that a standardized curriculum would be helpful. The goal of this study was to explore attitudes and preferences regarding a national family medicine sub-I curriculum among a broad set of stakeholders. METHODS: Focus groups were conducted with medical students, residents, residency faculty, and undergraduate medical education faculty at the 2020 STFM Conference on Medical Student Education. Focus groups were transcribed, and a qualitative analysis was conducted with participants' responses about the benefits and characteristics of a family medicine sub-I, recommendations for core sub-I skills/objectives, likelihood of using a national curriculum, and preferred student and program evaluation methods. RESULTS: There were four focus groups with a total of 24 participants. The following main themes emerged: the family medicine sub-I has distinctive characteristics from other sub-Is and provides unique benefits for students and residency programs, a standardized curriculum should allow for adaptability and flexibility, and the sub-I evaluation for the students and program should be specific and experience-focused. These themes were classified into specific subthemes. CONCLUSIONS: The stakeholder emphasis on themes of uniqueness, adaptability, and specificity within evaluation will help educators structure a comprehensive framework for national recommendations for the sub-I curriculum. A well-designed family medicine sub-I may provide rigorous educational training for students and may also encourage career commitment to the discipline.

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BACKGROUND AND OBJECTIVES: Antiretroviral treatment has transformed human immunodeficiency virus (HIV) infection into a chronic disease. Prior research demonstrated a discrepancy between preparation to provide HIV care and current provision among recent residency graduates. Our study aimed to describe characteristics related to preparedness and provision of HIV care, and to identify the associations between physician and practice characteristics with current provision of HIV care among those prepared. METHODS: We obtained data from the 2016 through 2019 American Board of Family Medicine (ABFM) National Family Medicine Graduate Survey. Our main outcome was self-reported provision of HIV care. Bivariate statistics compared differences in personal and practice characteristics with self-reported preparation for HIV care, then among those prepared, provision of HIV care. We used logistic regression to determine associations between HIV care, among those prepared, with practice and personal characteristics. RESULTS: The response rate was 68.7% and our final sample size was 6,740 respondents. Only 25% of respondents reported preparedness in residency, and 44% of them reported current provision. Among those prepared, female gender (OR=0.604; 95% CI, 0.494-0.739) was associated with lower odds of practicing HIV care. Those working in high HIV prevalence areas (OR=1.718; 95% CI, 1.259-2.344) and in Northeast census region (OR=1.557; 95% CI, 1.137-2.132) had higher odds of providing HIV care. CONCLUSIONS: Fewer than half of those prepared in residency reported currently providing HIV care. Working in a high HIV prevalence area was associated with higher odds of providing HIV care, which suggests early-career family physicians are responding to community needs.

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BACKGROUND AND OBJECTIVES: Identifying underperforming residents and helping them become fully competent physicians is an important faculty responsibility. The process to identify and remediate these learners varies greatly between programs. The objective of this study was to evaluate the remediation landscape in family medicine residency programs by investigating resident remediation characteristics, tools to improve the process, and remediation challenges. METHODS: This study analyzed responses from the Council of Academic Family Medicine Educational Research Alliance (CERA) national survey of family medicine program directors in 2017. Survey questions included topics on faculty remediation training, remediation prevalence, tools for remediation, and barriers to remediation. RESULTS: Two hundred sixty-seven of 503 program directors completed our survey (53% response rate). Most residency programs (245/264, 93%) had at least one resident undergoing remediation in the last 3 years. A majority (242/265, 91%) of residents undergoing remediation were successful within 12 months. The three most important tools to improve remediation were an accessible remediation toolkit (50%), formal remediation recommendations from national family medicine organizations (20%), and on-site faculty development and training (19%). The top-two challenges to the remediation process were a lack of documented evaluations to trigger remediation and a lack of faculty knowledge and skills with effective remediation strategies. CONCLUSIONS: Residents needing remediation are common, but most were successfully remediated within 12 months. Program directors wanted access to a standardized toolkit to help guide the remediation process.

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