J Am Board Fam Med
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The social contract between the public and health professions is fraying, challenged by changes in the organization and financing of health care, and by a collective failure to meet some of the expectations of society. It is timely for family medicine to acknowledge the social contract, to accept responsibility for its the role in renegotiating this contract, and to partner with other practice communities in doing so. ⋯ Current leveraging of professionalism is a path to burnout and the alternative is to create a built environment for good care that also supports professionalism rather than taking advantage of it. There are good examples to draw on, and further experimentation, partnerships, policy, and facilitation of practice redesign are needed to get there.
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Actualization of knowledge and skills learned in medical education is required for medical students and residents to adopt effective clinical patterns and behaviors into their lives as practicing physicians. In addition, the imprinting of clinical behaviors that these trainees incorporate from the observations they make in the clinical learning environment in which they train has been well established to have a substantial and long-lasting impact on their approaches to care in subsequent practice settings. While much attention is paid to the formal curriculum for students and residents, supported by the need to meet requirements for accreditation, it is less common to witness explicit discussions and planning about the role that the clinical learning environment plays in the ultimate outcomes of educational efforts. ⋯ In this commentary, the impact of the clinical learning environment on the production of graduates who are both knowledgeable about health system science competencies and incorporate them into the ways in which they view themselves and their work is posited to be one of the reasons contributing to the lack of consistent application of effective approaches to improving care. Recommendations for further training of faculty, alongside residents and students, are explored. Finally, models of medical education and curriculum must make the clinical learning environment "visible" in their planning, lest the outcomes they desire, and the nation needs, may never come to fruition.
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The evaluation of professionalism is embedded in the American Board of Medical Specialties' continuing certification programs for its 24 member boards.1 Currently, professionalism assessment is largely restricted to documenting professional standing, such as the status of medical licenses and medical staff privileges. With increased recognition of an expanded view of professionalism to include professional behaviors and competencies comes an opportunity for medical specialty boards to embrace a more formative approach to professionalism assessment. The goal of such an approach is to educate, reaffirm, and reinforce positive professional behaviors long beyond completion of formal medical education.
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Randomized Controlled Trial
Low-Intensity Intervention Supports Diabetes Registry Implementation: A Cluster-Randomized Trial in the Ambulatory Care Outcomes Research Network (ACORN).
Previous research demonstrated that registries are effective for improving clinical guideline adherence for the care of patients with type 2 diabetes. However, registry implementation has typically relied on intensive support (such as practice facilitators) for practice change and care improvement. ⋯ Remotely provided guidance paired with limited in-person assistance can support rapid implementation of diabetes registries in typical primary care practices.
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Prior research has documented disparities in asthma outcomes between Latino children and non-Hispanic whites, but little research directly examines the care provided to Latino children over time in clinical settings. ⋯ In a multi-state network of clinics, Latino children were less likely to have their asthma entered on their problem list the first day it was noted than non-Hispanic white children, but otherwise did not receive inferior care to non-Hispanic white children in other measures. Further research can examine other parts of the asthma care continuum to better understand asthma disparities.