July is the first month of training for resident physicians and commonly known as “not the time to need emergent medical care” in case a newbie doctor is assigned to care for you. I still remember the feeling of dread as my classmate teased, “Ooh..Jen. You’re first up! You got Internal Medicine call on July 1!” Yikes.
Representing Illinois as a resident delegate to the AAFP National Conference was a remarkable experience. I was able to meet residents and medical students who were not only passionate about family medicine but eager to engage in meaningful discussions on how to improve our health care system for patients and providers alike. Jennifer Caudle DO, was the AAFP's National Conference’s keynote speaker. She delivered an inspirational speech reminding us of the reasons why family medicine is such a rewarding specialty such as continuity of care, work life balance, and fulfilling relationships with patients from all walks of life.
To say attending this year’s American Academy of Family Physician’s (AAFP) National Conference was a life-changing experience for me would be an under-statement. I have never left a conference feeling more engaged, inspired, and galvanized than I am today after attending this conference. I am indebted to the tireless efforts of those who led and organized this truly spectacular event. As the Illinois Resident Delegate, I was honored to represent our state and delegation, IN PERSON, at the 47th annual AAFP National Conference in Kansas City, Missouri. Though this was my first AAFP National Conference, I was comforted by the hundreds of other medical students and Family Medicine residents who were also new to this 3-day gathering. I was even more enchanted when I ran into four of my former classmates from medical school (The Larner College of Medicine at the University of Vermont) who were at the conference representing their respective family medicine residency programs.
Health disparities and discrimination continue to exist throughout all walks of life, and in medicine it’s no different. As an African American 1st generation female in medicine, it has always been an interest of mine to become knowledgeable in areas which may impact my patient panel.
I am the current Chair of the Diversity and Inclusion Committee at the Northwestern McGaw Family Medicine Residency Program at Delnor, where our goal is to engage in meaningful discussions. This committee strives to help residents understand their implicit biases and how these shape interactions with others. It works to stimulate growth and insight on inequities and diversity while exploring various topics of social determinants of health with an ultimate goal of application to our local Kane County area. As the COVID-19 virus progressed and necessities arose, our shift in focus was also redirected. The pandemic created hindrances in areas of work life balance, added tremendous stress on the healthcare system by increasing demands on resources, and further highlighted disparities and inequities. As a result, it presented situations in which my fellow co-residents faced forms of discrimination in medicine. It was at this time that I wanted to explore the implications that this pandemic created toward our family medicine residents (FMR) across the United States.
Previous studies have identified that minority physicians are subject to greater experiences of discrimination perpetuated by both patients and colleagues alike (1, 2). These experiences are known to have negative impacts on an individual's wellbeing, but studies suggest that teaching and addressing implicit bias within residency education has positive benefits (3, 4). The current pandemic has placed additional stress on physicians, including increased anxiety, social isolation, and fear of spreading the virus to family members (5).
The purpose of this study is to investigate the impact of COVID-19 on family medicine residents’ wellbeing and potential experiences of discrimination. We aim to better understand the impact that this pandemic is having on family medicine residents’ training experience, specifically those from underrepresented minorities. With the help of my team, I have learned the nuances of an Institutional Review Board (IRB), how to construct survey designs, navigate REDCap data collection, and review statistical data. I now further appreciate research and also acknowledge that though it is not an easy feat, it can be quite rewarding in the end.
Methods
Study participants were recruited in March 2020 via a snowball sampling methodology, utilizing several sources, including social media outlets (IAFP, Program Directors’ list-serves, Twitter) as well as personal contacts. Inclusion criteria consisted of the ability to provide informed consent and active enrollment in an Accreditation Council for Graduate Medical Education Family Medicine Residency Program. Exclusion criteria consisted of individuals who are not in an ACGME-accredited program.
The survey instrument was created using a collection of previously validated survey questions, which included information on participant demographics, perception of discrimination, COVID-19 exposure, access of personal protective equipment, HERO Daily Experience Index an instrument which evaluates an individual’s wellbeing and health in the workplace, and lastly COVID-19 impact on daily activities.
Preliminary Results
Snowball sampling size of 75 participants, of which 62 participants completed the full survey in its entirety. Our sample included a geographically diverse group, with representation from 17 states. Respondents represented 8 religious’ affiliations. A majority (79%) indicated English was their first language. Residency class participation included doctors of osteopathic medicine (43%) and allopathic medicine (57%). Representation from first, second- and third-year residency classes respectively (40%, 37%, 27%) and reported marital status as 37% married while 52% selected single. Though small sample size, greatest percentage of responders selected female (69%) as identified gender, while others reported being male (26%), non-conforming (3%) and other (2%). Average age cluster of responders were between 25-34 (79%) with the second largest cluster 35-44 (10%). Predominance of participants identified as White (60%), Asian (19%), or African American (4%) race. Majority sexually identified as Heterosexual (83%), with smaller percentages of Bisexual (5%) and Homosexual (3%).
Initial survey instrument was implemented to evaluate family medicine residents during the COVID-19 pandemic. In figure 1, residents reported feeling tired (63%) and stressed (63%) in greater frequency than anger (15%) or in physical pain (12%). Our survey design doesn’t support causal inferences, so we aren’t able to directly link wellbeing metrics with Covid-induced stress. However, the data provides a snapshot of resident wellness during the early stage of the pandemic. This information can help tailor wellness interventions moving forward. Identified limitations to this study include cross-sectional survey, smaller sample size thus unable to calculate response rate. Stay tuned, as the remainder of the data continues to be analyzed.
I sympathize with my fellow co-residents across the United States and attest to the burden this pandemic has placed on our lives. I acknowledge my own experiences during residency mirrors the data provided. Despite our programs efforts to shelter us from this traumatic experience through counseling, time off, pregnancy limited exposures, and personal wellness.
Figure 1: Family Medicine Resident Wellbeing During the COVID-19 Pandemic
Future Plans
Our ultimate goal is to disseminate the research findings at the Family Medicine Residency research forum. Highlighting COVID-19’s implications on resident’s wellbeing, demographic impacts and exposures to discrimination.
Dr. Hirschfeld is an IAFP member who practices at Erie Family Health Center
Follow her on Twitter @Ahirschfeld5 #Protect340B
Ms. Chaudhry is an IAFP Public Health Extern working with the Public Health Committee Infection Prevention Workgroup. If you would like to join the Public Health Committee, please visit our website sign-up form.
Once the COVID-19 pandemic went from shocking arrival to ongoing reality, everyone’s meetings and conferences pivoted from live giant gatherings, to online experiences from home. Illinois AFP had already selected resident and student delegates and alternates for the annual Kansas City experience. The virtual format enabled the two residents and two students to “tag team” their responsibilities behind the scenes. Here is a summary from each.
The following blog post can serve as a template letter for physicians to explain applications where discontinuing benzodiazepine would not be advised.
As family medicine physicians and members of society, we grieve the death of George Floyd. His death, along with the deaths of hundreds of black people killed by police officers each year, is a tragic reminder of the unjust treatment of African Americans in our country. The protests across the world are a response to this event and the many injustices suffered by black people at the hands of institutions that hold power in our country.
I left for a global health trip to Costa Rica on March 7. We had discussed cancelling the trip, but were told as long as we wore masks and practiced hand hygiene at the airports we could still go. At that time, Costa Rica was a safe country for travel. That all changed while we were there; the in-country organization decided to send us home early without finishing all of our clinics. Since we arrived, the cases in Costa Rica climbed from one to 26. For the first time in my ten years of doing these trips, we were evacuated early. The CDC guidelines at that time did not say we needed to be quarantined, but our institution wanted to be safe and placed us on self-quarantine when we returned. Sadly, that meant our students would miss Match Day! A few days later, Match Day and all large gatherings were cancelled for all medical students everywhere as the pandemic worsened.
While there is uncertainty and fear around us right now, there is also love and kindness around us, always. During times of uncertainty, it helps to have some structured routines. We offer a daily anchoring message for those of you who may find it helpful for you, your coworkers, your loved ones, and/or your community/patients.
(Editor's Note) This blog originally appeared on KevinMD.com on March 1. Dr. Wheat has given her permission to re-post here.
I celebrated 30 years of working with and for you in 2019. Here are just a few wise sayings I have learned from various past presidents along the way:
Never, ever give up asking someone if they are ready to change (to quit smoking, to lose weight, to increase exercise, to eat healthier). The next time you do may be the catalyst for change. Stephen Rittmann, MD
See the possibilities in everyone you meet. Carolyn Lopez, MD
You or your replacement will get this done. Bruce Steffens, MD
When things seem bleak and without hope, remember there is as much energy around in dark times as in bright times. Michael Brummer, MD
I think family medicine chose me and I responded in 1989 when I joined IAFP. I chose a new personal physician, William Hulesch, MD, an IAFP and Foundation past president. He continues to care for my family throughout all our patient and ‘no-so-patient’ health adventures. I was in the office of another past president, Raymond Weber, MD, when I received the call that my wife, Patty and I, were approved to adopt our second child.
I’ve been blessed to observe you in practice, from circumcisions to C-sections to daily practice. The framework of my journey as your chapter executive is much like the Academy’s motto: Devoted to Advocacy, Education and Action.
From the FPs in FQHCs Member Interest Group
This “Dialed in on Diabetes” post will wind down National Diabetes Awareness Month. As we post this, it is Thanksgiving week, and the beginning of the holiday season that includes Hanukkah, Kwanzaa, Christmas and runs right on through New Year’s Day. Honestly, it kind of continues on with Valentine’s Day, St. Patrick’s Day and Easter! All these events also coincide with the cold winter and shorter daylight hours. This combination can sabotage diabetes management unless we can offer practical strategies for patients to manage the holidays and all the feasts throughout the season.
The incidence and mortality rates associated with cardiovascular disease are a growing concern. For patients also facing diabetes, heart disease is a serious threat. We can help patients with prediabetes and type 2 diabetes improve their risk factors for cardiovascular disease.
Over my 30-year career, I have developed a personal and professional interest in mental health challenges and how they impact health and well-being. Mental health issues affect patients of all ages, races, and socioeconomic groups. When a patient also has a chronic physical condition, mental health issues can even further complicate care. These disorders can negatively impact patients’ ability to manage medications, avoid medication complications, and advocate and care for themselves. I would like to share some simple techniques that can help you address behavioral health issues while improving outcomes for your patients with diabetes.
This is the first post in the series “Dialed in on Diabetes.” Here, we’ll take a big-picture look at type 2 diabetes - as it runs throughout our practices, and yours. Who are the patients in your practice with type 2 diabetes? Are they mostly in a certain age group? What barriers or challenges do they face in taking care of their health?
© Copyright Illinois Academy of Family Physicians. All rights reserved.
747 E. Boughton Road, Suite 253 - Bolingbrook, IL 60440
331-318-0680 and [email protected]
