Practice Characteristics of Graduates of East Tennessee State University Quillen College of Medicine: Factors Related to Career Choices in Primary Care

The nation is facing a physician shortage, specifically in relation to primary care and in rural underserved areas. The most basic function of a medical school is to educate physicians to care for the national population. The purpose of this study was to examine the physician practicing characteristics of the graduates of East Tennessee State University Quillen College of Medicine including factors that influence graduates’ specialty choices and practice locations, especially those related to primary care. Secondary data for this study were collected from the college’s student database system and the American Medical Association Physician Masterfile. The study population included all living graduates with Doctor of Medicine (MD) degrees who graduated from 1998 through 2009 (n=678). Statistical procedures included Pearson Chi-square, logistic regression, independent t tests, ANOVA, and multiple linear regression. Data analyses revealed that the majority of graduates were between 24 and 29 years of age, male, white, non-Hispanic, and from metropolitan hometowns. Most had completed the generalist track and initially entered a primary care residency training program. The majority passed USMLE Step 1 and Step 2 on the first attempt. The USMLE Step 2-CK average was 212.50. The average cumulative GPA was 3.44. Graduates were nearly evenly divided between primary care and nonprimary care practice, with the majority practicing in metropolitan areas. Graduates who initially entered primary care residency training were more likely to practice primary care medicine than those who entered nonprimary care programs; however, fewer graduates were practicing primary care than had entered primary care residency training. Graduates who attended internal medicine residency training were less likely to be practicing primary care medicine than those who attended family medicine, pediatrics, or OB/GYN programs. Women and Rural Primary Care Track graduates were significantly more likely to practice primary care than were men and generalist track graduates, respectively. Nonprimary care physicians had significantly higher USMLE Step 2-CK scores than did primary care physicians (PCPs). PCPs practiced in more rural locales than non-PCPs. Family physician graduates tended to practice in more rural locales than OB/GYNs or pediatricians. Hometown location predicted practice location over and above medical school track

Gender Differences in Working Memory in Humans Tested on a Virtual Morris Water Maze.

A computerized virtual version of the Morris water maze (vMWM) was used to assess human gender differences in spatial working memory. In Experiment 1, the release point and platform location was changed on every other trial for 20 trials. Men had significantly reduced acquisition latencies and more accurate heading errors on the first daily trial compared to women. In Experiment 2, the release point and platform location was changed every fourth trial for 20 trials. Men had significantly shorter acquisition latencies and path lengths than women. Experiment 3 was identical to Experiment 2, except that environmental cues were changed throughout testing. Men had significantly shorter acquisition latencies and path lengths than did the women. These studies are the first to demonstrate significant gender differences in a spatial working memory version of the vMWM

Does Structured Quality Improvement Training for Residents Increase QI in Practice?

East Tennessee State University implemented quality improvement (QI) training for second-year family medicine residents in 2009. Results in 2011 indicated training increased scores in QI skill assessments as well as self-efficacy in QI. With residents who completed the training now in practice, does the increase in knowledge and skill translate to increased QI in practice? A survey of graduates compares frequency of QI cycles and self-assessment of QI skills among graduating classes, those receiving QI training and those graduating before training began. Residents that completed the QI curriculum rated their training higher; however residents that did not receive training were more involved in QI in practice. We suggest that this is due to QI involvement increasing with practice. Results will guide curriculum improvements to strengthen future resident training

Family Medicine Clerkship Students’ Experiences With Team-Based Care

Interprofessional team-based care has the potential to improve patient outcomes, improve access to care, decrease costs, and improve team satisfaction. In recent years, efforts to implement team-based care have grown with the adoption of the Patient-Centered Medical Home (PCMH) and an increasing focus on value-based payment models. To better prepare our learners for this future, we introduced a formal team-based care curriculum in our three family medicine residency programs and one pediatric program. In addition to curricula for residents, we developed a team-based care didactic for family medicine clerkship students, presented by an interprofessional team of faculty. This session will describe our curricular efforts, team-based didactic for students, and outcomes related to students’ experiences with and knowledge of team-based care

Focused Anticoagulation Service in Family Medicine Residencies

A report on the creation of a new program to improve family medicine residents\u27 understanding, and quality of care, of anticoagulation patients. Patients requiring anticoagulation therapy pose unique issues requiring a systematic approach to their care, balancing the potential benefit from therapy with possible adverse events. Here, we describe a model that helps to standardize both the care received by patients on anticoagulation therapy as well as the training of family medicine residents caring for those patients. A team-based model of care (family medicine residents, clinical pharmacists, and nurses) is used to achieve the goals of improved care and education. Clinical pharmacists are used in concert with family medicine residents and attendings to assess patients\u27 medication profiles and help direct patient care and resident learning. Both the idea itself and the formal structure are presented in a model for possible adaptation to other program

Relationship of Patient Self-Administered COPD Assessment Test (CAT) to Physician Standard Assessment of COPD in a Family Medicine Residency Training Program

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the United States. COPD is of particular concern in certain sectors of the country, including Central Appalachia where our clinic is located. Assessing patients with COPD presents many challenges as symptoms range from those considered typical such as shortness of breath and sputum production to those less often identified like anxiety and social isolation. We conducted a pilot study comparing physician standard assessment of COPD to patient self-assessment using the COPD Assessment Test (CAT). The CAT is an eight-item questionnaire that measures the impact COPD has on an individual patient’s well-being and daily life. Based on our small sample size, physicians tend to underestimate the impact of COPD on a patient’s daily life. This discrepancy did not differ significantly by year of residency. Potential clinical impact of these findings include the need for more formalized and frequent patient self-assessment of disease burden as well as increased COPD assessment training within the residency curriculum

Access to Long Acting Reversible Contraceptives in Northeast TN: A Study of Reproductive Care in Hawkins County, TN

Unintended pregnancy leads to many public health consequences like lower educational attainment and diminished career opportunities, with higher rates of unintended pregnancies occurring in lower income communities and among women with drug addiction. Beyond preventing unintended pregnancies, effective contraception helps prevent poor birth spacing, thereby reducing the risk of both premature and low-weight births and maternal mortality and morbidity during the peripartum period. Long acting reversible contraceptives (LARCs), such as intrauterine devices (IUDs) and implants, are considered the birth control of choice for women of reproductive potential as they possess a number of advantages: cost-effectiveness, minimal maintenance for 3 to 10 years, reversibility, and high efficacy and continuation rates. Despite these benefits, LARCs have been widely underused in rural communities as a result of many factors including hospital and gynecology department closures, workforce shortages, provider knowledge, and access to care challenges that arise from complex social determinants of health specific to rural US communities. We therefore investigated the knowledge and current practice of clinical providers regarding LARCs counseling and provision in Hawkins County of Northeast Tennessee. Hawkins County is a primarily rural county with clinics serving a large lower income population with a high prevalence of substance use, therefore making it at risk for higher rates of unintended pregnancies. An online survey was sent to all consenting medical providers (NPs, PAs, and physicians) (n=7) to collect information on their practices related to contraception, including LARCs. Following completion of online surveys, semi-structured interviews (n=2) were planned to qualitatively explore providers’ perspectives. Quantitative analysis of survey data and thematic analysis of interviews were conducted. Analysis of survey data shows that though non-OB/GYN primary care providers reported on being somewhat comfortable to comfortable in their ability to counsel patients on LARCs, they reported low levels of actually counseling on LARCs, compared with oral contraception. Furthermore, the survey data also shows low levels of LARC insertion/removal among non-OB/GYN primary care providers, with most noting preference to refer patients to a private OB/GYN provider within the community or the health department. Additionally, non-OB/GYN primary care providers reported little to no interest in including insertion/removal of LARCs within their scope of practice, citing clinic supply, no time for procedures, and low patient desire as reasons. All providers reported believing that there are little to no barriers to obtaining LARCs by patients within Hawkins County.The semi-structured interviews, including one with the county’s main OB/GYN provider, indicated that though there is access to LARCs within Hawkins County, there may still be multiple barriers including possible poor quality of counseling on LARCs by non-OB/GYN primary care providers and preference for counseling specific populations on LARCs rather than all patients of reproductive potential, both of which may contribute to low patient desire for LARCs. This work is a useful starting place for increasing utilization of LARCs within Hawkins County. By exploring current knowledge and practices of primary care providers, we can better address potential systematic barriers to improve access to and utilization of LARCs in rural communities

Predictors of Marital Satisfaction in Couples That Include a Physician Partner

It is estimated that the divorce rate for marriages in which at least one party is a physician is 10-20% higher than the general population. Predicting the variables that contribute to marital satisfaction, identifying the skills associated with those behaviors and developing a residency curriculum to teach the skills to resident physicians is the focus of this study. Intimacy, conflict resolution and emotional expressiveness have all been identified as important aspects of marital satisfaction. We will determine how each of these variables contributes to marital satisfaction using multilevel logistic regression. The results will be used to develop a skills based training curriculum for residency to improve the lives and well-being of physicians and their families