Category Archives: Residency

Resilient Faculty, Resilient Residents

Kathleen Rowland, MD, MS

Change is here, and more is coming. In medicine, we often perceive change, especially external change from hospital systems or payers, to be a threat. We feel a loss of control, which can lead to anger, resentment, and burnout.1 A survey of 3,000 US physicians done by a staffing company found that 58% of physicians who left medicine in 2013 reported doing so because they didn’t want to practice in an era of health care reform. This is more than stated they left because of economic factors such as malpractice insurance or reimbursement concerns (50%).2 The changes we face can feel overwhelming, and we have to take measures to make the changes less daunting.  

Being resilient does not mean that we become pushovers. The goal of teaching resilience to change is to increase the sense that we are able to react to, triage, and adapt to changes while maintaining the core of who we are: physician teachers and healers. We can fight unwinnable battles or choose good ones. We can hold out on changing until the demand to do so is punitive, or we can adopt the change at a comfortable pace.  We often do not choose the changes we face, but can choose the way we respond. As we restore that independence, we can reduce our risk of burnout and increase our satisfaction with practice.  

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Feed a Discipline (With Research Questions): Become Shark Bait

Winston R Liaw, MD, MPH

Winston R Liaw, MD, MPH

Research is to see what everybody else has seen and to think what nobody else has thought.

  • Albert Szent-Gyorgyi

Each year, my colleague, Alex Krist, and I sit down with our Virginia Commonwealth University family medicine residents to brainstorm potential research topics for their scholarly activities, and each year, we encounter a similar series of events. Initially, there is silence (frequently prolonged and often deafening) followed by musings about their lack of research experience. Then, a brave soul offers a question that has been plaguing her. A classmate asks a similar but related question. The conversation reminds a third resident about a different question he always wanted to answer. By the end of the hour, we have a list of fascinating, important questions.

  • Do calorie counters improve patient outcomes?
  • Why do our patients use the emergency room next door when our walk in clinic is open?
  • Has the new patient portal affected the volume and type of phone calls we receive?
  • Are patients at the community health center interested in doing video visits?

Your STFM Research Committee thought that family medicine residents and faculty nationwide may similarly have pressing questions to answer but lack the means to do so. Initially conceived by STFM Research Committee members Tammy Chang and Rob Post, we launched a session at the 2016 STFM Conference entitled: “Shark Tank for Family Medicine: Real-time Feedback for Primary Care Research Ideas”. During the workshop, seven participants pitched research ideas to three “sharks” (well-established primary care researchers). The sharks provided real-time feedback and then selected participants to mentor over the year. For those of you not tuned in to pop culture, our workshop is based on the TV show Shark Tank where contestants pitch business ideas to established entrepreneurs and winners receive funding and mentorship.

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What Will Family Medicine Look Like in 10 Years?

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

megan2

Megan Chock, MD

This year, instead of receiving a written invitation to my 10-year high school reunion, I got a Facebook invite. My classmates from Honolulu, Hawaii are scattered across the US, overseas, and work in countless different fields. When I think of what family medicine will look like in 10 years, I imagine what this year’s Class of 2017 is going to do in the world. They will be the family physicians that will shape our specialty’s direction, and I am very excited to see what they do.

Every summer, our residency program sponsors a pipeline program for high school students interested in health care careers. Many of them are considering family medicine. These students are from a high school near the San Diego/Mexico border with traditionally low graduation rates, and most are bilingual and the first in their families to even think about college. Daily activities are run by undergraduates in pre-medical studies and a second-year medical student from the community. We residents get to present to the students on topics they request. One of these was “health issues affecting teens” and I chose to talk about mental health and suicide prevention.

Stepping into that classroom energized me. The students were engaged and open. They asked questions and shared personal experiences about friends and family members with mental illness. At the end of the lesson, when we discussed how to recognize and help a suicidal peer, many asked about volunteering in suicide hotlines. They demonstrated insight into the issue of mental illness in their community, a desire to help, and awareness of how to make that impact.

Using that microcosm, I believe that family medicine in 10 years will be open to sharing ideas and engaging patients, communities, and other medical professionals to improve health. The Class of 2017 has grown up in an era of increased global and national awareness and changing demographics. Technology is a natural extension of relationships and they have learned to communicate through text, e-mail, Facebook, Instagram, Skype, Snapchat, YouTube, Twitter, Reddit, and more. In a 2015 Pew survey, 92% of teens reported going online daily.1 The result is a constant sharing of ideas, and a recognition that this world is both larger and smaller than previous generations realized. Celebrities and world leaders share their inner thoughts and everyday routines, while millions view viral videos of baby animals sneezing and police shootings. These virtual channels reveal a shared human experience that has shown future family physicians that we are all connected. More than that, these channels give family medicine a unique mechanism to better care for our patients and communities.

In 10 years, family medicine will be pioneering better ways to bring prevention and health maintenance to everyday life. Others in this blog have written about technology in the form of the electronic medical record and big data, which are important in optimizing our healthcare system. However, the Class of 2017 will change health culture as well. They will e-mail patients, share healthy recipes on social media, and weigh in on public health issues by writing blogs and doing video interviews. The culture of health will be one of openness that recognizes that healthcare is only responsible for 10% of health; people’s social networks, everyday routine, and resources matter much more.

Our residency’s summer program is one of many pipeline projects that will bring more diversity into our field. These future physicians from different backgrounds will recognize shared issues affecting patients and seek solutions based on interconnectedness, searching for possible solutions through peer networks or building on pilot projects involving health care teams. The awareness that a single physician or a single patient is not insular already exists  and the next ten years will be full of learning on how to harness the capability of social networks to improve health and healthcare.

Family medicine will always be primary care. In 10 years, we will still act as the first person patients touch within the medical system, and serve as the principle coordinator of medical activities. What will continue to evolve is our awareness of the many factors affecting health and our willingness to engage with patients outside of 15-minute visits. In ten years, I see family physicians sharing ideas worldwide from California to New Zealand, and better understanding our patients’ lives through increased communication. And, at the Class of 2017’s ten-year reunion, I would love to hear their predictions for the Class of 2027.