Department of Family Medicine Works

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    Implementation of an Annual “Education Day” to Foster Medical Education Scholarship in a Regional Campus System
    (University of Minnesota Libraries Publishing, 2024-06-24) Kochhar, Komal; Soleimani, Leila; Byrne, Bobbi; Stefanidis, Dimitrios; Pettit, Katie; Zakeri, Bita; Denny, Kim; Brokaw, James; Wallach, Paul
    We implemented an annual “Education Day” at Indiana University School of Medicine to promote educational scholarship across our nine-campus system. Held each spring from 2020 to 2023, Education Day showcased the educational scholarship of our faculty, staff, and learners, and provided a forum to share best educational practices and forge new collaborations.
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    Effectiveness of a Third Dose of mRNA Vaccines Against COVID-19–Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Adults During Periods of Delta and Omicron Variant Predominance — VISION Network, 10 States, August 2021–January 2022
    (U.S. Department of Health & Human Services, 2022-01-28) Thompson, Mark G.; Natarajan, Karthik; Irving, Stephanie A.; Rowley, Elizabeth A.; Griggs, Eric P.; Gaglani, Manjusha; Klein, Nicola P.; Grannis, Shaun J.; DeSilva, Malini B.; Stenehjem, Edward; Reese, Sarah E.; Dickerson, Monica; Naleway, Allison L.; Han, Jungmi; Konatham, Deepika; McEvoy, Charlene; Rao, Suchitra; Dixon, Brian E.; Dascomb, Kristin; Lewis, Ned; Levy, Matthew E.; Patel, Palak; Liao, I-Chia; Kharbanda, Anupam B.; Barron, Michelle A.; Fadel, William F.; Grisel, Nancy; Goddard, Kristin; Yang, Duck-Hye; Wondimu, Mehiret H.; Murthy, Kempapura; Valvi, Nimish R.; Arndorfer, Julie; Fireman, Bruce; Dunne, Margaret M.; Embi, Peter; Azziz-Baumgartner, Eduardo; Zerbo, Ousseny; Bozio, Catherine H.; Reynolds, Sue; Ferdinands, Jill; Williams, Jeremiah; Link-Gelles, Ruth; Schrag, Stephanie J.; Verani, Jennifer R.; Ball, Sarah; Ong, Toan C.; Family Medicine, School of Medicine
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    Effectiveness of COVID-19 Pfizer-BioNTech BNT162b2 mRNA Vaccination in Preventing COVID-19–Associated Emergency Department and Urgent Care Encounters and Hospitalizations Among Nonimmunocompromised Children and Adolescents Aged 5–17 Years — VISION Network, 10 States, April 2021–January 2022
    (Centers for Disease Control and Prevention, 2022-03-04) Klein, Nicola P.; Stockwell, Melissa S.; Demarco, Maria; Gaglani, Manjusha; Kharbanda, Anupam B.; Irving, Stephanie A.; Rao, Suchitra; Grannis, Shaun J.; Dascomb, Kristin; Murthy, Kempapura; Rowley, Elizabeth A.; Dalton, Alexandra F.; DeSilva, Malini B.; Dixon, Brian E.; Natarajan, Karthik; Stenehjem, Edward; Naleway, Allison L.; Lewis, Ned; Ong, Toan C.; Patel, Palak; Konatham, Deepika; Embi, Peter J.; Reese, Sarah E.; Han, Jungmi; Grisel, Nancy; Goddard, Kristin; Barron, Michelle A.; Dickerson, Monica; Liao , I-Chia; Fadel, William F.; Yang, Duck-Hye; Arndorfer, Julie; Fireman, Bruce; Griggs, Eric P.; Valvi, Nimish R.; Hallowell, Carly; Zerbo, Ousseny; Reynolds, Sue; Ferdinands, Jill; Wondimu, Mehiret H.; Williams, Jeremiah; Bozio, Catherine H.; Link-Gelles, Ruth; Azziz-Baumgartner, Eduardo; Schrag, Stephanie J.; Thompson, Mark G.; Verani, Jennifer R.; Family Medicine, School of Medicine
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    Factors Associated With the Intention to Receive the COVID-19 Vaccine: Cross-sectional National Study
    (JMIR, 2022-11) Kasting, Monica L.; Macy, Jonathan T.; Grannis, Shaun J.; Wiensch, Ashley J.; Lavista Ferres, Juan M.; Dixon, Brian E.; Family Medicine, School of Medicine
    Background The COVID-19 pandemic is an unprecedented public health crisis, and vaccines are the most effective means of preventing severe consequences of this disease. Hesitancy regarding vaccines persists among adults in the United States, despite overwhelming scientific evidence of safety and efficacy. Objective The purpose of this study was to use the Health Belief Model (HBM) and reasoned action approach (RAA) to examine COVID-19 vaccine hesitancy by comparing those who had already received 1 vaccine to those who had received none. Methods This study examined demographic and theory-based factors associated with vaccine uptake and intention among 1643 adults in the United States who completed an online survey during February and March 2021. Survey items included demographic variables (eg, age, sex, political ideology), attitudes, and health belief variables (eg, perceived self-efficacy, perceived susceptibility). Hierarchical logistic regression analyses were used for vaccine uptake/intent. The first model included demographic variables. The second model added theory-based factors to examine the association of health beliefs and vaccine uptake above and beyond the associations explained by demographic characteristics alone. Results The majority of participants were male (n=974, 59.3%), White (n=1347, 82.0%), and non-Hispanic (n=1518, 92.4%) and reported they had already received a COVID-19 vaccine or definitely would when it was available to them (n=1306, 79.5%). Demographic variables significantly associated with vaccine uptake/intent included age (adjusted odds ratio [AOR] 1.05, 95% CI 1.04-1.06), other race (AOR 0.47, 95% CI 0.27-0.83 vs White), and political ideology (AOR 15.77, 95% CI 7.03-35.35 very liberal vs very conservative). The theory-based factors most strongly associated with uptake/intention were attitudes (AOR 3.72, 95% CI 2.42-5.73), self-efficacy (AOR 1.75, 95% CI 1.34-2.29), and concerns about side effects (AOR 0.59, 95% CI 0.46-0.76). Although race and political ideology were significant in the model of demographic characteristics, they were not significant when controlling for attitudes and beliefs. Conclusions Vaccination represents one of the best tools to combat the COVID-19 pandemic, as well as other possible pandemics in the future. This study showed that older age, attitudes, injunctive norms, descriptive norms, and self-efficacy are positively associated with vaccine uptake and intent, whereas perceived side effects and lack of trust in the vaccine are associated with lower uptake and intent. Race and political ideology were not significant predictors when attitudes and beliefs were considered. Before vaccine hesitancy can be addressed, researchers and clinicians must understand the basis of vaccine hesitancy and which populations may show higher hesitancy to the vaccination so that interventions can be adequately targeted.
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    2023 Indiana Family Medicine Residencies Exit Survey Report
    (2023-11) Kochhar, Komal; Ho, Monling; Khan, Mariam
    In order to plan effective healthcare workforce development initiatives, it is important to understand the reasons why Indiana family medicine residents choose to practice in specific locations. Thus, having a better understanding of the factors that influence how residents choose a practice location will help improve efforts to recruit and retain family medicine physicians in areas of need within the state. The 2023 Indiana Family Medicine Residencies Exit Survey© marks the 12th consecutive year of determining what these physicians plan to do after graduation; and, for those planning to primarily provide clinical care, to determine where they plan to practice. In addition, the survey also obtained overall feedback on the residents’ training and their program’s curricula, as well as ideas and suggestions for improvement.
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    2023 Graduate Medical Education Exit Survey Report
    (2023-12) Kochhar, Komal; Ho, Monling; Khan, Marian
    In order to plan effective healthcare workforce development initiatives, it is important to understand the reasons why the Indiana University School of Medicine (IUSM) residency and fellowship graduates’ choose to practice in specific locations. This study documented the proportion of residency and fellowship graduates that were planning to practice in areas of need in Indiana. The 2023 IUSM Graduate Medical Education Exit Survey© identified factors affecting graduates’ choice of practice location and gathered feedback on their self-rated level of competency training to serve the rural and underserved populations; assessment of their training program and the six Accreditation Council for Graduate Medical Education (ACGME) competency areas.
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    Bridging the Feedback Gap: The Efficacy of the Strategic Student Survey in Capturing the Medical Student Experience
    (2024-04) Kochhar, Komal; Masseria, Anthony; Walsh, Sarah; Skillman, Brian; Dunham, Jennifer; Wallach, Paul
    Indiana University School of Medicine (IUSM) developed the annual Strategic Student Survey (S3) in 2018 as both a mechanism to continuously monitor compliance with LCME standards and to provide a view of the student experience and allow for timely interventions. Selected items from the S3 were matched to questions asked on the in-house End of Clerkship evaluations (EOC) and the AAMC surveys - Year 2 Questionnaire (Y2Q) and Graduation Questionnaire (GQ). The present study seeks to determine the efficacy of the S3 to complement this suite of other evaluation instruments and provide a comprehensive, longitudinal view of student satisfaction with their educational experiences. Analysis of selected items common to all instruments shows evidence that the S3 does indeed provide a reasonable proxy for findings from other surveys.
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    Building Faculty Learning Communities for Medical Education Scholarship in a Multi-Campus System: Four Years of Experience
    (2024-04) Kochhar, Komal; Longtin, Krista; Wilson, Shawn; Ho, Monling; Brokaw, James; Hobson, Tara; Wallach, Paul
    The Indiana University School of Medicine employs a large geographically distributed system of medical education composed of 8 regional medical campuses and the main medical campus in Indianapolis. An inherent challenge is being able to provide relevant faculty development opportunities across the state. Beginning Fall of 2019, we implemented Faculty Learning Communities (FLCs) specifically designed to develop faculty competence in medical education research. Each FLC team consisted of 4-6 medical educators engaged in a collaborative educational research project led by an experienced faculty mentor. In addition to the group work, participants were expected to attend a series of monthly seminars to build foundational skills in educational research. To date, 69 medical educators (both preclinical/clinical) have participated in 13 FLC teams. To assess participant satisfaction, surveys were administered at the mid-point and end of each FLC team’s term (68% cumulative response rate). By the end of their term, approximately half of the participants had submitted their work for publication or presentation. A successful FLC program requires strong administrative oversight and organization but can easily be replicated elsewhere.
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    Engaging All Stakeholders to Create a Trusted, Data-Driven, Process Improvement Approach to Addressing Learner Mistreatment
    (Taylor & Francis, 2022-09-15) Walvoord, Emily C.; Howenstine, Michelle S.; Allen, Bradley L.; Ribera, Amy K.; Nabhan, Zeina M.; Tori, Alvaro J.; Eichholtz, Rebekah D.; Dankoski, Mary E.; Family Medicine, School of Medicine
    Problem: Learner mistreatment has remained an ongoing challenge in academic medicine despite accreditation requirements mandating that every program has systems in place to prevent and respond to mistreatment. While efforts vary across institutions, much remains unanswered in the literature about best practices. Additionally, for the foreseeable future, challenges in the learning environment will likely continue and potentially worsen, given the confluence of multiple external stressors including the COVID-19 pandemic, faculty burnout and general political divisiveness in the nation. It is essential, therefore, to focus on indicators of improvement via process metrics such as knowledge and awareness of mistreatment policies and procedures, willingness to report, reasons for not reporting, and satisfaction with having made a report, while simultaneously focusing on the more complex challenge of eliminating mistreatment occurrences. Intervention: We describe the aspects of our mistreatment prevention and response system first implemented in 2017 along with process and outcome measures. The interventions included expanding our policy outlining appropriate conduct in the teacher-learner relationship; a graduated response protocol to allegations of mistreatment with a clear escalation approach; an online reporting system; a graduate medical education exit survey which mirrors the AAMC Graduation Questionnaire on mistreatment; a robust communication and professional development campaign; a comprehensive data dashboard; and a comprehensive summary report dissemination plan. Context: The interventions were implemented at the largest allopathic medical school in the U.S., with nine campuses across the state. The system is available to all learners, including medical students, graduate students, residents, and fellows. Impact: Both institutional and national data sources have informed the continuous improvement strategies. Data from internal reporting systems, institutional surveys, and national data are presented from 2017 to 2021. Findings include an increasing number of incidents reported each year, including confidential reports from students who include their contact information rather than report anonymously, which we view as an indicator of learner trust in the system. Our data also show consistent improvements in learners’ awareness of the policy and procedures and satisfaction with having made a report. We also include other data such as the nature of complaints submitted and timeliness of our institutional response. Lessons Learned: We present several lessons learned that may guide other institutions looking to similarly improve their mistreatment systems, such as a close partnership between faculty affairs, diversity affairs, and educational affairs leadership; communication, professional development, and training through multiple venues and with all stakeholders; easily accessible reporting with anonymous and confidential options and the ability to report on behalf of others; policy development guidance; data transparency and dissemination; and trust-building activities and ongoing feedback from learners.
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    Reaching underserved people during the pandemic
    (MA Healthcare Limited, 2022-05-02) Taylor, Jennifer; Behrens, Sandra; Donahue, Ronald; Family Medicine, School of Medicine
    Background: As the COVID-19 crisis evolved, many emergency medical technicians (EMTs) and community paramedics (CPs) were already positioned to engage with both the community and the health system. Aim: This project, based in Indiana, USA, aimed to provide resources for EMTs and CPs to build knowledge and skills necessary to use promising practices related to COVID-19 and provide culturally competent care using telehealth to improve access to care for underserved populations during the pandemic. Methods: Between May 2020 and April 2021, EMT and CP participants completed a retrospective pre-test and post-test assessing self-efficacy around best practices related to COVID-19 and culturally competent care using telehealth. Findings: Forty-nine EMTs and CPs completed the project and results demonstrate a significant (P<0.05) improvement in self-reported level of preparedness to demonstrate best practices related to COVID-19 culturally competent care using telehealth. Conclusion: The project identified a potentially effective strategy for increasing practitioner self-efficacy, resulting in a more effective system for caring for vulnerable individuals during a pandemic.