Health expectations : an international journal of public participation in health care and health policyVivien Min Er Lee, Laurie J Goldsmith, Anna Szücs, V Vien Lee, Jun Cong Goh, Jeffrey Jiang, Nicola Ngiam, José M Valderas, Victor Weng Keong Loh
INTRODUCTION: Patient interaction has long been central to medical training. In recent years, involving patients as educators and bringing their lived experiences of illness or disability to the classroom has been valued in clinical education. These "experts by experience" enrich learning by offering authentic perspectives that foster empathy, challenge assumptions, and promote person-centred care. To our knowledge, there is no existing research on the experiences of persons with disabilities (PWD) serving as patient educators. METHODS: Semi-structured in-depth interviews conducted with seven patient educators with physical disabilities (all PWD patient educators who consented to the study) about their experiences teaching in an undergraduate medical student workshop on communication with PWD. Reflexive thematic analysis was used for analysis. RESULTS: Illustrating that "engagement is not one-dimensional," participants described engaging students through three overlapping and dynamic roles: patient, educator, and advocate. Four distinct types of patient educator were identified: Type A (Patient role is more predominant than the Educator role), Type B (Patient and Educator roles are equally important with less emphasis on the Advocate role), Type C (Patient, Educator, and Advocate roles are all equally important), and Type D (Patient and Advocate roles are equally important with less emphasis on the Educator role). Patient educators who demonstrated stronger integration of the educator role (Types B and C) were more confident, pedagogically effective, and aligned with curricular aims than those in Type A, whereas those whose engagement was primarily advocacy-oriented (Type D) occasionally diverged from educational goals. CONCLUSIONS: This study highlights the multidimensional nature of patient educator roles and identifies the strengths and limitations associated with different engagement orientations. Recognising and supporting these intersecting identities can inform recruitment and facilitation practices. Structured training and guided reflection may help patient educators balance personal narratives and advocacy aims with educational objectives, thereby optimising learner outcomes and strengthening the meaningful inclusion of PWD voices in medical education. PATIENT OR PUBLIC CONTRIBUTION: This study focuses on the perspectives of PWD as educators in an undergraduate medical student workshop on communication with PWD. This workshop was co-created with patient educators with disabilities.
Journal of the American Board of Family Medicine : JABFMOmolola E Adepoju
Telemedicine for opioid use disorder (teleOUD) represents a critical opportunity to expand access to evidence-based treatment while reducing stigma and structural barriers that have long impeded recovery. Yet, gaps persist in awareness, education, and trust among both clinicians and patients. Family medicine, grounded in continuity, collaboration, and community-centered care, is uniquely positioned to close these gaps. By embedding teleOUD education into training programs, normalizing its use in primary care, and fostering interprofessional partnerships, family physicians can transform how OUD is treated and perceived. As teleOUD becomes an integral part of care delivery, the challenge ahead is not only technological adoption, but rebuilding trust, reshaping clinical culture, and ensuring that every patient can access treatment without fear or stigma.
Journal of the American Board of Family Medicine : JABFMRichard A Young
Family medicine care in the United States has been suppressed through structural impediments in the healthcare system, yet could provide more care and better health outcomes with appropriate changes. The role of general practitioners in other developed countries provide insights on the value of primary care that could be better incorporated into US healthcare. The fundamental value of family physicians' care emerges from generalist thinking, particularly the use of probabilistic reasoning that supports care variation when patient preferences, situations, capabilities, as well as potential outcomes, are incorporated. Important strengths of family physicians include comfort with uncertainty, use of safety-netting, and listening to patient concerns and preferences, thereby providing balance in medical care decisions. These strengths occur through negotiating with patients to balance many concurrent considerations, reducing low-value care, establishing reasonable expectations with patients, providing a comprehensive basket of services, and continuing to function as a reservoir of resilience for the overall healthcare system. Efforts to grow US family medicine have been hampered by: (a) current measures of value-based care, (b) an over-emphasis on team-based care, and (c) some "un-American" aspects of family medicine culture, such as the belief that more care is not necessarily better care, that time can be used as a diagnostic tool, that it's important to be comfortable with mortality and end-of-life care, and being mindful of quaternary prevention. If family physicians communicate their value to patients and other stakeholders, and their unique strengths are better supported by stakeholders, patients will be better served, and future family physicians will have more joyful careers.
Journal of the American Board of Family Medicine : JABFMRichard A Young
The US environment for healthcare and healthcare research is not conducive to providing adequate family physicians to care for the needs of the US population. Medical student interest in family medicine is discouraged by many factors, including the culture of medical schools; physician-payment realities, including the American Medical Association's (AMA) Current Procedural Terminology (CPT) codes; the rules by which Centers for Medicare and Medicaid Services (CMS) determines physician and hospital payments; a lack of family medicine research funding; and a favoritism of resources devoted to hospitals and partialists (specialists). Family medicine is also negatively impacted by the generally poor understanding of its value among US policy makers and health-system observers. Family physicians contribute to better population health at a lower total cost. But many policy makers and observers have internalized inaccurate assumptions and misunderstandings of: (a) the role of wellness and lifestyle education, (b) the limits of the triple aim and common preventive services and single-disease metrics, (c) the results of 50 years of cost-effectiveness research, (d) inattention to referral rates, (e) inadequate recognition of family physicians' knowledge and ability to work within complex healthcare systems for the benefit of their patients, and (f) an over-reliance on population management. The full potential of family medicine to make its most effective contributions will only emerge when these issues are addressed.
Journal of the American Board of Family Medicine : JABFMLarry A Green
A family physician recalls the success of his back surgery, critiques the overwhelmingly transactional care he received, and suggests alternatives and possibilities available for family medicine to be a collaborative partner to strive with patients, healthcare professionals, and communities for a more humane and satisfying healthcare system.
BACKGROUND: The digitalization of health care has accelerated the adoption of mobile health (mHealth) apps in general and family medicine in Portugal. These tools may support chronic disease management and clinical decision-making. However, limited high-quality scientific evidence and the absence of a national framework for certification and quality standards create uncertainty about their safe integration into clinical practice. OBJECTIVE: This study aimed to characterize mHealth app use among general and family medicine residents and physicians in Portugal. It also examined factors influencing app selection, barriers to adoption, and clinicians' perceptions regarding the integration of AI into clinical practice. METHODS: An observational, cross-sectional, quantitative study was conducted using an online survey developed with LimeSurvey. The survey was distributed to residents and physicians registered with the Ordem dos Médicos (Portuguese Medical Association) who were in active clinical practice. Data were analyzed using descriptive statistics, with absolute and relative frequencies reported. RESULTS: The final sample included 141 participants (n=104, 73.8% female; n=37, 26.2% male). Most clinicians were aware of mHealth apps (138/141, 97.9%), and 85.1% (120/141) reported using them in clinical practice. Among 120 users, 87.5% (n=105) regularly used 2 to 5 apps. A total of 69 unique apps were identified; the 13 most cited accounted for 77.4% (246/318) of all mentions, including Tonic, UpToDate, Cardio4all, and PEM Móvel. Apps were mainly used during clinical consultations (111/120, 92.5%). The most frequent factors influencing app choice were ease of use (114/120, 95.0%) and evidence-based clinical effectiveness (79/120, 65.8%). Reported barriers included lack of knowledge about available apps (117/139, 84.2%) and the absence of national evaluation standards (66/139, 47.5%). Among nonusers (n=21), the main structural barrier was poor integration with clinical information systems (n=15, 71.4%). Regarding AI, 56.0% (79/141) reported awareness of AI-integrated apps, mainly Tonic and ChatGPT. The same proportion considered AI use beneficial, especially for clinical decision support (114/141, 80.9%) and administrative automation (88/141, 62.4%). Key concerns included ethics, data security, and privacy (105/141, 74.5%) and limited interoperability (94/141, 66.7%). CONCLUSIONS: mHealth app adoption in Portugal is high but fragmented and largely driven by personal initiative (98/218, 45.0%) and informal recommendations, with limited institutional guidance. Tonic was the only app identified by respondents as reporting compliance with ISO 13485 (medical software quality), ISO/IEC 42001 (AI management systems), and UEMS-EACCME clinical accreditation. Most clinicians perceive national regulatory guidance as insufficient (73/139, 52.5%). Future progress requires the urgent development of a national framework for the curation and recommendation of mHealth apps aligned with international assessment frameworks such as DiGA (Digitale Gesundheitsanwendungen [Digital Health Applications], Germany) and DTAC (England), increased digital health training, and improved interoperability with clinical systems to ensure safe, effective, and equitable use in primary health care.
Primary health care research & developmentMehmet Kibar, Erhan Şimşek
AIM: To characterise baseline levels and contextual triggers of public speaking anxiety (PSA) among family medicine residents and to examine whether a theory-driven educational intervention was associated with short-term changes in PSA across cognitive, behavioural, and psychological dimensions. BACKGROUND: Effective communication is a core competency in primary healthcare. However, while clinical consultation skills are prioritised, academic presentation skills are systematically absent from most family medicine residency curricula. This 'null curriculum' leaves primary care trainees unprepared for professional advocacy, academic leadership, and teaching roles. METHODS: A quasi-experimental one-group pre-test-post-test study was conducted involving 199 family medicine residents at a tertiary hospital in Türkiye. A theory-based single-session educational intervention was delivered. PSA was measured using the validated Turkish Public Speaking Anxiety Scale (PSAS). The study was reported in accordance with TREND and CRISP guidelines for primary care research. FINDINGS: Before the intervention, 87.4% of residents had never received formal PSA training. Academic instructors were the most frequently reported source of anxiety (82.9%) compared with patient encounters (4.0%). Following the intervention, total PSAS scores were associated with a statistically significant short-term decrease (p < 0.001). Significant short-term reductions were observed across cognitive (p = 0.005), behavioural (p < 0.001), and psychological (p < 0.001) dimensions. In exploratory subgroup analyses, married residents (p = 0.026) and senior residents (p = 0.002) appeared to experience larger short-term improvements, although these findings should be interpreted cautiously. These findings suggest that structured educational support may be beneficial for a subset of family medicine residents and that academic presentation skills warrant consideration as part of residency training; however, given the mixed individual-level responses and absence of a control group, this recommendation should be treated as preliminary pending controlled longitudinal evidence.
BMC medical educationPhilip Vogt, Nadine Wolf, Sandra Jordan, Sara Volz-Willems, Johannes Jäger, Fabian Dupont
BACKGROUND: Beyond technical feasibility of Artificial Intelligence (AI)-generated multiple-choice questions (MCQs), their educational value in assessment remains unclear. This study aims to evaluate whether students can distinguish between AI-MCQs and National Licensing Exam (NLE) questions in an exam setting and if they align with the curriculum. METHODS: In this cross-sectional study 119 year five medical students completed a Family Medicine MCQ tablet-based exam. Participants answered 30 AI-generated and 30 NLE MCQs. AI questions were generated from digital learning materials using ChatGPT-4o and Gemini 1.5 Pro. Experts accepted 82% of the questions, with minor edits to retained items and removing those needing major changes. During the exam, students were asked about the question source and whether each item aligned with the course curriculum. Statistical analyses were obtained using Jamovi 2.3.28.0. RESULTS: No significant difference in correct attribution of AI or NLE MCQs (t(29.6) = -1.24, p = .225; t(29.6) = 1.18, p = .246) was observed. No significant correlation was found between item difficulty and recognition (τ_b: p = .534). Distractor distributions did not differ across ChatGPT, Google Gemini and NLE (χ2(2) = 2.61, p = .271, U p > .05 for all comparisons). Item difficulty did not differ significantly between AI and NLE items; however, exploratory source-specific analysis showed an overall difference among ChatGPT, Google Gemini, and NLE items (χ²(2) = 6.71, p = .035), with a difference between Google Gemini and NLE items (p = .028). Student-perceived curricular alignment did not differ significantly between AI and NLE or among ChatGPT, Google Gemini, and NLE. CONCLUSIONS: Students' recognition did not differ between AI-generated MCQs and NLE MCQs. Easier MCQs are generally perceived as more aligned with the curriculum. AI-MCQs may provide a feasible approach to item drafting within a structured human-review process.
Annals of family medicineTobias Kube, Anna Seewald
PURPOSE: Reassuring patients that nothing serious is wrong is one of the most common interventions in family medicine. However, medical reassurance can sometimes fail, and it is not yet clear what role the doctor's behavior plays in this regard. We tested the preregistered hypothesis that a doctor's warmth and competence significantly and independently influence patients' responses to normal results from diagnostic testing. METHODS: We used an online convenience sample reporting medium somatic symptom burden (N = 349, mean age 29.9 years, 79% female) and completed an experimental analog study. After presentation of a symptom vignette, participants watched a videotaped medical report in which a doctor provided the results of diagnostic tests, stating that no abnormality had been identified. Whereas the diagnostic information was always the same, the doctor's behavior differed in terms of warmth (high vs low) and competence (high vs low). RESULTS: Participants rated the likelihood of a serious disease significantly lower if the doctor showed high warmth and high competence. Further results showed that high warmth and competence also led to improvements in other outcomes, such as a lower desire to seek another doctor's opinion or additional tests. A mediation analysis indicated that the effects of warmth and competence were modulated by the extent to which participants cognitively (de)valued diagnostic information. CONCLUSION: For patients, diagnostic information does not speak for itself; the doctor's behavior critically determines how they integrate such information. Showing high warmth and competence can help patients put trust in them and update their illness beliefs accordingly.
Annals of family medicineLauren E Harriett, Katherine M Wright, Lauren Anderson, Santina Wheat, Lauren Harrison, Kathleen Rowland, Lauren Oshman, Emma Worringer, Jacob Prunuske
BACKGROUND: Quality improvement (QI) is a core component of family medicine residency training, preparing physicians to lead system-level changes and deliver value-based care. However, there is no standardized curriculum or metric for evaluating success of residency QI projects and a lack of consensus on best practices for QI education and assessment in graduate medical education. We sought to characterize the current landscape of QI curricula in US family medicine residencies, including pedagogic methods, project requirements, faculty roles, and perceived markers of success and barriers. METHODS: This study was part of the 2025 Council of Academic Family Medicine Educational Research Alliance cross-sectional survey of family medicine residency program directors. Survey question topics included QI training, project logistics, characteristics, and outcomes. We analyzed data by descriptive statistics and χ2 analyses. RESULTS: The response rate was 44.2% (321/726). Programs reported using a residency-developed (38.8%) or hybrid (46.8%) QI curriculum, and most oversight was provided by core faculty (54.2%). Residents' access to QI data was typically limited (44.6%) or full (27.6%), and QI projects were often structured in resident teams (45.2%). Graduate QI proficiency was mostly rated as intermediate (63.5%). Greater graduate proficiency was significantly associated with programs reporting hybrid curricula, fewer barriers to data access, continuity of projects, and greater dissemination and implementation of project outcomes (all P < .05). CONCLUSIONS: Training and project characteristics linked to outcome measures, including resident proficiency and clinical practice change, highlight the need for more standardized and longitudinal approaches to QI training in family medicine residencies.Abstract available in: يبرع (Arabic); (Chinese); Francais (French); Deutsch (German); हिन्दी (Hindi); Indonesian (Indonesian); (Japanese); Portugues (Portuguese); Español (Spanish).
During a busy day of teaching rounds with family medicine residents, a social worker finds herself noticing the constant pull between connecting with patients as people and keeping up with the relentless demands of "the list." Through three clinical encounters, she reflects on what it means to teach and model humanism in a fast-paced inpatient setting, where the emotional and human needs of residents can be overlooked just as easily as those of the patients they care for.
Growing up as an undocumented immigrant in North Carolina shaped not only the author's path to medicine, but also how they understand patients, systems, and belonging. In this reflective essay, they describe the fear, uncertainty, and exclusion that marked their medical training in the United States while undocumented, despite academic achievement and a longstanding desire to become a physician. Policies designed to limit opportunity repeatedly threatened their progression, not because they lacked ability, but because institutions often viewed undocumented trainees as a risk. Although Deferred Action for Childhood Arrivals (DACA) allowed them to continue training, instability and uncertainty persisted. Now practicing rural family medicine with obstetrics, the author recognizes similar fears and structural barriers in patients who delay or avoid care because of exclusion, vulnerability, or mistrust. This essay reflects on what being undocumented cost them, what it taught them about caring for patients at the margins of medicine and society, and what communities lose when systems confuse legality with worth.Abstract available in: عربي (Arabic); (Chinese); Francais (French); Deutsch (German); हिन्दी (Hindi); Indonesian (Indonesian); (Japanese); Portugues (Portuguese); Español (Spanish).
Journal of primary care & community healthNana Kwame Ayisi-Boateng, Douglas Aninng Opoku, Abigail Kusi-Amponsah Diji, Eric Kojo Nsa Oduro, Emmanuel Konadu, Nana Akua Abruquah, Vitalis Anlaangmen Saadaa…
BackgroundPrimary healthcare systems in sub-Saharan Africa face numerous challenges that require innovative solutions. Key stakeholder perspectives are essential in the successful implementation of any interventions. This study assessed the acceptability, feasibility, and appropriateness of a family practice model (FPM) at a university hospital in Ghana.MethodsThis was a cross-sectional study conducted among 345 university staff who had accessed outpatient services at the University Hospital, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana, before the implementation of the FPM. A standardised pre-tested questionnaire was developed as a Google Form and distributed to university staff via all communication channels. Factors independently associated with willingness to accept the FPM were assessed using multivariable logistic regression analysis.ResultsThe mean age of the study participants was 45.5 (±10.5) years. Approximately 92.8% of study participants perceived the FPM implementation as acceptable and feasible, and 87.8% rated it as appropriate. About 92.2% of the study participants were willing to accept the FPM. In the main multivariable analysis, making 11 or more hospital visits per year was associated with lower odds of willingness to accept the FPM (AOR: 0.19, 95%CI: 0.05 - 0.76), while reporting frustration with the consultation process was associated with higher odds of willingness to accept the FPM (AOR: 8.70, 95%CI: 1.96-38.69). These associations remained in a sensitivity analysis.ConclusionThe FPM was perceived as acceptable, feasible and appropriate and willingness to accept it was high among the study participants. These findings reflect perceived attitudes and should not be interpreted as evidence of implementation readiness or actual uptake.
BACKGROUND: Fragmented outpatient care, and disrupted patient-provider continuity hinder progress towards the achievement of Universal Health Coverage (UHC) in many low- and middle-income countries including Ghana. Despite efforts such as the National Health Insurance Scheme and Community-based Health Planning and Services, continuity of care remains a challenge. This study explored stakeholders' perspectives on implementing a Family Practice Model to strengthen primary care and advance UHC at a University Hospital in Ghana. METHODS: A descriptive-analytical qualitative study was conducted from September 2023 to May 2024 at the University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi. Twenty-eight participants were purposively selected, comprising nine healthcare providers (physicians and physician assistants) and 19 care recipients (university staffs). Semi-structured interviews, guided by the Consolidated Framework for Implementation Research, explored experiences with the current outpatient system and views on the proposed FPM. Data were audio-recorded, transcribed verbatim, and thematically analyzed using NVivo version 14. RESULTS: Two major themes emerged: "Therapeutic Disconnection" and "A Doctor to Call My Own." Participants described the existing care system as fragmented, impersonal, and marked by rotating providers, poor documentation, and rushed consultations. These issues weakened trust and care continuity. In contrast, stakeholders supported a dedicated, relationship-based model that would ensure continuity, streamline care processes, and foster long-term provider-patient connections. CONCLUSION: The Family Practice Model could transform outpatient care at the university hospital and beyond by enhancing continuity, trust, and overall service quality. However, successful implementation depends on tailored strategies encompassing policy support, and pilot testing to assess feasibility and impact on UHC goals in Ghana.
Canadian family physician Medecin de famille canadienHussain Aboud, Ovie Martin Albert
OBJECTIVE: To provide family physicians with practical, evidence-informed guidance for initiating buprenorphine treatment in fentanyl use-including sublingual tablet, buccal film, and extended-release injectable formulations-and to outline structured approaches for transitioning patients from methadone to buprenorphine. SOURCES OF INFORMATION: The following were reviewed: Canadian and international clinical practice guidelines, randomized controlled trials, systematic reviews of buprenorphine formulations, cohort and emergency department studies of macro- and microinduction strategies, pharmacokinetic and withdrawal management studies in fentanyl-exposed populations, mortality and retention outcome analyses, and published methadone transition protocols. MAIN MESSAGE: In this time of widespread fentanyl use, buprenorphine initiation requires flexibility. Three practical oral induction pathways are available: standard induction (moderate opioid withdrawal confirmed), macroinduction (high-dose buprenorphine rapid stabilization), and microinduction (overlap buprenorphine while continuing full-agonist opioid). Extended-release injectable buprenorphine supports adherence and rapid test-dose initiation has the strongest evidence. Patients transitioning from methadone may use taper-and-switch, microinduction overlap, or slow-release oral morphine washout, selected according to methadone dose, destabilization risk, and patient preference. CONCLUSION: Family physicians can safely initiate and optimize buprenorphine treatment in community practice using structured but flexible approaches tailored to fentanyl exposure and patient goals. Clear protocols, anticipatory counselling, and early follow-up are central to successful treatment and retention in care.
Journal of the American Board of Family Medicine : JABFMKatherine Sanchez, Jason Ramm, Stephen Sewell, Christian Vazquez, Sharon Reece
Family medicine faces critical challenges including workforce shortages, limited patient access, and the need for sustainable care models. We implemented a Comprehensive Primary Care Team (CPCT) model pairing physicians with three to four advanced practice clinicians (APCs) in four community-based clinics serving rural Central Texas. This special communication provides insights into early implementation of this model (about 12 months post-implementation). We conducted informal qualitative interviews to understand clinician perspectives on early implementation. This included site visits with the four clinics piloting the CPCT model (n = 19). Interviewees included physicians and APCs. Interviews focused on daily workflows, scheduling, interprofessional communication, patient access, panel-size management, collaborative practices, and perceived barriers. We also conducted an analysis of third next available appointment using administrative data to get a snapshot of our goal to increase access. This analysis compares one CPCT model clinic with a solo-practice clinic. Insights from these informal interviews centered on 4 themes: (1) Teamwork and Collaboration, (2) Access and Scheduling, (3) Panel-Size Management, (4) Clinician Satisfaction. The third next available appointment analysis revealed substantially more appointment availability in the CPCT model clinic across multiple visit types. The CPCT model has potential to be a scalable innovation enabling family medicine practices to safely expand panel sizes, improve access to care, and operationalize physician-led population health management. Ongoing challenges include right-sizing teams, space limitations, and workflow optimization, but early insights support replication in primary care settings seeking to address access gaps and workforce constraints while maintaining quality of care.
Canadian family physician Medecin de famille canadienMariana da Silva Jardim, Lanujan Kaneswaran, Joanne A Permaul, Melanie Henry
OBJECTIVE: To assess the current representation of internationally trained physicians (ITPs) in family medicine (FM)-relevant medical leadership in Canada, compared to their representation in the Canadian FM workforce. DESIGN: Cross-sectional study using publicly available data. SETTING: Canada. PARTICIPANTS: Medical leaders across Canadian organizations relevant to FM and family physicians in the Canadian workforce. MAIN OUTCOME MEASURES: Demographic data of FM leaders in Canadian organizations relevant to FM were collected between September 2023 and January 2024, along with demographic data of family physicians in the Canadian workforce made publicly available by the Canadian Institute for Health Information (CIHI). Representation of ITPs in leadership positions was compared with their representation in the Canadian FM workforce. RESULTS: This study included data on 233 family medicine leaders from 33 medical organizations and 47,277 records from the CIHI workforce data. The results revealed that ITPs are significantly underrepresented in FM-relevant Canadian medical leadership, particularly in Ontario, Alberta, and Newfoundland and Labrador. The results also showed that in Manitoba, female physicians were more highly represented in leadership roles than in the general family physician population. Canada-wide, there were no significant differences in leadership representation based on years since medical school graduation. CONCLUSION: In a cross-sectional study of 233 family physician leaders in Canada, ITPs were underrepresented when compared with the Canadian FM workforce data. Future research should explore leadership trends, factors accounting for ITPs' underrepresentation, and strategies to overcome potential barriers.
Journal of the American Board of Family Medicine : JABFMRichard Guthmann, Robert Martin, Erin Lee, Christopher Boisselle
INTRODUCTION: Clinicians require concise, accurate summaries of new research to inform practice. Patient-Oriented Evidence that Matters (POEMs), published in American Family Physician, are a benchmark for summarizing primary literature in family medicine, while large language models (LLMs) offer scalable summarization but require rigorous evaluation. The objective of this study was to evaluate the accuracy and quality of summaries generated by large language models compared with expert-authored POEMs. METHODS: In this study, we compared LLM-generated summaries (Microsoft Copilot, GPT-4o class) with 24 recent matched POEMs using a standardized prompt. Two trained raters independently scored each summary with a 13-item tool (score range 0-13), cataloged errors, recorded word counts, and indicated preferences on a 5-point scale. RESULTS: LLM summaries outperformed POEMs in total score (mean 12.1 vs 10.6; mean difference 1.5, 95% CI 1.1-2.0; P < 0.001), with similar lengths (328 vs 353 words; P = 0.23). Errors occurred in fewer LLM-DOCSs (2/24) than POEMs (9/24), with a mean error score difference of 20% (95% CI 7% -33%; P < 0.001). POEMs most often missed in the categories Contextual Background and Limitations; both approaches frequently missed in Clinical Applicability. Reviewer preference favored LLM-DOCS (mean 2.44 on a 1-5 scale; 95% CI 2.1-2.8). CONCLUSIONS: An enterprise LLM, prompted in POEM style, produced accurate, low-error clinical summaries that matched or exceeded expert-edited POEMs and were generally preferred by reviewers, though further research is needed to assess broader applicability and impact. Findings support pragmatic LLM-assisted summarization and highlight the need for standardized evaluation tools and explicit prompts for clinical applicability.
Journal of the American Board of Family Medicine : JABFMCarl G Morris, Dean A Seehusen, Sarah Cole
In August 2025, family physicians gathered for the Family Medicine Leaders Consortium to share perspectives on whether family physicians should continue to prioritize clinical preventive services amid rising patient complexity, documentation burdens, policy constraints, and post-pandemic challenges. This paper synthesizes competing perspectives and overarching commentary from the consortium meeting. One viewpoint argues that preventive care remains essential to family medicine's core values, patient expectations, and economic viability. The opposing viewpoint contends that preventive services are increasingly algorithmic, delegable, poorly reimbursed, and, while important, are no longer core to family medicine. Together, these perspectives illustrate the need for ongoing, future-focused discussions about family medicine's identity as a specialty.
Advances in health information science and practiceJoseph E Capito, Jonathon T Williamson, Kelsey Samek, Kimberley Lanham, Erika Bodkins
BACKGROUND: Preventive visits may be converted to problem-oriented evaluation and management (E/M) services when documentation does not clearly support preventive service criteria, resulting in lost reimbursement despite appropriate care delivery. The objective of this study was to evaluate whether a diagnosis-triggered documentation template embedded within the electronic health record reduces conversion of preventive visit codes to problem-oriented E/M codes. METHODS: We conducted a 4-month observational evaluation in an academic family medicine clinic. A SmartText-based documentation template was triggered by the diagnosis of "annual physical examination" and inserted a standardized health care maintenance attestation into the clinical note. Encounters were classified as templated or nontemplated based on the presence of a SmartData Element. Preventive visit billing data were obtained from institutional reporting systems, and conversion rates were compared using a chi-square test, with effect size calculated using Cramér's V. RESULTS: Among 2310 preventive encounters, the template was used in 685 (29.7%). Overall, 37 visits (1.6%) were converted from preventive visit codes to problem-oriented E/M codes. Conversion occurred in 4 templated visits (0.6%) compared with 33 nontemplated visits (2.0%). Template use was associated with a statistically significant reduction in conversion (χ2 = 6.40, df = 1, P = .011), with a small effect size (Cramér's V = 0.053). CONCLUSIONS: A diagnosis-triggered documentation template was associated with reduced conversion of preventive visit codes to problem-oriented E/M services. Relatively simple electronic health record (EHR) configuration changes may improve documentation consistency and influence downstream coding outcomes in primary care.
Journal of the American Board of Family Medicine : JABFMMadeline Byrd, Melissa K Filippi, Anam Siddiqi, Sarah Fleischer, Andrew Bazemore, Annie Koempel
BACKGROUND: Women physicians face multiple systemic and social biases in the clinical setting that erode mental and physical well-being. Gender-based discrimination was reported by 76% of early-career women physicians, decreasing to 57% for mid-career, and 36% for late-career. While these trends suggest that these biases may diminish with career progression, they remain a persistent burden of women physician's careers. This article offers a unique contribution by centering early-career women family physicians, a group underrepresented in qualitative research on workplace bias. This article focuses on participants' microaggressive experiences in the clinical setting to better understand the biases they face. METHODS: Via email we recruited 25 geographically and racially diverse early-career women physicians who responded to the 2021-2023 American Board of Family Medicine National Graduate Survey. A semi-structured interview guide was developed following a life-history approach to better understand the transitionary phase from residency to the practicing workforce. Interviews were transcribed verbatim, cleaned, and analyzed via Inductive Content Analysis in NVivo by qualitative researchers. RESULTS: We identified three main themes that emerged from the data. First, biased communications within the clinical setting exposed a pattern of gender bias. Second, patients invalidate physicians' positions based on appearance and perception. Third, women physicians described navigating the emotional and psychological labor of clinical and societal expectations. CONCLUSION: In the context of primary care, microaggressions demand direct and intentional intervention. Failing to address these experiences jeopardizes both equity and workforce sustainability. Leadership must be equipped to recognize, interrupt, and respond to microaggressions-not only to support individual clinicians but to strengthen organizational culture and the broader primary care mission. Interference reflects the broader societal imperative and commitment to equity in healthcare.
Journal of evaluation in clinical practiceKonrad Hierasimowicz, Laura Purkl, Norbert Donner-Banzhoff
BACKGROUND: Uncertainty is part of everyday medical practice, especially in family medicine. Former studies have focused on how clinicians manage uncertainty, but its emotional experience has received less attention. This study looks at irritation as a distinct affective entry point through which family medicine residents first perceive disruptions in clinical, interactional or organisational issues. METHODS: Between 2019 and 2021, we spoke with 15 residents in Hesse, Germany. In semi-structured interviews, they described situations where they felt uncertain, including the context, their emotions, and what they did next. We transcribed, pseudonymised and analysed the interviews using Kuckartz's qualitative content analysis. RESULTS: In many cases irritation was the first emotional reaction when something in the consultation didn't feel right. We identified three common triggers: (1) a mismatch between intuition and medical findings, (2) irritation during patient interactions and (3) irritation caused by structural issues. The last two were our main focus, as they disrupt usual ways of working rather than pointing to hidden diagnoses. These moments of irritation could be confusing at first, but in some cases, they led residents to dig deeper into what shaped the patient's perspective, to ask colleagues for advice or pay more attention to systemic and organisational issues. CONCLUSION: Irritation acts as a harbinger of uncertainty by embodying those small breaks in routines and expectations from which uncertainty first arises. At first, it might throw residents off balance, but if they take the time to reflect on it, irritation can help them see things differently, stay attentive and improve their clinical skills. Residency programmes should give residents room to talk about these experiences, helping them handle uncertainty more effectively in their daily work.
Canadian medical education journalDelane Linkiewich, Oksana Babenko, Karen L Forbes, Ann Lee
Clinical reasoning and associated clinical decision-making (CDM) skills are crucial to determining an accurate diagnosis and appropriate management plan. Medical trainees are intended to learn these skills in the clinical environment, yet these settings are inherently variable leading to gaps in clinical cases encountered. Selecting and incorporating meaningful clinical scenarios with active student participation help address variability in clinical encounters necessary to enhance learning CDM. Expanding CDM sessions using key feature questions and a team-based learning approach could address clinical encounter gaps and continued development of CDM skills across clerkships.
Canadian medical education journalMartina Ann Kelly, Kristy Penner, Aaron Johnston
INTRODUCTION: The rising prevalence of multimorbidity poses a significant challenge to healthcare systems. However, medical education predominantly emphasizes single-disease frameworks, offering limited guidance on how learners can navigate the complexities of managing co-existing health conditions. Given the high incidence of multimorbidity in family medicine, this study aimed to explore the experiences of family medicine residents in managing multimorbidity, with the goal of informing curriculum development. METHODS: We conducted a qualitative study comprising four focus groups (mean duration 47 minutes) with a convenience sample of 28 family medicine residents learning in urban and rural settings. Data were analyzed inductively using reflexive thematic analysis. We drew on generalism and adaptive expertise as sensitizing theoretical lenses to support thematic development and our final interpretation. RESULTS: Participants described a shift from their undergraduate focus on "getting the list" of diagnoses toward a more nuanced, patient-centred approach to multimorbidity, which they characterized as "bespoke to the patient." Throughout residency, learners reported increased confidence conducting more flexible consultations-incorporating social determinants of health, the unique patient's context, realizing and navigating how healthcare structures impact, and sometimes impede, patient care. Balancing competing priorities became a key feature of their evolving practice, supported by exposure to diverse patient populations, meaningful preceptor relationships, and varied clinical environments. Residents increasingly identified their role coordinating the patient's care team, leveraging a generalist perspective to organize care and address complexity. CONCLUSIONS: Family medicine residents described learning to manage multimorbidity as a developmental process of acquiring generalist adaptive expertise, supported through working in a variety of learning environments. Encouraging preceptors to explicitly share strategies-such as managing limited time and navigating health system constraints-may further enhance resident education in caring for patients with multimorbidity.
Canadian medical education journalJeanne MacLeod, Frank X Scheuermeyer
Rural and remote physicians face challenges including management of critically ill patients. At eleven British Columbia resident teaching sites, seven of which were rural, we developed interactive video simulation sessions for treating such patients, and these were video-preceptored by a remotely located physician providing real-time debriefing. Family medicine residents found this program acceptable and educational, felt it increased confidence in managing sick patients, and could lead to future rural experiences and retention. Given this program additionally decreases cost and time of simulations due to less travel, we anticipate similar benefits for other Canadian family medicine programs.
This study aims to analyze the impact of "Rational Laboratory Test Ordering" training given to family medicine residents on their test request habits, number of tests, and costs. A total of 27,085 applications made to the Family Medicine Polyclinic of Düzce University Faculty of Medicine between June 1, 2022, and June 1, 2024, were retrospectively examined. Based on the educational intervention provided to resident doctors on June 1, 2023, the periods before and after were compared in terms of the total number of tests, tests per application/per patient, and costs based on Health Implementation Communiqué prices. After the training, although there was no significant difference in the monthly number of admissions (P = .660), the average monthly total number of tests decreased from 8382 to 5808 (P < .001). The number of tests per visit decreased significantly from 7.74 to 5.03, and the cost per patient decreased significantly from 167.37 Turkish Liras (TRY) (4.74 United States Dollars [USD]/ 4.56 Euros [EUR]) to 136.94 TRY (3.88 USD/ 3.73 EUR) (P < .001). During the 1-year period, a savings of 17.3% (255,009.13 TRY; 7228.15 USD/ 6942.80 EUR) was achieved in the total laboratory costs. Especially, a significant decrease was observed in the requests for sodium, aspartate aminotransferase, and serum free thyroxine, while the requests for alanine aminotransferase and thyroid-stimulating hormone remained stable. The educational intervention significantly reduced unnecessary test requests and costs without narrowing clinical capacity. Changes in specific tests (such as the preference for alanine aminotransferase over aspartate aminotransferase, thyroid-stimulating hormone over serum free thyroxine) suggest that physicians' test ordering patterns may reflect greater adherence to evidence-based medicine guidelines. The rational laboratory approach serves both economic sustainability and the protection of patients from excessive medicalization within the framework of the principles of quaternary prevention.
Revista da Associacao Medica Brasileira (1992)Büşra Çakmak, Betul Battaloğlu Inanç
OBJECTIVE: The aim of this study was to evaluate the knowledge, attitudes, and vaccination practices of family physicians in Muğla, Turkey, regarding rotavirus infection and vaccination. METHODS: This descriptive cross-sectional study included family medicine residents and family physicians working in primary care settings in Muğla. Data were analyzed using Kruskal-Wallis, Mann-Whitney U, and Pearson chi-square tests. A p<0.05 was considered statistically significant. RESULTS: Among the participants, 88.6% recommended at least one vaccine not included in the national immunization schedule, with rotavirus vaccine being the most frequently recommended (91.9%). Rotavirus vaccine knowledge scores were significantly associated with age and the recommendation of vaccines not included in the national immunization schedule (p<0.001). Physicians who had vaccinated their own children had significantly higher knowledge scores (p=0.011). CONCLUSION: Although family physicians demonstrated adequate general knowledge of rotavirus infection, vaccine-related knowledge was insufficient. Knowledge level appears to play a key role in shaping vaccination attitudes and behaviors, highlighting the need for targeted continuing medical education.
Journal of primary care & community healthGary Karagodsky, Jon P Furuno, Megan C Herink, Megan Viehmann, Phuong Y Duong, Jennifer J Stanislaw
IntroductionDepression is a common mental health disorder in the United States and associated with increased morbidity, mortality, and health care costs. We assessed the association between language preferences on the frequency of depression screenings and follow-up actions within a primary care setting.MethodsThis was a retrospective cohort study of adult patients at a Federally Qualified Health Center in 2019. Our exposure was patient preference to use a non-English language. Our primary outcome was a completed annual depression screening. We also assessed follow-up actions after a positive depression screen. We used multivariable logistic regression to predict the odds of having a depression screening while adjusting for age, sex, race and ethnicity.ResultsAmong 10,187 patient encounters, 4,049 (39.8%) received depression screening. English-preference patients were significantly more likely to complete screenings compared to non-English-preference speakers (adjusted odds ratio (aOR) 2.25; 95% Confidence Interval (CI) 1.80-2.81). Compared to white patients, Black patients were less likely to complete a depression screening (aOR 0.74; 95% CI 0.63-0.88). Follow-up actions were documented in 31.3% of patients with English language preference and 23.5% of non-English language preference.ConclusionsPatients with English language preference were more likely to complete a depression screening and receive follow-up actions following a positive screen compared to those with non-English language preference. System-level interventions to improve equitable screening and follow-up are necessary in primary care. Collaborative care models, bilingual providers, and culturally tailored care may help reduce these disparities.
Rural and remote healthAlicia Thiel, Zekeriya Aktürk, Marco Roos, Anna Sporkert, Wolfgang Blank
INTRODUCTION: The shortage of GPs and the aging population in Germany, with older people requiring increasing amounts of medical care, is creating considerable strain on the German healthcare system. The lack of young doctors in general practice poses challenges to the health care of the population. The 'Excellent Project' aims to draw interest in the field of general practice/family medicine and rural work among medical students. The project provides structured and supervised internships designed to present general practice as a valuable professional choice, and as an attractive and fulfilling career option in rural settings. This cross-sectional study investigated the impact of a structured internship program in a rural general practice. The internship combined intensive one-on-one supervision by experienced GPs with an accompanying teaching program. To assess the impact, former students were asked by questionnaire about their interest in general practice before and after participation, as well as their willingness to work in rural areas. METHODS: The project was offered as a 4-week internship as part of the block internship required by the German Licensing Regulations for Physicians. Participation in the project was open to all medical students at German universities. Participants were placed in rural general practices across the Bavarian Forest, a rural region in the south-east of Germany. As part of the internship, in addition to interactive teaching sessions and gaining experience in general practice, exploration and leisure activities in the rural environment played a significant role. During the project, the students built connections with peers and mentors. To evaluate the 'Excellent Project', the evaluation focused on changes in students' career aspirations towards general practice and rural work. Specifically, the main outcome measure was whether students reported greater interest in becoming GPs after completing the internship compared with before the program. Additional outcomes included self-reported growth on personal and professional levels. RESULTS: The internship promotes development on both personal and career-related levels. After completing the internship, the participants' preference for pursuing a career in general practice increased. On a scale from -100 to +100, the wish of being a GP in the future increased from a median of -40 (interquartile range (IQR): -70-20) before the project to a median of 30 (IQR: -12.5-52.5) after the project. The participants' interest in working in rural areas was assessed on a scale of -100 to +100 and showed that the further the participants progressed in their careers, the greater their desire to work in rural areas in the future (students: median 20 (IQR: -20-50); further training: median 35 (IQR: 0-60)). A total of 24.3% of participants who have already obtained their medical license have decided to pursue further training in general practice. CONCLUSION: A structured rural practice experience during the initial years of a medical career can sustainably increase medical students' motivation to choose further training in general practice and work in rural areas, with lasting effects still observable years later. Initiatives such as the 'Excellent Project' can help to address the shortage of GPs in rural areas.
Journal of graduate medical educationFreesia Quezada, Peter Manfredonia, Trenten L Fenster, Michael Topmiller, Yalda Jabbarpour, Jeongyoung Park
BACKGROUND: Community-based training is crucial for the equitable development of the physician workforce and influences the practice location of new physicians. However, little is known about the distribution of the physicians trained in community-based settings across areas of varying social risks. OBJECTIVE: To examine the association between community-based training of family physicians and subsequent practice comprising socially disadvantaged populations. METHODS: Using the 2017-2022 American Board of Family Medicine Initial Certification Questionnaires and the 2024 American Medical Association Physician Masterfile, we performed a multivariate logistic regression analysis to assess the association between community-based training-applying a broad definition (training outside of large academic centers) and a narrow definition (training specifically in Teaching Health Centers [THCs] or rural/Rural Training Tracks [RTTs])-and subsequent practice location in communities with high health-related social needs. RESULTS: Among the 15 851 family physicians, 5717 (36.1%) trained outside a hospital or large academic center (broad), whereas only 1419 (9%) trained in THCs or rural/RTTs (narrow). Family physicians from a narrowly defined community-based training had higher odds of practicing in socially disadvantaged communities (Social Deprivation Index≥median) compared to their counterparts (OR, 1.224; 95% CI, 1.097-1.366; P<.001). No significant association was found in the model using the broad definition of community-based training. Male, non-White, Hispanic, and international medical graduates were statistically positively associated with practicing in areas with high health-related social needs. CONCLUSIONS: This study shows that family physicians who trained in THCs or rural/RTTs are significantly more likely to be practicing in areas with high social needs than those who did not.
Primary health care research & developmentTumay Sadikoglu, Duygu Altiparmak, Helen Shields
AIM: This study aims to evaluate the feasibility and educational impact of utilizing SHCs as primary care training sites in undergraduate medical education, with the goal of enhancing clinical competencies in young adult healthcare. BACKGROUND: Family Medicine (FM) is essential for integrating community-based health services into medical education. In Turkey, final-year medical students complete a one-month rotation at Family Health Centers (FHCs). However, young adults often utilize Student Health Centers (SHCs) on university campuses, resulting in a gap in students' experience with this age group. Addressing this, our programme initiated the inclusion of SHCs in the FM internship rotation for the 2024-2025 academic year. METHODS: A mixed-methodology study was conducted in two phases. A retrospective analysis was performed on medical records of patients aged 18-25 who attended the SHC over a one-month period. A prospective 9-item online survey assessed the educational impact on final-year medical students following their FM internship, which included the SHC rotation. Descriptive and qualitative statistical analyses were performed to summarize the survey and clinical data. FINDINGS: A total of 1228 patients were seen at the SHC, mirroring FHC trends. All 87 interns surveyed rated the FM programme initiative positively, with 94.1% highly satisfied and 85.9% reporting improved primary care skills. Qualitative feedback highlighted the value of practical experience and called for longer rotations. CONCLUSION: Integrating SHC rotations into undergraduate medical education is both feasible and beneficial, providing relevant primary care experience for medical students and enhancing training in the care of young adult populations.
Primary health care research & developmentBerna Terzioğlu Bebitoğlu, Esra Akdeniz, Mehmet Ali Gülpınar
PURPOSE: It was aimed to determine the competencies of Family Medicine residency students regarding the treatment planning of diseases coded with diagnosis-treatment in the 'National Core Education Programme' (NCC) in Turkey. We aimed to identify areas where residents feel less competent, which can inform curriculum improvements to better address gaps in treatment planning skills for core diseases. METHODS: The study was conducted with Family Medicine residency students from one medical school selected from each geographical region of Turkey. Students were asked to assess themselves at the time of graduation from medical school and currently during their residency training, in terms of 'appropriate drug selection', 'prescribing', 'non-drug treatment planning' and 'processing treatment management and giving information' competencies for 59 diseases in the NCC. RESULTS: The rate of Family Medicine residency students who felt competent in treatment planning/management when they graduated from medical school was very low; although this rate increased to a certain extent with residency training, it could not reach an acceptable rate. Despite partial improvements after graduation, the results suggest potential gaps in achieving the desired competency levels, even after 1-3 year of residency training. The residency students' competency perceptions ranged from 10-30% to 60-80% across different diseases. CONCLUSION: It is important to review and reconstruct the six-year medical education and Family Medicine residency training programs, based on the framework drawn by NCC, focusing on rational treatment planning/management to reconceptualize treatment planning/management and decision-making.
JMIR medical educationKai Ping Sze, Jia Qing Lim, Yng Miin Loke, Teck Yong Gabriel Ding, Wei Chieh Wee, Tongyuan Chen, Jingkai Lawrence Wu, Vivek Bansal, Qi Wei Fong, Minyang Chow
BACKGROUND: Generative artificial intelligence (GenAI) is increasingly used to draft multiple-choice questions (MCQs) for health professions education, but much evidence concerns raw model outputs, expert ratings, or item difficulty alone. Educators edit GenAI drafts before use, and whether such items are psychometrically ready for postgraduate assessment remains unclear. OBJECTIVE: This study aimed to compare human-edited GenAI-assisted and educator-crafted MCQs for postgraduate Family Medicine Applied Knowledge Test-level assessment, examining difficulty, discrimination, reliability, distractor functioning, and participant perceptions. METHODS: We conducted a blinded cross-sectional, within-participant comparative psychometric evaluation in Singapore. Sixty best-of-five single-best-answer MCQs were evaluated, 30 human-edited GenAI-assisted items and 30 educator-crafted items, topic-matched across postgraduate FM domains and randomized across 2 assessment sets. Eligible participants were postgraduate doctors enrolled in FM residency or postgraduate family medicine programs, preparing for the Applied Knowledge Test, and blinded to item origin; incomplete paired responses were excluded. Outcomes included paired total scores, score correlation and agreement, Kuder-Richardson Formula 20 reliability, item difficulty index, corrected point-biserial discrimination, distractor functioning, and perceived difficulty, clarity, and relevance. Analyses used paired-sample tests, Pearson correlation, Fisher exact tests, and item-level psychometric statistics, with α=.05 and Bonferroni correction within comparison families. RESULTS: Of 74 participants, 73 completed both item sets and were included in the analysis. The final sample comprised 36 graduate diploma in FM trainees, 5 MMed FM trainees, and 32 FM residents. Paired-sample testing showed lower scores on GenAI-assisted than educator-crafted items (mean 19.12, SD 2.83 vs mean 21.10, SD 3.42 out of 30; mean difference -1.97, 95% CI -2.72 to -1.23; P<.001; Cohen d=0.62), indicating that GenAI-assisted items were not easier. Scores were positively correlated (r=0.49, 95% CI 0.30-0.64; P<.001), but Bland-Altman analysis indicated limited agreement. Kuder-Richardson Formula 20 reliability was lower for GenAI-assisted items (0.38 vs 0.60). Mean difficulty index did not differ significantly (0.64 vs 0.70; mean difference -0.07, 95% CI -0.19 to 0.06; P=.29), and more GenAI-assisted items fell within the acceptable difficulty range (18/30, 60.0% vs 13/30, 43.3%). However, mean corrected point-biserial discrimination was lower for GenAI-assisted items (0.09 vs 0.18; mean difference -0.08, 95% CI -0.16 to -0.01; P=.04), and negative discrimination was more common (6/30, 20% vs 3/30, 10%). GenAI-assisted items also had more nonfunctioning and negatively discriminating distractors, although these differences were not statistically significant. Participant ratings of perceived difficulty, clarity, and practice relevance did not differ by origin. CONCLUSIONS: Human-edited GenAI-assisted MCQs can achieve plausible difficulty, but difficulty and surface acceptability did not ensure assessment readiness. Using trainee response data, this study extends work on raw outputs or expert opinion. GenAI should be used as a drafting adjunct within educator-led workflows prioritizing key verification, distractor engineering, pilot testing, empirical item analysis, and repair before item-bank or summative use.
Journal of educational evaluation for health professionsAlberto Pino-Postigo, Rocio Lorenzo-Alvarez, Dolores Dominguez-Pinos, Eugenio Lázaro Navarro-Sanchis, Eduardo Ochando-Pulido, Miguel Jose-Ruiz Gomez, Francisco…
PURPOSE: This study aimed to evaluate a structured basic radiology course for Family Medicine residents delivered in a 3-dimensional (3D) virtual environment (Second Life). We hypothesized that participation would be associated with higher post-course knowledge test scores and high learner satisfaction. METHODS: A quasi-experimental multi-cohort pretest-posttest study was conducted across 3 consecutive cohorts of Family Medicine residents in Spain in 2019. Ninety-six participants engaged in a 15-day course combining synchronous and asynchronous activities. Sixty-five participants provided paired pre- and post-intervention knowledge assessments, which were analyzed using paired t-tests. Learner satisfaction was evaluated using a structured questionnaire with Likert-scale items, numerical ratings (0-10), and open-ended responses. Pre- and post-test scores and ratings were compared using paired t-tests, and Mann-Whitney U tests were used for Likert-scale data. Qualitative data from open-ended responses were analyzed using thematic coding. RESULTS: Participants had significantly higher post-course knowledge test scores, increasing from 47.4±11.6 to 58.2±11.9 (mean difference, 10.8; P<0.001; paired-sample Cohen's d [dz]=0.67). High agreement was observed across most satisfaction items, with median scores ranging from 4 to 5. Content relevance, usefulness for clinical practice, and instructor performance received the highest ratings. Lower scores were observed for peer interaction and platform usability. CONCLUSION: A structured radiology course delivered in a 3D virtual environment was associated with higher immediate post-course knowledge test scores and high learner satisfaction among Family Medicine residents. The findings support the feasibility of repeated course delivery, although controlled studies are warranted.
Annals of medicineLi Ping Marianne Tsang, Mui Suan Tan, Yang Yann Foo, Cia Sin Lee
BACKGROUND: 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. AIM AND METHODS: 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. RESULTS: 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. DISCUSSION AND CONCLUSION: 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.
Journal of the American Board of Family Medicine : JABFMAndrew Bazemore, Alexander Krist, Alan Katz
Comprehensiveness has long been a defining principle of family medicine (FM), and a reason that primary care delivers better outcomes at lower cost with greater equity. Yet rising patient complexity, narrower scopes of practice, workforce strain, and misaligned payment and credentialing systems have made sustaining traditional "full-basket" care increasingly difficult. In 2025, the Family Medicine Leadership Consortium convened a national dialogue to examine whether and how the discipline should reaffirm comprehensiveness as its core organizing principle. Participants agreed it remains essential to family medicine's identity and public value but emphasized the need to redefine it for modern realities, balancing breadth and depth of care, recognizing limits on individual physicians, and shifting accountability toward interprofessional teams and broader care ecosystems. The envisioned next-generation model situates comprehensiveness across the clinician, team, practice, and community levels, supported by longitudinal relationships, team-based care, and enabling technologies such as artificial intelligence (AI). This reconceptualization offers a framework for training, workforce strategy, measurement, and payment that preserves family medicine's generalist identity while advancing access, quality, equity, and sustainability.
Journal of the American Board of Family Medicine : JABFMStephen A Wilson, Erika Steinbacher, Tracey Conti
Family physicians should be providing care for hospitalized patients. This fulfills part of our mission and opens opportunities for us to improve patient care and metrics, advance in leadership, teach residents and medical students, and influence and do research; caring for hospitalized patients also brings value to the patients, the system, and family physicians generally. Some of the value we bring to hospital-based care includes addressing workforce shortages, continuity across care settings, cost-effective and high-value care, educational impact, enhanced career satisfaction, flexibility in career options, holistic patient care, improved health outcomes, support transitions of care, training and professional growth, and versatility and breadth of training. The question is not if we should deliver hospital-based care, but rather how we should deliver it.
American family physicianLenard I Lesser, Mary N R Lesser, Sean C Lucan
Family physicians can provide helpful dietary advice that is efficient and uncomplicated. Key themes include emphasizing whole foods that are primarily made from plants, limiting ultra-processed products, and flexibility to accommodate taste preferences and familiar foods. Healthy eating can be achieved across a range of dietary patterns, cultural traditions, and nutrient distributions. The best diet for any given patient will be one they can maintain. However, the strongest evidence for producing sustained dietary change comes from comprehensive moderate-contact programs, which are generally beyond what primary care physicians can provide. When lack of time, training, and comfort are obstacles to having comprehensive in-clinic conversations about diet, family physicians can refer patients to specialists trained in nutrition and behavior change. For patents with complex needs, collaboration with dietitians can optimize clinical outcomes.
Journal of the American Board of Family Medicine : JABFMDavid W Price, Sarah Z Cole, Saroj Misra
In August 2025, leaders from family medicine organizations and representative patient stakeholders met for discussions regarding the evolution of the clinical model for family medicine. Performance improvement (PI), long a part of the continuing board certification process, was among the topics discussed. Pockets of concern or confusion remain about the relevance, importance, practicality, and administrative burden of PI for practicing family physicians. This discussion paper summarizes concerns about PI as commonly currently operationalized and outlines the rationale for inclusion of PI in the clinical model of family medicine. It outlines opportunities for the progression of PI to become less single-disease metric focused to practically focus on team-based care, complexity, and patient-centered outcomes, while accounting for the variety of contexts in which family physicians practice.