Goodbye 50th Anniversary—Hello to the Next 50 Years

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STFM President Stephen Wilson, MD, MPH

Well, it’s over. From the 105 family medicine educators who signed on at the first STFM meeting in 1967 to the more than 1,850 who attended our Annual Spring Conference in 2017, STFM’s year of celebrating our 50th Anniversary is at an end. From blog posts and other social media activities to written pieces in Family Medicine and other journals, to in-person, live celebrations at our conferences, it has been a year for recollection and reflection. We closed the time capsule at the Conference on Practice Improvement in Louisville, KY.

All too often the present is used to inform the past, and time is spent reinterpreting, representing, and even reforming the past through the lens of the current. This was never the intention of learning from history. The past is best used to better understand the present in order to inform the future. STFM is poised to do just that as we press forward into the unknown: the future.

The Past and the Present
STFM’s tagline is “transforming health care through education.” Academic family medicine has made an impact on medical education and medical practice for the better. Two prominent examples are The Five Microskills and Evidence Based Medicine (EBM).

One of the single most impactful educational articles ever written was “A Five-Step Microskills Model of Clinical Teaching” by Neher, Gordon, Meyer, and Stevens in 1992.1 It has been used, referenced, and taught by many medical educators, and has even been repackaged by others as the “One-Minute Preceptor.”

The interprofessional, collaborative work of David Slawson, MD and Allen Shaughnessy, PharmD in the arena of EBM, with their emphasis on prioritizing findings relevant to patients and on outcomes that matter (mortality, morbidity, quality of life, and cost) have immeasurably changed how family doctors categorize data, think, write, research, and practice. Across family medicine and medicine in general the principles established by these educators have enhanced the quality of teaching and patient care.

The Present and the Future
Looking to the future as a community of teachers and scholars working to advance family medicine, the Society of Teachers of Family Medicine will continue to work to positively transform health care through education and be the indispensable academic home for medical educators. We will continue proven practices while developing new tools for, and new approaches to medical education in the evolving health care landscape.

We will continue to pursue patient-centered, learner-centered education. We will be resolute in pursing patient-centered, population-beneficial care. We will ensure that all three legs of the EBM stool—best available evidence, clinical expertise, and patient values—are valued in the medical decision-making process.

We envision a time of accelerated growth and impact of family medicine in which STFM remains instrumental and becomes more influential in medical education. We envision:

  • Growth in size and impact through progressive medical education research, assessment, investigation, and appraisal that advances our mission and informs our ability to provide the fundamental skills for excelling in education;
  • Refining conferences, programs, and activities to meet the evolving needs of interprofessional medical student and residency educators, leadership development, and medical practice;
  • Every US medical school having graduates who match into family medicine residencies;
  • Secure and robust funding for primary care research, with outcomes that enhance medical education and lead to health care innovation;
  • Every American having secure health insurance for basic, urgent, and emergent needs;
  • Family medicine being established as the provider of first-contact, continuous, com­prehensive, coordinated, culturally aware care in a family and community context; and
  • Advancing medical education and patient care toward better outcomes (effectiveness), better value (efficiency), better access and care (equity), and better experience for patients and physicians (attractiveness).2

The future looks like bright and busy as we continue working to bring about an adequate and effective primary care workforce capable of providing excellent health care to all Americans in a way that addresses social determinants of health in order to bring about health equity.

References

  1. Neher JO, Gordon KC, Meyer B, Stevens N. A five-step “microskills” model of clinical teaching. J Am Board Fam Pract. 1992;5(4):419-424.
  2. Goodell M, Wilson SA. STFM – 50 Years of working to transform health care through education. Fam Med. 2017;49(4):265-267.

It Is Time to Serve as a Primary Care Physician

By Sumi Dey, MD and Harland Holman, MD

It’s time to serve as a primary care physician.

This is what we tell our students. Why? Because the US Department of Health and Human Services estimates that by 2025 the United States will be short 35,000 to 44,000 adult care primary care physicians. We believe this is a crucial time for medical students to become interested in serving as primary care physicians. If future students will not prepare to care for our nation’s needs, who will?

If a student asks why they should be primary care physicians, this is our answer.

Americans who regularly visit their primary care physician have a 33% lower health care cost and 19% lower odds of dying than patients who visit only specialists. According to the Report on Financing the New Model of Family Medicine, if every American had an established relationship with their primary care physician, it would reduce national health care costs by $67 billion per year.

Primary care access is correlated with more equitable distribution of health within a population and can mitigate the adverse effects of income inequality. This is especially important in the United States, where minorities and economically challenged people are struggling to access regular primary care.

Countries where patients have established relationships with primary care physicians have lower depression and suicide rates. Mental health problems including depression and anxiety are part of patients’ everyday life experience, and often primary care physicians address mental health at almost every visit. According to the National Alliance on Mental Illness, more than 70% of visits to primary care physicians are associated with psychological issues.

Establishing a long-term, strong relationship with a primary care physician plays a crucial role in early disease diagnosis and prevention. The Centers for Disease Control show that disease prevention is important in creating healthier communities and productive lives, and in reducing overall health care costs.

Primary care physicians provide continuity and preventive care for a wide range of medical conditions and undiagnosed health concerns. They also serve as the framework for building a strong health care system that ensures positive, cost-effective health outcomes and health equity for the nation, especially in underserved populations.

Students, it’s time to serve as a primary care physician.

Mrs Claus and My Journey to Family Medicine

This blog post is a finalist in the STFM Blog Competition.

Anna Balabanova, MD

Anna Balabanova, MD

How does a little Russian-speaking girl living in a small town south of Moscow come to be a Chief Resident in family medicine at Northwestern in Chicago? Growing up in that small Russian town, I frequently witnessed my grandmother, a pediatrician, step out into late-night blizzards because a patient needed help. Like a year-round Mrs Santa Claus, she would even bundle herself in a sleigh to reach her patients. The entire town spoke highly of how she truly got to know patients and their families. Throughout my journey to and during my medical career, that image of a caring physician remained in my mind: one who believes that a patient is more than his or her illness, and maybe brings a little Mrs Claus-like magic to them, too.

When my parents and I moved to America from Russia, we could only afford to rent one room in a two-bedroom apartment, with a second family living in the other. Even as an enthusiastic little girl getting underfoot in a small space, I noticed my parents immersed themselves in helping others. I watched my mother teach piano ten hours a day and volunteer for every musical event in the community, and witnessed my father walk to graduate school because we couldn’t afford a car but put in extra hours at work when a coworker needed help. Like my grandmother, my parents made me realize that the values of compassion, dedication, and service are what create magical moments.

In high school I spent over 900 hours volunteering at my local hospital, annoying every medical professional who was willing to answer my many questions and discovering my passion for medicine. The summer after my freshman year in the seven-year Honors Program in Medical Education at Northwestern University, I encountered an obstacle I never thought I would face: during a routine appointment, my family medicine physician confirmed some breast masses I had felt. After numerous biopsies, I was diagnosed with a Phyllodes tumor, as well as multiple fibroadenomas. That year, I learned what it is like to experience the medical system from the patient perspective. My encounters with multiple medical professionals taught me about the physician I do and do not want to be. Later that year, after surgery, I finally was given a clean bill of health, and with that came a deep sense of empathy for my future patients and a desire to choose family medicine, a field that focuses on the patient-physician connection and lets me be there for my patients like my family doc was there for me.

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