Place-based clinical education is vital for promoting the growth of the rural clinician workforce; where learners receive their education strongly influences where they practice. Yet students may struggle to find rural placements. In this study, we sought to understand trends in teaching by family physicians for varied health professions and the associated physician, practice, and community factors. We analyzed data from 14,789 early career family physicians surveyed from 2016 to 2023. We compared the teaching status of rural and urban physicians overall and by year. We conducted trend analyses and multivariate regression to investigate the relationship between physician and practice characteristics, practice activities, community characteristics, and teaching status. More rural than urban physicians taught premedical students (30.8% vs 18.7%), medical students (62.2% vs 54.4%), and advanced practice professional students (51.2% vs 33.7%), while more urban than rural physicians taught residents (41.9% vs 37.8%) and fellows (8.7% vs 2.3%). Trend analyses showed an 8.4% increase in rural physicians teaching residents from 2016 to 2023, and a decline in teaching advanced practice professional students over the same time period. In adjusted analyses, family physicians who were younger, male, and White non-Hispanic were more likely to teach, as were osteopathic physicians, those with a broad scope of practice, and those who provided obstetric services. A larger share of rural than urban early career family physicians teach health professions students, but the rate who are teaching advanced practice professional students has declined significantly. Understanding and arresting the decline will be essential to addressing rural workforce capacity.
About half of all patients seeking abortion report having a history of prior abortions and are at high risk for repeat abortion. Data about postabortion contraception in China are limited. This study investigated the knowledge, attitude, and practice (KAP) of women undergoing induced abortion regarding postoperative oral short-acting contraceptives. This cross-sectional study enrolled women at Beijing Luhe Hospital, Capital Medical University, from December 2023 to February 2024. The minimal calculated sample size was 385 participants. A self-administered questionnaire was developed to collect demographic information and assess knowledge, attitudes, and practices regarding postabortion oral short-acting contraceptives. Scores >70% of the possible maximum score of each dimension were considered as good knowledge, positive attitudes, and proactive practice. Among 420 women with questionnaires passing quality control, mean knowledge, attitude, and practice scores were 5.60 ± 2.96/12 (46.67%), 31.27 ± 4.54/45 (69.49%), and 21.70 ± 2.94/25 (86.80%). Lower education (junior high school or below) was associated with lower odds of sufficient knowledge and positive attitudes. Higher knowledge scores were associated with higher odds of positive attitude. Higher knowledge and attitude scores and parity >1 were independently associated with higher odds of adequate practice, while age 36-39 was associated with lower odds. In Beijing, women after induced abortions had poor knowledge and attitudes scores, but a proactive intended practice toward short-acting contraception. Specific knowledge items were identified as requiring improvement. Educational interventions should particularly target women with a lower socioeconomic status to reduce repeated induced abortions. This study explored what women in Beijing know, feel, and actually do about using short‑acting birth control pills after an induced abortion. Researchers surveyed 420 women aged 18 years or older who were admitted for abortion at a single hospital between December 2023 and February 2024, asking about their background, knowledge, attitudes, and contraceptive practices before the procedure. Overall, women correctly answered fewer than half of the knowledge questions, revealing substantial gaps and misconceptions about the safety, long‑term use, and impact of oral short‑acting contraceptives on future fertility and fetal malformations. Attitudes toward using these pills postabortion were only moderately positive, indicating lingering doubts and concerns, whereas reported behavior was more favorable: most women stated they would follow medical advice and take the pills after abortion, and generally described proactive contraceptive habits. Higher education and income are consistently related to better knowledge, more positive attitudes, and better reported practice, while lower socioeconomic status is associated with poorer KAP. Statistical analyses showed that higher knowledge scores were linked to more positive attitudes and better practices, and more positive attitudes were also associated with better practices, suggesting that improving accurate contraceptive knowledge may indirectly enhance both attitudes and real‑world use. Given the rapid return of fertility after abortion and the risk of repeat unintended pregnancies, these findings underscore the need for targeted, understandable counseling on short‑acting contraception, especially for women with lower education and income.
Physician burnout and retention are critical challenges in Family Medicine (FM). Professional Identity Formation (PIF) in family physicians (FP) fosters resilience and job satisfaction but is often overlooked in residency training, particularly in predominantly hospital-based programs where residents are disconnected from the primary care community. This qualitative study explored FP PIF in a predominantly hospital-based FM residency program in Singapore and identified factors influencing its development. Individual in-depth semi-structured interviews were conducted with FM residents and post-residency FPs selected through maximum variation purposive sampling. Data was collected and analysed iteratively using Braun and Clarke's reflexive thematic analysis. Cruess et al.'s conceptual model for PIF was used as a sensitising framework, alongside Lankveld et al.'s framework describing psychological processes underlying identity formation. Thirteen participants were interviewed. Three themes were constructed. First, FP PIF wasunderpinned by four psychological 'senses' of competence, connectedness, appreciation, and career trajectory. Second, reflection and socialization drove development of these senses by enabling meaning-making, learning and belonging within the FM community of practice (CoP). Third, residency program features both enabled and/or constrained PIF; while some components scaffolded PIF, more intentional support was needed. PIF is a dynamic, context-dependent psychological process shaped by reflective practice, social participation, and program structure. Intentional support through curriculum design and faculty practices may strengthen PIF. These findings extend existing PIF frameworks and have implications for curriculum design, faculty development, program evaluation, and future research on fostering PIF in hospital-based residency training. This study provides new resident-centered insights on family physician professional identity formation (PIF) in a predominantly hospital-based Family Medicine (FM) residency context.Family physician PIF is formed through developing senses of competence, connectedness, appreciation, and career trajectory, driven by reflection and socialization.FM residency programs can enhance family physician PIF through supportive program features together with faculty development. Program features supportive of PIF include longitudinal clerkships, preceptor roles and structured reflections. Faculty development should be directed at equipping preceptors with the knowledge and skills to facilitate reflection and socialization around PIF.
Point-of-care ultrasound (POCUS) is increasingly used in primary care and is now an Accreditation Council for Graduate Medical Education training expectation for family medicine residents. However, standardized methods for teaching, observing, and assessing POCUS skills in clinical settings remain limited. The University of Hawai'i Family Medicine Residency Program developed direct-observation checklists for obstetric (OB) and musculoskeletal (MSK) POCUS. OB assessments included first- and third-trimester scans, while MSK assessments focused on knee and shoulder examinations. Checklist content was adapted from existing validated tools and refined through Plan-Do-Study-Act cycles. The checklists were designed for use before, during, and/or after patient encounters to guide observation and feedback. Faculty and residents completed surveys to evaluate usability, workflow integration, and educational impact. From March to October 2025, 39 checklists (28 OB, 11 MSK) and 60 surveys were collected from faculty and residents at two clinical sites. Most attending physicians reported checklist completion and feedback delivery in less than 5 minutes. Faculty most frequently used the tools postencounter. Perceived utility was high: 76% of OB and 88% of MSK attending responses rated the checklist as very useful, and nearly all residents (95% OB; 100% MSK) reported that the checklists supported a systematic approach and reinforced learning. Time constraints and certain indirectly observable checklist items were identified as implementation challenges. Structured POCUS teaching checklists are feasible and well-received in family medicine residency training. These tools support direct observation, structured feedback, and standardizing expectations during supervised scanning encounters.
New Accreditation Council for Graduate Medical Education and American Board of Family Medicine guidelines encourage training family medicine residents in point-of-care ultrasound (POCUS). Prior studies have focused on the perceived needs of learners but did not assess patient or community need. We performed a triangulated learner- and patient-oriented needs assessment to inform POCUS curriculum development within a family medicine residency. Our learner assessment consisted of a Likert scale survey of the perceived skill and importance of 36 POCUS modalities discussed in the 2016 American Academy of Family Physicians POCUS curriculum guidelines. Our patient-oriented needs assessment was collected through analysis of all family medicine practice (FMP) site imaging orders placed in 2023. The learner survey demonstrated the highest skill gaps in POCUS training to be evaluation for hemothorax and evaluation for pleural effusion. FMP site imaging order analysis demonstrated that hepatobiliary and obstetrics/gynecology concerns were the most frequently answered by POCUS for patients seen at the FMP site. POCUS is an important and underutilized diagnostic tool in family medicine. POCUS curricula in graduate medical education are vital to successful implementation of POCUS in primary care; however, needs assessment techniques used in prior studies differ from the patient and community needs in our study. We recommend the use of both needs assessment strategies for optimal POCUS training outcomes. Further research replicating this modality is necessary to determine the optimal needs assessment approach for POCUS in family medicine.
Pregnancy during orthopedic surgery practice presents unique challenges related to family planning, workplace accommodations, occupational exposures, board certification requirements, and postpartum return to work. Despite increasing numbers of women entering orthopedic surgery, there remains a lack of centralized guidance addressing pregnancy-related considerations. The purpose of this review is to summarize current evidence, to provide practical recommendations for orthopedic surgeons navigating pregnancy during their career, and to guide practice partners and organizations on how to create a culture of support and belonging during this time frame. Available literature, professional society guidance, federal workplace regulations, and occupational safety data were reviewed. Key topics included advanced maternal age and fertility considerations, American Board of Orthopaedic Surgery (ABOS) certification accommodations, workplace disclosure and legal protections, occupational exposure to methyl methacrylate (MMA) and ionizing radiation, physical demands of orthopedic practice, postpartum support, parental leave, and breastfeeding accommodations. Delayed childbearing associated with orthopedic training and career progression may contribute to increased rates of infertility and obstetric complications among female orthopedic surgeons. Federal protections, including the Pregnant Workers Fairness Act, Family and Medical Leave Act, and Equal Employment Opportunity Commission regulations, provide important frameworks for workplace accommodations. Contemporary evidence demonstrates that occupational exposure to MMA and radiation during orthopedic procedures remains below established safety thresholds when appropriate precautions are employed. Physical demands such as prolonged standing, heavy lifting, and extended work hours may warrant workplace modifications during pregnancy. Postpartum support, equitable parental leave policies, and access to lactation accommodations may improve surgeon well-being and facilitate successful return to clinical practice. Pregnancy should be recognized as a normal life event rather than a barrier to success in orthopedic surgery. Evidence-based accommodations, occupational safety measures, supportive workplace policies, and equitable parental leave practices can promote maternal and infant health while supporting professional development. Normalizing pregnancy and postpartum support within orthopedic surgery is essential to fostering a more inclusive and sustainable workforce.
Multiple organizations and accrediting bodies support or require teaching of point-of-care ultrasound (POCUS) in US family medicine residency programs. To date, no evidence-based approach has been used to determine which of the numerous POCUS applications should be required components of curricula. A task force of expert POCUS educators sponsored by the American Board of Family Medicine Foundation and the Society of Teachers of Family Medicine was formed to conduct research and draft guidelines addressing these gaps. We conducted a traditional three-round Delphi study with a national group of 25 expert panelists, all POCUS educators at US family medicine residency programs. Panelists were diverse in geographic location, practice setting, and scope of practice. A systematic literature search identified 243 potentially relevant clinical applications of POCUS. Surveys were administered to the panel with anchored Likert scale questions. Rounds were iterative and anonymous, with 80% agreement required for consensus. Clinical applications that did not meet consensus after three rounds were excluded. Three Delphi rounds were completed with a 100% response rate for each. Among the applications, 54 met positive consensus for inclusion, 41 met consensus for exclusion, and the remaining 162 were excluded for lack of consensus. US family medicine residency programs should prioritize these 54 consensus applications when structuring POCUS curricular implementation plans with a goal of facilitating graduating residents' competency in these clinical applications.
This article presents the development of the concept enhancing caregiver personhood to deepen understanding of family caregiving for children with medical complexities within pediatric home health nursing. Guided by Liehr and Smith's concept-building process and grounded in Boykin and Schoenhofer's theory of nursing as caring, the concept emerged from a practice story and was refined through literature review and interviews. Core qualities of the concept were synthesized into a concept story and visualized in a conceptual model. The resulting synthesis emphasized the importance of theory-guided nursing practice and the centrality of caring in sustaining the family-nurse partnership.
There has been an international resurgence in antisemitism in healthcare education and practice since October 7, 2023, prominently affecting the United States (US), United Kingdom (UK), Canada, and Australia. In the US, federal investigations by the US Department of Justice and the Congressional Subcommittee on Education and the Workforce were initiated into antisemitic harassment and hostile learning environments in medical schools. Healthcare organizations in the UK also came under investigation, and the US Congress opened an investigation into alleged antisemitism within a national psychological association. Quantitative and descriptive studies of the prevalence and characteristics of this phenomenon within medical, psychology, and social work education and practice are scant. We conducted a narrative review given the under-recognized nature of antisemitism in this context and the limited literature on this international, inter-professional issue. We searched PubMed using a search string to capture peer-reviewed descriptive and quantitative studies of antisemitism in medicine, psychology, social work, nursing, pharmacy, physician assistant, dentistry, physical, and occupational therapy education and practice. We searched 17 ProQuest databases for media and other online or written materials and conducted a hand search for additional relevant publications. We identified studies showing a high prevalence of antisemitism particularly in medical education, psychology, and social work, where >50% of subjects experienced antisemitism since October 7, 2023. Fewer than 2% of institutions had incorporated education about antisemitism into anti-discrimination training. Our review revealed that antisemitism as a form of bigotry, hatred, and discrimination has been inadequately addressed, now taking on urgency given its reach including an anti-Israel bias "mutation" and the need to assure unbiased healthcare. Actionable recommendations to counter antisemitism in healthcare derived from the publications to date are presented.
Psilocybin-assisted therapy is continuing to show significant positive effects for palliative cancer patients, both in reducing symptoms and improving one's sense of hope and meaning. Most research has focused on individual therapy models, limiting access and overlooking potential community-based benefits. This qualitative study describes the results of patients experiencing distress related to a terminal health condition who enrolled in six to eight once-weekly group resilience-based community of practice (CoP) sessions combined with one psilocybin-assisted therapy (PaT) session. This virtual hybrid group therapy model is research informed, with a curriculum that provides knowledge-based content, combined with the relational elements necessary to successfully deliver group-administered psilocybin-assisted therapy. Patients were interviewed using semi-structured question list and transcripts were coded and themes captured in an iterative manner. The CoP sequence included preparation meetings before the in-person medicine session and integration meetings afterward, allowing the group relationship and safety practices to be established before dosing. Thirty-one PaT sessions were provided for 25 participants within four iterative cohorts over the span of 1 year (November 2021-November 2022). Completion rates were high (84%), with participants reporting enhanced trust in self, improved outlook on life, and strengthened connection to community. Peer support, relational safety, and regulation practices were central to outcomes. This study demonstrates the feasibility, safety, and psychosocial benefits of group-administered PaT supported by virtual CoPs, providing a scalable, cost-effective model for public health interventions in end-of-life care. Its novelty lies in combining group therapy, hybrid delivery, and resilience-based curriculum to expand access and enhance community support for a vulnerable population. Participants' mixed feedback also suggests that hybrid group PaT may offer distinctive benefits of peer witnessing and community continuity while requiring careful attention to individual preference, room logistics, and sensory control during group dosing.
Resistant hypertension poses significant management challenges in primary care, with varying practices influencing patient outcomes. We evaluated current practices of primary care physicians in Singapore in managing resistant hypertension and examined their concordance with local and international guidelines. An anonymised cross-sectional survey was conducted from July 2021 to October 2023, using a 26-item questionnaire distributed to primary care physicians across Singapore. The survey included physicians from both the public and private healthcare sectors, while specialists were excluded. The survey assessed their knowledge of the definitions, diagnostic criteria, treatment preferences and referral patterns for resistant hypertension. A total of 85 respondents participated in the survey. Only 74% (n = 63) of respondents correctly defined resistant hypertension as uncontrolled blood pressure (BP) (above 140/90 mmHg) despite concurrent use of three or more antihypertensives, including a diuretic. In addition, 53% (n = 45) correctly defined uncontrolled hypertension as home BP exceeding 135/85 mmHg. The majority (69%, n = 59) of primary care physicians would consider referral to a specialist after a trial of three antihypertensives, whereas 13% (n = 14) chose to continue management in primary care. Referrals were made mainly to Endocrinology (43%, n = 47) and Cardiology (35%, n = 39). Notably, few primary care physicians (27%, n = 23) considered the necessary work-up for secondary causes such as primary aldosteronism. This study identifies discrepancies between clinical practice and guidelines. The findings highlight a need to improve education on accurate definitions and guideline-based diagnosis of resistant hypertension, and develop clear national referral pathways for suspected secondary hypertension in primary care.
To examine how nurses maintained and reconfigured boundaries between work and home in order to protect themselves and their families during the pre-vaccination phase of the COVID-19 pandemic. A qualitative descriptive study using a cross-sectional online survey with open-ended questions. A self-designed online survey was conducted between October 2020 and February 2021 with a sample of nurses. Qualitative data from open-ended survey responses were analysed using thematic analysis then deductively mapped onto the theories of boundary maintenance, spillover and crossover. A total of 69 nurses participated in this study, drawn from hospital, aged care, general practice and community settings, with ages ranging from 18 to 74 years. Five themes were identified: stress and work intensification; confusion arising from rapidly changing guidelines; resource constraints; anger and resentment towards colleagues able to work remotely; and deliberate strategies to protect family members from infection. The final two themes highlight how nurses actively constructed new physical, emotional and symbolic boundaries between work and home in response to the perceived risks of viral transmission. Prior to vaccination, nurses created their own infection control rituals at home to shield their families, revealing how professional knowledge spilled into domestic life, becoming an extension to nurses' work. These critical boundary practices often remained unseen but are vital to frontline nursing labour work during an infection-control crisis. Understanding and recognising these early responses provides valuable insight for future pandemic preparedness, workforce support and infection prevention policy. No patient or public contribution.
Older adults experience high rates of chronic disease that reduce quality of life and independence. In South Texas, these challenges are compounded by limited access to culturally aligned care and a high burden of chronic conditions. Addressing these disparities requires infrastructure that bridges research and practice to support the translation of evidence into real-world care. This manuscript describes the establishment of the Supporting Older Adults through Research Network (SOARNet), a population-specific practice-based research network (PBRN) and reports early lessons from its development and recruitment strategies. SOARNet employs a multi-level leadership structure and an Advisory Board to guide research priorities, review member-initiated proposals, and facilitate collaboration among clinical, research, and community stakeholders. Recruitment strategies included informational materials, clinic visits, and targeted email outreach. Since inception, SOARNet has enrolled 61 members representing healthcare clinicians (55.7%), researchers (18.0%), community members (32.8%), and organizations (8.2%), with targeted email outreach proving most effective (n = 56). SOARNet has supported a collaborative research study, facilitated member consultations, and contributed to dissemination activities. These findings demonstrate the value of population-specific PBRNs in advancing community-engaged translational research to improve care for older adults. Future priorities focus on expanding partnerships and strengthening culturally responsive, bidirectional research.
The COVID-19 pandemic forever changed health care delivery and led to a rapid uptake in telehealth visits. However, the quality and equity of these visits compared to in-person visits are unknown. This analysis interviewed oncology practitioners to understand how US-based cancer centers considered care quality and equity in the implementation and sustainability of telehealth programs. This qualitative study employed semistructured interviews to explore practitioners' experiences and perceptions regarding care equity and quality within integrated telehealth services. Primary data collection occurred through interviews conducted between October 2021 and January 2023. These interviews were audio-recorded, transcribed, and analyzed using qualitative thematic analysis. Four main themes, representing interviews with 39 professionals from 16 organizations, were identified: 1) organization-level diversity, equity, and inclusion (DEI) efforts remained conceptual and disconnected from oncology telehealth services, 2) equity and quality-related actions were predominately reactive rather than proactive, 3) equity was misinterpreted as providing equal care to all patients, and 4) telehealth quality and equity were not systematically measured or prioritized. These findings highlight how organizational DEI efforts did not translate to tangible operational practices in oncology telehealth care. These results suggest limited organization DEI maturity and practice-level accountability for equity and quality and a lack of understanding of equity. To deliver high-quality and equitable oncology telehealth, cancer centers and other health care organizations must progress beyond awareness of equity issues. They need to implement concrete resources, support systems, and policies that facilitate effective strategy execution.
Hemoglobin A1c (HbA1c) remains a cornerstone of glycemic assessment in diabetes mellitus care, yet discordance between HbA1c and measured glucose values is common in clinical practice. Failure to recognize this discordance can lead to inappropriate treatment escalation, increased hypoglycemia risk, and patient distress. This article reviews the biological and clinical factors that contribute to HbA1c-glucose discordance and translates these findings into practical strategies for routine care. Common causes include iron deficiency, chronic kidney disease, altered red blood cell turnover, hemoglobin variants, and rapid changes in glycemia. A stepwise, practice-oriented framework is presented to guide clinicians in evaluating discordant glycemic data using targeted laboratory testing and continuous glucose monitoring metrics. Emphasis is placed on avoiding reflexive medication intensification and using glucose monitoring data to individualize treatment decisions. The role of interdisciplinary care and patient-centered communication is also highlighted.
The Footprints Project is a humanizing initiative that elicits and displays personal information from patients and families about a patient's life before illness. Key details recorded on a form are then written on a whiteboard in the patient's room to support person-centered care. The whiteboard keeps personal identity, preferences, and daily plans visible. The objective of this study was to explore how the Footprints Project evolved over time and to identify contextual determinants and practical strategies that may support its ongoing sustainability from the perspectives of patients, families, and clinicians. This qualitative descriptive study was co-designed with patients and families in a 23-bed university-affiliated medical-surgical Intensive Care Unit (ICU). Implementation followed a preparatory audit, staff surveys, multi-directional communication, and volunteer integration. We enrolled survivors of critical illness, family members of ICU patients, and clinicians to participate in focus groups and individual interviews. Transcripts were analyzed using conventional qualitative content analysis and interpreted with attention to constructs within the Clinical Sustainability Framework as a sensitizing lens. Participant interviews and focus groups with 7 patients, 19 family members and 40 clinicians identified four transitions reflecting the evolution and embedding of the Footprints Project: 1) transition from a nurse-led tool to an intentional interprofessional intervention; 2) transition from a patient-centered tool to a patient and family-partnered intervention; 3) transition from a stand-alone intervention to one embedded into daily workflows; and 4) transition in the format and content of the form and whiteboard. In this qualitative study, patients, families, and clinicians identified practical strategies and contextual features that supported the evolution and ongoing use of the Footprints Project through interprofessional and family-partnered efforts, workflow alignment and refreshed tools. Embedding Footprints into daily ICU workflows may strengthen person-centered care by making patient identity visible at the bedside. Interprofessional ownership and explicit family partnership can enhance consistency and sustainability. Updating and intentionally embedding tools may support staff engagement in high-acuity environments. These strategies may help ICUs to operationalize other humanizing practices in practice.
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Palliative care is an integral component of comprehensive primary health care and is particularly relevant for older adults living with chronic and progressive illnesses. In low- and middle-income countries (LMICs), including many African settings, access to palliative care remains limited despite substantial need. Sociocultural beliefs shape perceptions of ageing, illness, suffering and death, and influence how palliative care needs are recognised and addressed within primary care and family medicine contexts. To synthesise existing evidence on how sociocultural beliefs influence palliative care needs and utilisation among older adults in LMICs, with implications for primary care and family practice. A narrative literature review was conducted using published qualitative, quantitative and mixed-methods studies identified through searches of major electronic databases and relevant grey literature. Evidence was synthesised thematically, focusing on sociocultural influences relevant to primary care settings. Key themes identified included cultural constructions of ageing and suffering, family-centred decision-making, religious and spiritual interpretations of illness, and misconceptions surrounding palliative care. These factors influence symptom reporting, care-seeking behaviour, referral patterns and utilisation of palliative care services at the primary care level. Sociocultural beliefs are fundamental to understanding palliative care needs among older adults in LMICs. To improve access and quality of care, culturally sensitive palliative care models that involve families, recognise spiritual concerns and dispel myths are crucial. More empirical research from under-represented LMIC regions is required to inform contextually appropriate policy and practice.
The decentralized U.S. child welfare system has resulted in significant variation in practices and outcomes across states and counties. Despite growing attention to varying child welfare experiences based on urbanicity, particularly rural child welfare practice concerning younger children, few studies have examined how child welfare practices for transition-age youth (TAY) in foster care differ across rural and urban contexts. Using administrative data from California, this study examined differences in transitional housing placement programs for nonminor dependents, a specialized, treatment-oriented placement for high-acuity TAY. We found that urbanicity was not a significant predictor of living in a new transitional housing placement. Instead, the likelihood of living in a new transitional housing placement varied based on the supervising county's transitional housing placement practices and TAY characteristics and experiences in foster care. Our results underscore the importance of ongoing research and policy and practice reforms to ensure equitable transitional housing support for TAY in decentralized systems, where inequities may otherwise persist.