Tag Archives: Family Medicine

Incoming STFM President Linda Myerholtz, PhD Sits Down for a Conversation With STFM

As the 2021-2022 term comes to a close, we sat down with incoming STFM President Linda Myerholtz, PhD to learn about her journey into family medicine education and her plans as President of the STFM Board of Directors.

"I'm proud and humbled to represent the STFM membership as president. My passion for interprofessional team-based education and practice promotes system change and supports wellbeing within the graduate medical education structure. The journey to family medicine education is exhilarating and exhausting. What I most look forward to, though, is continuing to foster connections among our members." - Linda Myerholtz, PhD
“I’m proud and humbled to represent the STFM membership as president. My passion for interprofessional team-based education and practice promotes system change and supports wellbeing within the graduate medical education structure. The journey to family medicine education is exhilarating and exhausting. What I most look forward to, though, is continuing to foster connections among our members.” – Linda Myerholtz, PhD

Linda Myerholtz, PhD, Associate Professor and Director of Behavioral Science Education at the University of North Carolina, Chapel Hill start her term as STFM President during the 2022 STFM Annual Spring Conference. She brings with her a passion for human behavior, building community, and integrated healthcare.

Growing up as a “professor’s kid”, Myerholtz was born in Caracas, Venezuela. “My father was working for a company at the time, though I have no memory of living in South America. Our family moved back to the US when I was 6 months old, and landed in Racine, Wisconsin.” Myerholtz explained. “I spent my early childhood in Wisconsin, before we moved to Bowling Green, Ohio when I was 14. There was quite a bit of culture shock going from a big city like Milwaukee to a very small town, where I could see cornfields growing from my bedroom window.”

Myerholtz began to love the rural, small town university life, and went on to complete her undergraduate and graduate work at Bowling Green State University in Bowling Green, Ohio. “I married my husband and we started our family. The winters were long and gray, and we dreamed of moving further south.”

When asked if she always knew medicine was the career for her, Myerholtz said “I’m not sure why, as I lived in the middle of the Midwest far away from any beach or ocean, but as a child, I always wanted to be a marine biologist. I loved biology, and it sounded exciting. When I took Introduction to Psychology my freshman year, I was fascinated about human behavior, and I knew this was my career path.” Myerholtz went on to give a shout out to her professor, Dr Stone, proving the impact good educators have on young minds beginning their academic medicine journey.

As Myerholtz’s career took off in community mental health, she moved into more administrative roles, but continued providing training for graduate psychology interns. “This brought me so much joy, and there were a few STFM members who trained with me at the same time.” While this passion for working with marginalized individuals continued to grow, the administrative aspects pulled Myerholtz away from the more enjoyable parts of her work, namely clinical care, teaching, program development, and research.

“One day, I saw a posting in my inbox for a position as a Director of Behavioral Science in a family medicine residency program [Mercy Family Medicine in Toledo, Ohio]. I was enticed by the opportunity to teach bright young adults who shared my passion in making communities healthier and the opportunity to resume my research and practice integrated behavioral healthcare. When I first started at Mercy, I couldn’t tell you much about medical education or what it was like to be a resident, but the residents taught me and I felt like I really found my passion.”

That passion resulted in Myerholtz’s ability to work closely with different learners and fellow faculty. “Each day is different,” she went on to explain. “We’re always reflecting on how we can continue to improve the wellbeing of our communities through the practice of family medicine – what could be better?”

Myerholtz is quick to mention lessons abound in family medicine education, but there is one that has stuck with her. “Be kind to your future self. As you reflect on your past self, do so with compassion,” she explained. The first part helps me prioritize and reminds me to make decisions today that support myself in the future. The second part reminds me not to judge my past self, based on the knowledge and the wisdom I have today. Past decisions and mistakes are a part of being human, and we need to offer compassion for the person we were when those things happened.”

While her career progressed, Myerholtz’s dream to move her family further south was solidified when she accepted a position with the University of North Carolina. “Being a behavioral scientist in graduate medical education is truly a dream job, and it’s been fantastic living in North Carolina. We still get the change of seasons, but the winter is much shorter! We can go hiking in the mountains, relax at the beach, and explore great restaurants and cultural gems.”

As she prepares to be installed as STFM President, Myerholtz looks forward to bringing that passion for wellbeing to STFM members. “I’m proud and humbled to represent the STFM membership as president. My passion for interprofessional team-based education and practice promotes system change and supports wellbeing within the graduate medical education structure. The journey to family medicine education is exhilarating and exhausting,” she explained. “What I most look forward to, though, is continuing to foster connections among our members. I’m so excited we will be able to renew collaborations together at our Annual Conference in Indianapolis. Connection is what makes STFM so exceptional,” she continued. “None of us can do this alone, nor do we have to reinvent the wheel. Through STFM, we come together to make the wheel even better.”

Part of improving that wheel comes from the utilization of STFM resources. “As I reflected on what I’ve used most, the list continued to grow. I was fortunate to participate in the first class of the Behavioral Science Family Systems Educator Fellowship, and this was pivotal in my career. I found so many collaborative relationships and true friendships. I also utilize the STFM Resource Library frequently to gain inspiration from other excellent educators. I’ve learned so much from our Collaboratives – being able to reach out to a Listserv of amazing colleagues when I have a question is so incredibly valuable. Whether through fellowships, collaboratives, toolkits, certificate programs, or the resource library, STFM allows us to connect with each other and share our learning, with the ultimate goal of transforming family medicine education and the health of our communities.”

When she’s not revolutionizing family medicine education and empowering marginalized communities, Myerholtz finds joy with her family. “While my career has brought me a strong sense of accomplishment, I’m most proud of the adults my children have become. Raising three human beings who are living the values that are important to me… kindness, compassion for others, generosity, a commitment to social justice, valuing diversity… it fills my heart. Watching them go out into the world, knowing they make the world a better place now, and for future generations, is a tremendous joy.”

That love for her family extends to acting as a personal travel guide for their adventures. “Planning the trip is about enhancing the joy while practicing delayed gratification.”

STFM and its members will benefit immensely from Myerholtz’s leadership, experience, compassion, and drive. We welcome her to the Board of Directors for the 2022-2023 year.

Working for Health Equity –Together

By Lloyd Michener, MD

Family medicine groups have responded wonderfully to the COVID-19 pandemic, providing critical clinical services, and helping staff testing and vaccination sites. As COVID-19 underscored the depth of the disparities across our states and communities, family physicians have also taken on local and national leadership roles in health equity efforts, efforts to achieve health equity are now expanding rapidly, and the approaches and even the language used are changing as well.

As a particularly horrific example, a new report from the US Civil Rights Commission calls for equity in maternal health, noting that Black women in the United States are 3 to 4 times more likely to die from pregnancy-related complications than White women in the United States. The report calls for coordinated prenatal, maternity, delivery, and postpartum care that manages chronic illness and optimizes health, and points out the role that states can play in supporting equitable health, including Georgia, New Jersey, and North Carolina. Maternal health equity is an opportunity for family medicine, partnering with our health systems, our communities, and our states, to make a difference.

At the same time, academic health centers (AHCs) are increasingly engaged in health equity efforts, seeking to build and strengthen community partnerships for health. As David Skorton, CEO for the Association of American Medical Colleges, stated:

“the traditional tripartite mission of academic medicine — medical education, clinical care, and research — is no longer enough to achieve health justice for all. Today, collaborating with diverse communities deserves equal weight among academic medicine’s missions. This means going beyond “delivering care” to establishing and expanding ongoing, two-way community dialogues that push the envelope of what is possible in service to what is needed.

It means working with community-based organizations in true partnership to identify and address needs, and jointly develop, test, and implement solutions. This requires bringing medical care and public/population health concepts together and addressing upstream fundamental causes of health inequities.”

https://journals.lww.com/academicmedicine/pages/articleviewer.aspx?year=9000&issue=00000&article=96573&type=Abstract

This is a new challenge for many AHCs, and a place in which family medicine can make a much-appreciated difference. A private, research-intensive school headlined such an example:

In many ways, the COVID-19 pandemic forced positive changes in how medicine is practiced in communities and at academic medical centers, with family medicine departments working at the front lines to provide care and forge relationships with community partners, according to a Duke Health review.

https://corporate.dukehealth.org/news/pandemic-response-shows-path-improved-health-care-future?utm_source=newsletter&utm_medium=email&utm_content=The%20pandemic%20shows%20a%20path%20toward%20a%20better%20health%20care%20future&utm_campaign=dukedaily2021_09_20

As these partnerships grow, the language shifts. Family medicine is growing accustomed to the idea that we have a role in the ‘social determinants of health,” while community organizations may use a broader, more positive framing of the “vital conditions of health” which is inclusive of the intersections of health and safety, work, transportation, education, civic muscle, housing, and the environment. Family practices can have important roles in this larger effort, both as trusted sources of care and information, as one of the community hubs that link individuals and families to needed services, and as respected advocates for needed policy change so that all communities have the opportunity to thrive.

Guidance on how to partner and support community health equity is increasingly available, including, to cite just a few:

It is noteworthy that every one of these draws from diverse groups and sectors, as working effectively with community organizations towards health equity requires partnerships far beyond any one discipline, profession, or sector.

Within all this complexity and challenge, family medicine has a wonderful opportunity to serve as builders of bridges to and with our diverse communities, many of whose members come to us for care. By expanding our vision so that we are engaged with communities around their priorities and needs, we can help build on their strengths, add our own and those of our academic colleagues, to our shared goal of achieving health equity.

Double Feature: Global Family Medicine & The Case for Eliminating Global Health Rotations

Note from the Editor: This quarters publications contains two important submissions on global family medicine and it’s greater ramifications on the world at large. Thank you to William Ventres, MD, MA, Shailey Prasad, MD, MPH and Esther Johnston, MD, FAAFP, MPH as well as the Global Health Educators Collaborative.

Global Family Medicine
By William Ventres, MD, MA and Shailey Prasad, MD, MPH

Practicing global family medicine means more than working internationally. It means seeing the world from new perspectives, applying skills in solidarity with people in need, and learning from others.

Global family medicine embraces many themes, including educating the medical profession at home and abroad about the importance of family medicine as a foundational element of primary care, developing family medicine training programs in rural and urban settings to help ensure the provision of equitable medical care, and striving to ensure that family medicine is an essential part of health systems around the globe (Haq et al. 1995).


From a philosophical perspective, the concept of global family medicine means seeing the health of the world’s people in all its complexity from a point of view that includes, but is not limited by, the confines of the biomedical model (Ventres 2017). This concept prioritizes the needs of those people around the world who disproportionately suffer under the burdens of economic poverty and social marginalization due to political and economic structures that preferentially benefit the rich and powerful.


For physicians from the United States and other economically wealthy countries, global family medicine means looking beyond their training in increasingly fragmented professional cultures that neglect such basic tenets of primary care, community health, social accountability, and the equitable provision of universal health care. It means understanding how such basic principles like access, equity, and appropriateness are essential to improving health outcomes in medically underserved settings.


Global family medicine means doing the conceptual work of turning the world “upside down” from its conventional orientation, just as skilled physicians do when practicing patient- and people-centered clinical care, wherever they may be. The goal in each circumstance is to recognize differences in how people approach the structure and provision of medical care, to understand that many non-biological factors influence the presentation and amelioration of disease and illness, and to practice where need is greatest due to the effects of adverse social determinants of health. Global family medicine builds on the tenets of primary care (Starfield et.al 2005) by encouraging among its practitioners five attitudes (Ventres & Wilson 2015):


Awareness—Open one’s eyes and ears (and, within, one’s mind) to the historical, social, cultural, political, and economic contexts of the communities in which one lives and works.


Curiosity—Adopt a questioning approach—an anthropological gaze—to patient and community concerns. Exercise one’s senses, so often heightened in unfamiliar settings, to engage in honest, realistic, and inclusive assessments of how upstream causes affect disease and illness.


Humility—Engage with others, wary of the (often unconscious) influences of desires for power, yearnings for control, and the conceit that what we have, others in the world must want.


Meaning—Work with patients, families, and communities, not just for them: find worth in solidarity—in sharing—rather than simply in doing. Solidarity signifies recognizing, with others, the structural forces that contribute to poor health outcomes; it also signifies recognizing, with others, the structural barriers that negatively affect abilities to ameliorate those forces.


Intention—Learn through one’s work practicing and growing global family medicine. True learning implies welcoming a definitive change in some aspect of one’s own life.


Haq C, Ventres W, Hunt V, Mull D, Thompson R, Rivo M, Johnson P. Where there is no family doctor: The development of family medicine around the world. Academic Medicine. 1995;70(5):370-380.

Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Quarterly. 2005;83(3):457-502.

Ventres W, Wilson C. Beyond ethical and curricular guidelines in global health: attitudinal development on international service-learning trips. BMC Medical Education. 2015;15(1):68.

Ventres WB. Global health and family medicine: a ‘UNIVERSAL’ mnemonic. Journal of the American Board of Family Medicine. 2017;30(1):104-108.


The Case for Eliminating Clinical Global Health Rotations
By Esther Johnston, MD;FAAFP;MPH

I was rounding one morning in the newborn nursery at a regional hospital in Tanzania, supervising 3rd and 4th year students from a nearby medical school, when a fellow educator grabbed my arm and pointed me to a bassinet in the corner. There was no movement, no respirations. I took a pulse – none.

Looking back at my year as a Global Health Service Partnership educator in Dar es Salaam, from 2014-2015, what strikes me about this moment was the sudden appearance in the midst of this code of several visiting undergraduate students from Europe, all wearing white coats.

Seemingly out of nowhere, these visiting students appeared in a flurry, running to look for supplies and stepping in front of my own Tanzanian medical students as they looked on in surprise.

There was no bag mask and no epinephrine easily accessible, and the code did not end well. I stepped outside with my own Tanzanian medical students to debrief together. And out of the corner of my eye, I saw the visiting student looking shell-shocked in a corner.

In taking a little time to connect afterwards, I learned that these visitors were associated with a major international volunteer organization known for offering short term global health rotations to students at various levels of training. They were dropped into a hospital in Tanzania, without proper supervision or mentorship, medical licenses or credentials, to participate in direct patient care. Over the coming weeks I met others placed through the same mechanism who, perceived to be licensed attending physicians in their white coats, were allowed to deliver babies or suture unsupervised.

This practice was harmful to the visiting students, witnessing confusing and traumatic events without guidance. It was harmful to medical and nursing students in Tanzania, whose faculty and clinical mentors felt obligated to help manage unsupervised visitors. It was harmful to the hosting hospital and the patients it served, who were misled about the qualifications of those providing their care. Practices such as these are deeply unethical. And sadly, the organization involved was just one of many sending trainees abroad to perform clinical work in this fashion.

The world has changed much since 2014. In health professions training schools around the United States, discussion occurs more often regarding the utility and application of the Working Group on Ethics Guidelines for Global Health Training (WEIGHT), which offers ethical principles and best practices for international training experiences. Greater attention is being paid to the need for antiracism and decolonization of global health. A pandemic has occurred, and in the process many academic institutions in the United States have pulled back their students and residents from rotations abroad.

And now, as we look towards a day when we will again be able to more fully engage in international partnership, we have a unique opportunity to pause and ask, is our practice of sending students and residents abroad for clinical global health rotations truly ethical, legal and responsible?

The Brocher Declaration has emerged in this year of pause. Developed by a coalition of stakeholders involved in short-term global health engagements, from faith-based organizations to academic institutions, the declaration challenges existing practices for short term global rotations, and asks us to commit to better.

This building movement should compel us to ask an essential question: why do we allow our learners to work clinically when on international rotations at all? Would we think it was acceptable for someone from another country to drop into our own clinics, without a license or credentialing, without the weeks of orientation and onboarding expected of our own residents and clinicians, demanding the supervision of often overworked clinical faculty in areas with severe health professional shortages, to evaluate, diagnose, and treat patients? If we wouldn’t find this appropriate in our own clinic, why do we facilitate our learners to do it abroad?

Arundhati Roy wrote that “[h]istorically, pandemics have forced humans to break with the past and imagine their world anew. This one is no different. It is a portal, a gateway between one world and the next. We can choose to walk through it, dragging the carcasses of our prejudice…our avarice, our data banks and dead ideas…[o]r we can walk through lightly, with little luggage, ready to imagine another world.”

As borders open and flights resume, will we as educators seize on this moment to let go of outdated practices and unethical approaches, and find better ways to teach future family medicine physicians to engage in the global environment?