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Although progress is being made toward defining the family physician and the specialty of family practice, there remains a need to describe more clearly a conceptual base for family medicine as an academic discipline. This paper explores common misconceptions and fallacies which have confused or prevented greater understanding of the intellectual basis for family practice. A thesis is presented and defended which holds that patient management is the quintessential skill of clinical practice and the unique field of knowledge of family physicians. The sine qua non of family practice is the knowledge and skill which allow the family physician to confront relatively large numbers of unselected patients with unselected conditions and to carry on therapeutic relationships with patients over time.
BACKGROUND: Our study objectives were to assess the validity and reliability of the Woman Abuse Screening Tool (WAST) in the general population within the family practice setting; to determine the comfort levels of family physicians administering the WAST, their perceptions of its ability to help them identify abused women, and their willingness to continue using it in practice; and to determine the self-reported comfort of patients being asked the WAST questions by their family physicians. METHODS: We included a stratified random sample of 20 physicians practicing in both urban and rural settings drawn from 400 family physicians in London, Ontario, Canada, and the surrounding area. These physicians administered the WAST to 10 to 15 eligible and consenting patients during the course of regular care. Following the physician-patient encounter, patients were asked to complete both a measure about their comfort in being asked each of the WAST questions and the Abuse Risk Inventory (ARI). RESULTS: Scores on the WAST correlated well with those on the ARI. The reliability of the WAST among this sample was demonstrated by a coefficient alpha of 0.75. With the WAST-Short (the first 2 questions of the WAST), 26 of the 307 patients screened (8.5%) were identified as experiencing abuse. The physicians were comfortable administering the WAST to their women patients, and 91% of the patients reported being comfortable or very comfortable when asked the WAST questions by their family physician. CONCLUSIONS: The WAST was found to be a reliable and valid measure of abuse in the family practice setting, with both patients and family physicians reporting comfort with it being part of the clinical encounter.
OBJECTIVES: Little is known about men's expectations of their family physicians regarding sexual disorders. Our goal was to evaluate the frequency of sexual problems among male patients in family practice and to assess their need for help. STUDY DESIGN: We performed a cross-sectional survey based on structured questionnaires answered by patients and physicians in German family practices. POPULATION: We approached 43 family physicians; 20 (43%) participated. On a single day all men 18 years and older visiting the participating practices were approached, and 307 (84%) took part in the survey. OUTCOMES MEASURED: Patients were asked about their frequency and type of sexual problems, their need for help, and their expectations of their physicians. The physicians described their perceptions and management of sexual problems in family practice. RESULTS: Nearly all patients (93%) reported at least 1 sexual problem from which they suffered seldom or more often. The most common problems were low sexual desire (73%) and premature ejaculation (66%). Occupational stress was considered causative by more than half of the men (107/201). Forty-eight percent considered it important to talk with their physicians about sexual concerns. However, most physicians initiated a discussion about sexual concerns only seldom or occasionally. There was a nonsignificant correlation between the physicians' assumed knowledge and the patients' wish to contact them in case of sexual problems (rho=0.26). CONCLUSIONS: The high frequency of self-reported sexual disorders and the hesitancy of family physicians to deal with this topic signals a neglected area in primary health care. Certain conditions, such as occupational stress, which may be associated with sexual concerns, should encourage the physician to initiate discussions about sexuality.
BACKGROUND: Reducing the number of antibiotic prescriptions given for common respiratory infections has been recommended as a way to limit bacterial resistance. This study assessed the validity of a previously published clinical score for the management of infections of the upper respiratory tract accompanied by sore throat. The study also examined the potential impact of this clinical score on the prescribing of antibiotics in community-based family practice. METHODS: A total of 97 family physicians in 49 Ontario communities assessed 621 children and adults with a new infection of the upper respiratory tract accompanied by sore throat and recorded their prescribing decisions. A throat swab was obtained for culture. The sensitivity and specificity of the score approach in this population were compared with previously published results for patients seen at an academic family medicine centre. In addition, physicians' prescribing practices and their recommendations for obtaining throat swabs were compared with score-based recommendations. RESULTS: Of the 621 cases of new upper respiratory tract infection and sore throat, information about prescriptions given was available for only 619; physicians prescribed antibiotics in 173 (27.9%) of these cases. Of the 173 prescriptions, 109 (63.0%) were given to patients with culture-negative results for group A Streptococcus. Using the score to determine management would have reduced prescriptions to culture-negative patients by 63.7% and overall antibiotic prescriptions by 52.3% (both p < 0.01). Culturing of throat samples would have been reduced by 35.8% (p < 0.01). There was no statistically significant difference in the sensitivity or specificity of the score approach between this community-based population (sensitivity 85.0%, specificity 92.1%) and an academic family medicine centre (sensitivity 83.1%, specificity 94.3%). INTERPRETATION: An explicit clinical score approach to the management of patients presenting with an upper respiratory tract infection and sore throat is valid in community-based family practice and could substantially reduce the unnecessary prescribing of antibiotics for these conditions.
BACKGROUND AND OBJECTIVES: Domestic violence is an important problem that is often not recognized by physicians. We designed a short instrument for domestic violence screening that could be easily remembered and administered by family physicians. METHODS: In phase one of the study, 160 adult female family practice office patients living with a partner for at least 12 months completed two questionnaires. One questionnaire was the verbal and physical aggression items of the Conflict Tactics Scale (CTS). The other was a new four-item questionnaire that asked respondents how often their partner physically Hurt, Insulted, Threatened with harm, and Screamed at them. These four items make the acronym HITS. In phase two, 99 women, who were self-identified victims of domestic violence, completed the HITS. RESULTS: For phase one, Cronbach's alpha was .80 for the HITS scale. The correlation of HITS and CTS scores was .85. For phase two, the mean HITS scores for office patients and abuse victims were 6.13 and 15.15, respectively. Optimal data analysis revealed that a cut score of 10.5 on the HITS reliably differentiated respondents in the two groups. Using this cut score, 91% of patients and 96% of abuse victims were accurately classified. CONCLUSIONS: The HITS scale showed good internal consistency and concurrent validity with the CTS verbal and physical aggression items. The HITS scale also showed good construct validity in its ability to differentiate family practice patients from abuse victims. The HITS scale is promising as a domestic violence screening mnemonic for family practice physicians and residents.
BACKGROUND: This study developed a screening tool for use by family physicians to identify and assess women patients experiencing emotional and/or physical abuse by their partner. METHODS: An initial set of eight questions developed for the Woman Abuse Screening Tool (WAST) was completed by both abused and non-abused women. Participants were also asked to indicate their comfort in answering the questions in both research and family practice contexts. They also completed the Abuse Risk Inventory and a demographic questionnaire. Analysis of the WAST included 1) standard assessment of the validity and reliability of the measure and 2) examination of the efficacy of further reducing the number of questions on the WAST for screening purposes. RESULTS: The final samples of abused (n = 24) and non-abused women (n = 24) differed significantly on a number of demographic and abuse variables. After eliminating one of the original items, a strong single factor structure was identified for the WAST that accounted for 85% of the total variance in responses to the WAST items. The WAST was found to be a highly reliable measure; coefficient alpha was estimated at.95. The scale also demonstrated construct and discriminant validity. The abused women reported being less comfortable responding to the WAST questions, in both the research and family practice contexts, than the non-abused women. The two WAST questions the abused women reported being most comfortable with were used to construct the WAST-Short for initial screening purposes. The WAST-Short correctly classified 100% of the non-abused women and 91.7% of the abused women. CONCLUSIONS: The WAST demonstrated good reliability and validity and discriminated between abused and non-abused women. Development of the WAST-Short provides physicians with a relatively unobtrusive screening tool for assessing abuse. The use of additional WAST questions can be used to further explore the possibility that a woman patient is experiencing abuse by her partner. Further study includes field testing the WAST in the family practice setting.
Borrowed and adapted knowledge is insufficient to optimize the potential of a comprehensive, integrative, relationship-centered generalist approach to improve the health of individuals, families, and communities. The knowledge base for family practice must be expanded by integrating multiple ways of knowing. This involves (1) self-reflective practice by clinicians, (2) involving the patient voice in generating research questions and interpreting data, (3) inquiry into the systems affecting health care, and (4) investigation of disease phenomena and treatment effects in patients over time. A multimethod, transdisciplinary, participatory approach is needed to create knowledge that retains connections with its meaning and context and therefore is readily translated into practice. This research integrates quantitative and qualitative traditions and involves the active participation of both clinicians and patients. The generation of relevant knowledge should be supported through (a) developing a culture of reflective practice among clinicians, (b) expanding the infrastructure for practice-based research, (c) developing a multimethod, transdisciplinary, participatory research paradigm, (d) longitudinal study of the process and outcomes of broad, integrative, relationship-centered care, and (e) incorporating pursuit of new knowledge as a central feature of training programs and policy. The time has come for the generalist disciplines to commit to the generation of new knowledge based on the needs of patients, families, and communities for relationship-centered, integrated, prioritized health care. Development of a culture of learning and inquiry, and the necessary research methods and skills will require a long-term commitment, creation of partnerships, and a focus on core principles by individuals and organizations.
The medical records of 176 patients with an isolated diagnosis of fatigue (ICHPPC-7901) were reviewed. The study population represented the experience of four family physicians in private practice and of residents and staff of a university family medicine center in Denver, Colorado, over a 12-month period. Variables included for study were age, sex, family structure, diagnostic testing, duration of symptoms, and associated final diagnosis. Women outnumbered men in the study population two to one. Fatigue occurred most frequently in people ages 15 to 34 years. Single people, both men and women, were represented in the study population at a higher rate than family members. Single women tended to have physical diagnoses associated with their fatigue, while women who were members of family units tended to have psychological diagnoses associated. Fatigue lasting longer than four months was more frequently associated with psychological problems, while symptoms less than four months in duration were more frequently associated with physical problems. Physical problems were involved in just over half the cases, with the most common being the prolonged viral syndrome. A discussion with the patient regarding his or her fatigue and its origin was documented in only about half of the cases.
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.
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.
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.
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.
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.