J Am Board Fam Med
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This poem describes how minor injuries to my body repeatedly called to my mind the devastating torture experienced by a man who is seeking asylum in the USA.
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Randomized Controlled Trial
Patient, Clinician, and Communication Factors Associated with Colorectal Cancer Screening.
Screening for colorectal cancer is beneficial. Yet, screening remains suboptimal, and underserved populations are at greater risk for not being appropriately screened. Although many barriers to screening are understood, less is known about how the decision-making process on whether to receive colonoscopy or stool testing influences screening. ⋯ Having a long-term relationship with a primary care clinician and sharing decisions may be key drivers to ensure evidence-based preventive care for underserved populations.
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The history of the American Board of Family Medicine (ABFM) is briefly recounted by focusing on 4 major touchstones that can be considered instrumental in shaping its development as the third largest specialty board in the United States. These include the board's founding, its implementation of maintenance of certification, the creation of its research enterprise, and its culture. The importance of each of these touchstones to the unique contributions that the ABFM has made to the specialty board community is explored.
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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 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.