Department of Family Medicine Works

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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.
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    Longitudinal assessment of Indiana dentists’ participation in Medicaid before and after expansion
    (Elsevier, 2022-07) Maxey, Hannah L.; Vaughn, Sierra X.; Medlock, Courtney R.; Dickinson, Analise; Wang, Yumin; Family Medicine, School of Medicine
    Background Although Medicaid expansion aims to eliminate financial barriers to health care for low-income people in the United States, health care accessibility cannot be guaranteed without clinicians who provide health care to Medicaid recipients. This study examined the characteristics of Indiana dentists that are associated with the likelihood of participating in Medicaid after expansion in 2015. Methods This study included Indiana-licensed dentists who renewed their licenses in 2018 and provided supplemental data elements related to demographics, education and training, and professional characteristics. Dentists’ Medicaid engagement behavior was categorized on the basis of when claims were submitted from 2014 through 2017. Statistical analyses included the χ2 test and generalized multinomial logit model. Results Overall, 2,037 Indiana-licensed dentists were included in the study. Of these, 802 (39.4%) were continually active in Medicaid during the study period, and 116 (5.7%) became active after expansion. Dentists had a greater likelihood of engaging in Medicaid after expansion if they were female, specialized in oral and maxillofacial surgery, practiced in a group practice, and were located in a rural county. Conclusions This study shows that dentists with certain demographic and practice characteristics had a greater likelihood of participation in Indiana Medicaid after expansion in 2015. Several findings from this study are consistent with previous research regarding the emerging trends in workforce diversity and show the impact of expansion policies on the dental safety net. Practical Implications This study presents an effective framework for the use of administrative and regulatory data sources for state-level analysis of the Medicaid safety net.
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    Can behavioral therapies assist with cannabis use disorder?
    (Wolters Kluwer, 2023-04) Adame, John D.; Jhon, Nogales-Pimienta; Poonia, Jasmin; Family Medicine, School of Medicine
    Psychosocial/behavioral interventions (primarily cognitive behavioral therapy and motivational enhancement therapy) decrease cannabis use frequency (SOR: A, systematic reviews with meta-analyses of randomized controlled trials [RCTs]). Digital treatment interventions are also effective in reducing cannabis use, albeit with a small overall effect size (SOR: A, systematic review and meta-analysis of RCTs).
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    Raising the Bar: Evolution of a Statewide Interprofessional Education Program Following a 5-Year Outcomes Evaluation
    (JCIPE, 2022) Daulton, Brittany J.; Weber, Zachary A.; Newton, April D.; Romito, Laura; Manz Friesth, Barbara; Family Medicine, School of Medicine
    Indiana University is a complex campus system across the state of Indiana. IU-Bloomington hosts the main campus with nearly 50,000 students, while Indiana University-Purdue University Indianapolis (IUPUI) has approximately 30,000. Additionally, there are seven regional medical school campuses located throughout the state in Gary, Evansville, Fort Wayne, Muncie, South Bend, Terre Haute, and West Lafayette.
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    Becoming an Agile Change Conductor
    (Frontiers, 2022) Mehta, Jade; Aalsma, Matthew C.; O'Brien, Andrew; Boyer, Tanna J.; Ahmed, Rami A.; Summanwar, Diana; Boustani, Malaz; Family Medicine, School of Medicine
    Background: It takes decades and millions of dollars for a new scientific discovery to become part of clinical practice. In 2015, the Center for Health Innovation & Implementation Science (CHIIS) launched a Professional Certificate Program in Innovation and Implementation Sciences aimed at transforming healthcare professionals into Agile Change Conductors capable of designing, implementing, and diffusing evidence-based healthcare solutions. Method: In 2022, the authors surveyed alumni from the 2016–2021 cohorts of the Certificate Program as part of an educational quality improvement inquiry and to evaluate the effectiveness of the program. Results: Of the 60 alumni contacted, 52 completed the survey (87% response rate) with 60% of graduates being female while 30% were an under-represented minority. On a scale from 1 to 5, the graduates agreed that the certificate benefited their careers (4.308 with a standard deviation (SD) of 0.612); expanded their professional network (4.615, SD of 0.530); and had a large impact on the effectiveness of their leadership (4.288, SD of 0.667), their change management (4.365, SD of 0.742), and their communication (4.392, SD of 0.666). Graduates claimed to use Agile Processes (Innovation, Implementation, or Diffusion), storytelling, and nudging weekly. On a scale from 0 to 10 where 10 indicates reaching a mastery, the average score for different Agile competencies ranged from 5.37 (SD of 2.80) for drafting business proposals to 7.77 (SD of 1.96) for self-awareness. For the 2020 and 2021 cohorts with existing pre and post training competency data, 22 of the 26 competencies saw a statistically significant increase. Conclusion: The Graduate Certificate has been able to create a network of Agile Change Conductors competent to design, implement, and diffuse evidence-based care within the healthcare delivery system. Further improvements in building dissemination mastery and program expansion initiatives are advised.