Residents and faculty present at 50th annual STFM conference

STFM link

New faculty face unique challenges navigating the multifaceted domains of medical student education, residency training, and research. Family medicine departments often struggle to provide a comprehensive orientation for new faculty or a sustainable model for continuous faculty development. Presenters will provide a toolkit for new faculty, providing guidance on faculty development, mentorship, coaching, giving effective feedback, scholarly activity, research development, advocacy, and faculty and resident wellness. Presenters will facilitate discussions on common challenges and fundamental resources including an updated toolkit incorporating feedback from annual sessions presented 2011–2016. A faculty panel will present leadership development activities, mentorship and coaching styles for seeking adequate support, take questions and offer advice including guidance on seeking and giving feedback, establishing an advocacy learning plan and agenda, research development, and creating an educator portfolio. A balanced approach to faculty life is becoming increasingly important with the increased administrative burden and limited wellness resources. Presenters will review wellness activities and modeling work-life balance.

Upon completion of this session, participants should be able to:

1. Describe the most common personal, clinical, administrative, and academic challenges identified by new faculty in family medicine and identify resources for overcoming barriers.
2. Identify effective mentoring and coaching concepts and styles, identify accessible opportunities for building mentoring and coaching relationships, and describe strategies for maintaining and modeling work-life balance.
3. Implement faculty development programs, by learning about family medicine advocacy, faculty roles in supporting medical student interest in family medicine, and developing a pipeline of students and residents as new family medicine faculty.

STFM link

With the increasing amount of knowledge accumulating in medicine today, family medicine is in the business of creating life-long learners. Frequently, 3 years does not feel like enough time to acquire all the knowledge a family physician will need. Though family physicians are generalists at heart, individual residents often have a specific area of interest in which they wish to further develop skill. With the growth of Accreditation Council for Graduate Medical Education (ACGME) accredited fellowships such as sports medicine, adolescent medicine, geriatrics, and palliative care, there are more and more opportunities to expand the knowledge base. However, when a trainee’s area of interest falls outside of these few areas, how to acquire additional knowledge is more elusive. This seminar will share our experience at creating non-ACGME accredited fellowships in an area of individual residents’ choosing (community medicine and behavioral medicine). We will detail how we overcame the institutional and financial barriers, as well as success and outcomes, to help participants brainstorm similar programs within their own institutions.

Upon completion of this session, participants should be able to:

1. Describe a model in which resident trainees apply and create a non-ACGME fellowship in an area of interest of their choosing.
2. Articulate an approach to a financial model for a proposal for a non-ACGME fellowship.
3. Articulate the pros and cons of developing a non-ACGME accredited self- directed fellowship and articulate the steps needed to create this within their individual setting.

STFM link 

We will be showing that a one-on-one model using a physician to teach physicians how to better use electronic medical records (EMR) is effective and well received. Dissatisfaction among physicians with EMR, inefficient use of many of the helpful tools due to lack of interest, perceived time to learn, or understanding of how to access features all indicate the need for a more effective teaching method. Improved use of the EMR can lead to improved patient care, quality of care, physician satisfaction, and patient satisfaction. Our approach is unique in that it identifies gaps in knowledge or use of EMR tools, and then targets an individualized educational effort using a respected peer physician in a one-on-one setting, including observation during a clinic session with debriefing afterwards. Outcomes showed that physicians found the one-on-one sessions to be the most effective training method—it improved their job satisfaction, and it increased their ability to use the EMR. The fact that the teacher was a physician was very important to them. Productivity measures showed that participants decreased the time it took to close an office visit after training whereas nonparticipants time to close encounters markedly increased over the same time period.

Upon reviewing the poster, participants should be able to:

1. Implement a one-on-one teaching strategy to help physicians increase their efficient use of EMRs.
2. Use questionnaires to aid in planning a personalized curriculum as well as to evaluate the teaching.
3. Use productivity metrics from the EHR as a proxy measure of evaluating teaching effectiveness.

STFM link 

Excess weight gain during pregnancy is a strong risk-factor for long-term obesity among mothers and infants, especially among adolescent mothers. The objective of the study is to understand the knowledge, beliefs, and factors that influence weight gain among pregnant adolescents. In this mixed method study, pregnant adolescents age 14-24 with access to cell phones were asked a series of structured and open-ended questions using text messaging. The text message questions were sent after 20 weeks gestational age and focused on adolescents’ ideas regarding diet, exercise, body, image, and health during pregnancy. Descriptive statistics were performed on quantitative responses and open-ended text message responses will be qualitatively analyzed using a grounded theory approach to identify the knowledge, beliefs, and factors that influence weight gain among adolescents during pregnancy. Among our sample (n=54), the mean age was 21 (SD=2.2), with 52% identifying as Black or African American, 30% White, 13% multiracial, and 13% identified as Hispanic or Latino. Fifteen percent did not graduate from high school, 42% were high school graduates, 9% attended at least some vocational school, and 20% attended some college. In preliminary analysis of responses to date, three main findings have emerged. First, participants show insight into healthy lifestyle changes, including "cutting out candy", "do more exercising", and "not stressing so much." However, many women report barriers to engaging in these healthy behaviors ("No I have not been working out. I work a job 8 hours a day 5 days a week. I chill on my off days, I feel like that is enough"). The most common educational resources reported were the Internet, their physicians and midwives, and their mothers. Many young women also report frequently drinking sugar sweetened beverages ("I drink juice the most") and may benefit from skills to cope with managing unhealthy cravings ("Sometimes I have [cravings] and I deal with them by getting what I’m craving for" "I crave hot wings this week and I got hot wings"). Pregnant adolescents face significant barriers to engaging in healthy behaviors during pregnancy including limited knowledge and resources. Adolescent-centered interventions that address both social and educational gaps, and focus on appropriate diet, exercise, and stress management may help to improve health outcomes among adolescent mothers and their infants.

STFM link 

Purpose: Surveys administered via text messaging may offer a convenient and cost-effective way for patients to "speak" to researchers in real-time about their health care knowledge, opinions, and beliefs. Our study aims to assess the feasibility and acceptability of administering a text message survey in the waiting room of a low-income primary care clinic. Methods: We obtained a convenience sample of individuals who entered the waiting room of a primary care clinic in a low-income community. All adults, including those who were accompanying patients to their appointments, were invited to join. Those that accepted the invitation to participate in the survey were given written and verbal instructions on how to begin the texting "conversation" on their cell phones. Survey questions included open ended and multiple choice questions. Descriptive statistics were used to characterize the participants and determine the response rates. Bivariate analyses were performed to identify predictors of incomplete surveys. Results: Of those accepting a flyer invitation, 43% (461/1061) attempted the survey. Of those who attempted it, 80% (370/461) completed it in full. The average age of respondents was 35.4 years (SD = 12.4). Respondents were predominantly non-Hispanic black (42%) or non-Hispanic white (41%), female (75%), and with at least some college education (70%). Of those who completed the survey, 84% (312/370) reported willingness to do another text message survey at a different time. Those with incomplete surveys answered a median of 9 questions before quitting. The majority of respondents (82%) reported using a smartphone. Smartphone users were less likely to leave the survey incomplete compared to non-smartphone users (15% vs 30%, respectively; P=0.004). Conclusions: Text message surveys are a promising modality for real-time data collection among low-income, clinic-based samples. Key lessons to maximize initiation and minimize attrition of text message surveys include a) offering a time for immediate completion of the survey (e.g. the waiting room of a clinic), b) minimizing the number of questions, c) simplifying the presentation of questions, and d) allowing "free text" responses for all question types, even multiple choice ones.

STFM link

Purpose: The role of total testosterone (TT) production as a contributing factor for health and vitality in men is steeped in controversy. There is ongoing debate about what constitutes optimal physiological levels across different ages. Previous studies have shown a link between higher TT and protection against diabetes and cardiovascular disease, while other studies have reported no benefit. There is also a well-known link between TT and muscle strength in men, as well as between low muscle strength and chronic disease risk across populations. The purposes of this study were therefore to evaluate the independent and joint effects of TT and muscle strength on prevalent chronic multimorbidity in a population-representative sample of men. Methods: A population-representative sample of 2,399 men, aged 20 years old and older were included from the 2011-2012 National Health and Nutrition Examination Survey (NHANES). Prevalence of 9 chronic conditions was evaluated. Analysis were performed to examine the prevalence of multimobidity among young (20-39.9 years), middle-aged (40-59.9 years), and older (=60 years) men, with and without low TT. Multivariate logistic models were used to determine the association between age-specific TT tertiles and multimorbidity, adjusting for age categories and key sociodemographic variables. Results: Prevalence of low TT was 22.6%, 36.0%, and 34.9% for young, middle-aged, and older men, respectively. Multimorbidity was significantly more prevalent among men with low TT, compared to normal TT in the group (34.2% vs 50%; p<0.001); however, significant differences were only seen within the young (low TT: 33.3%; normal TT: 12.7%; p<0.001) and older men (low TT: 68.3%; normal TT: 57.3%; p<0.001). Fully adjusted models revealed an association between the age-specific low-TT (OR: 2.51; 95%CI 1.93-3.27) and moderate-TT (OR: 1.47; 95%CI 1.11-1.96) tertiles (reference high TT tertile) and multimorbidity. Mediation analysis demonstrated a mediation effect when NGS was included in the model, such that only low TT (OR: 1.78; 95%CI 1.20-2.64) was associated with multimorbidity. Conclusions: Low TT in men was independently associated with multimorbidity at all ages; however, multimorbidity was significantly more prevalent among young and older men with low TT. This provides evidence to support expanding testosterone testing to being considered as a screening test as a predictor of overall health.

STFM link

Purpose: Depression during the antenatal and postpartum period affects 3-15% of pregnant women and is associated with multiple maternal and neonatal morbidities such as pre-term birth, small for gestational age, decreased breastfeeding initiation and decreased antepartum clinic visits. This study aims to determine rates of depression screening during pregnancy to help implement quality improvement metrics. Methods: Study Design: Single-site cross-sectional study from June 2014-June 2016 at the University of Michigan. Setting/Intervention: 14 clinical practice sites including: obstetricians (maternal fetal medicine, resident run clinics, and attending only obstetricians), certified nurse midwives, and family medicine physicians. Dates of Edinburgh Postpartum Depression Screen (EPDS) completion, medical complications of the pregnancy, continuity provider and delivery group, and social work or psychiatry referrals were gathered from the EMR. Participants: 4,376 of 6,936 women who delivered between 6/2014 and 6/2016. Exclusion criteria: did not receive complete prenatal care at University of Michigan (prenatal, delivery, postpartum care), multiple fetuses, delivery prior to 36 weeks gestation. Measures/Main Outcomes: Data will be collected from the Epic EMR and analyzed for completion of EPDS surveys within each site and group for each trimester and post-partum screening. As a second component of the study, a survey will be distributed to providers at each site to gather opinions on current depression screening practices. Results: Initial results show that overall rates of depression screening vary from 9% to 57% depending on the trimester screening is provided and the continuity group. First trimester screening rates ranged from 37% to 48%. Post-partum screening ranged from 9% to 51%. Further data analysis is needed to verify results and identify which clinical groups and clinics are performing above average depression screening for the institution. Conclusions (anticipated): It is expected that EPDS screening rates will be highest in the 1st trimester due to an institutionalized work flow process that allow for screening to be offered regardless of provider or site. Initial data shows rates for screening at the post-partum visit are significantly below those at the 1st trimester visit. If this is verified with further analysis quality improvement measures will be determined to create the largest impact in depression screening in pregnancy. 

STFM link

With increased emphasis on primary care and the social determinants of health, family medicine physicians are in a crucial position in today’s health care landscape. Likewise, family medicine educators are well positioned to lead change in medical education in these areas—though this can be a daunting task. How does a family medicine educator create an innovative, effective curriculum to engage learners in these important areas? At the University of Michigan, family medicine educators are leading curriculum development in specialized, non-clinical areas of focus for medical students. This lecture-discussion session aims to summarize the experience of family medicine faculty creating a global and domestic health disparities curriculum for second year medical students. Key, generalizable features of successful curricula will be reviewed, including characteristics of adult learners, evidence-based hallmarks of effective curricula in medical education, and techniques for actively engaging learners in relevant material. Participants are encouraged to share lessons learned and best practices in the development of similar curricula in their home programs.

Upon completion of this session, participants should be able to:

1. List four techniques to actively engage adult learners in a teaching session.
2. Identify three characteristics unique to adult learners as a target audience for education efforts.
3. Apply lessons learned in curriculum development to their own educational endeavors.

STFM Link

Family medicine physicians care for diverse population and recent events in the media, such as police shootings of civilians and the Syrian refugee crisis, affect us emotionally. The Detroit Medical Center/Wayne State University Family Medicine Residency has developed a structured tool to facilitate conversations on topics that are potentially difficult to discuss, such as race, gender, sex, culture, and religion. This tool, the FRESH-CC (Framework for Racial, Economic, Social/Sexual, and Humane Cultural Conversation) provides a processing method for use with any teaching technique, such as book club, didactic lecture, field experience, or longitudinal curriculum. The FRESH-CC starts with identifying the subject matter to be discussed, followed by a survey of the learner’s attitudes and comfort with the material. Using this survey, a facilitator can use different techniques (i.e. write-pair-share, small group discussion) to help group members discuss potentially difficult topics. Our seminar will introduce this FRESH-CC tool through an interactive session where participants will use the tool to discuss an article addressing a controversial topic, and we will share preliminary data of our experience using the FRESH-CC.

Upon completion of this session, participants should be able to:

1. Define the key components of the FRESH-CC that provide a structured intervention in facilitating discussions among family medicine learners.
2. Use the FRESH-CC to facilitate a difficult discussion among a diverse group of family medicine learners.
3. Identify opportunities in their family medicine curriculum where the FRESH-CC can be used to foster more effective communication on important but difficult conversations.

STFM link 

Universal, high-quality health education for adolescents is lacking, especially in underserved communities. Maximizing the interactive nature of curriculum and utilizing presenters who are not traditional classroom teachers can improve health education outcomes. Additionally, medical students’ empathy has been reported to wane during medical school, yet community involvement seems to be a protective factor. In this session, we’ll tell the story of what happened when preclinical students set out to improve adolescent health outcomes at a local, at-risk high school. We will share experience, data, and insight gained through our first two years of MiHealth, an intervention that brings medical students into the classroom to tackle critical topics like sexual health, mental health, and substance abuse. This session will engage in a deeper dive into how student-led organizations can start out with a strong foundation, use data to continuously improve, and establish a sustainable framework to make a long-term impact. We will ponder cost-benefit of programs like MiHealth, discuss common challenges, and share ideas and lessons learned from any similar programs from their home institutions.

Upon completion of this session, participants should be able to:

1. Identify potential needs, stakeholders, and anticipated challenges involved in starting an intervention to address community health.
2. Reflect upon approaches to curriculum design and outcomes for medical student educators and leaders as well as learners in the community.
3. Consider the variety of tools used in program evaluation and discuss ways to increase the utility of data collected, while anticipating common limitations and constraints.