The prevalence and risk factors for perinatal depression in the South Asian community in the West

Background: In the United States, it is estimated that 13-19% of women experience perinatal depression. While the South Asian immigrant population continues to grow in the Western World, little is known about the experiences of perinatal mental health and its risk factors in this population.

Methods: We performed a systematic search of articles examining mental health outcomes of South Asians living in the West published after 2000. South Asia was defined as India, Pakistan, Bangladesh, Bhutan, Sri Lanka, and Nepal. The West was defined as the US, Canada, Australia, and Western Europe. Our search strategy had 3 main parts: 1. database search 2. manual article screen and 3. topic based article selection. First, we performed a database search. Next, identified articles were screened by two independent reviewers to confirm inclusion. Discrepancies were decided by a third independent reviewer. Finally, articles were further subdivided according to major topic areas with this review focusing on women’s reproductive mental health.

Results: Our search identified 6 papers on perinatal mental health in the South Asian community living in Western Diaspora. Reported prevalence’s were between 11-28%, and risk factors included previous depression, social isolation, and socio-economic status.

Conclusion: The prevalence and risk factors of perinatal mental illness in the South Asian community are similar that in the United States (Hutchens et al, 2020). Our review highlights that this population is understudied and further research must be done to provide culturally competent care.

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Impact of a Gender Affirmation Curriculum on Resident Confidence and Medical Knowledge

Background: Residency training provides an opportunity for new physicians to practice the art of medicine in a variety of capacities. The goals of training are often dictated by the patient population in which the residency functions, and sometimes new needs arise, especially amongst the most vulnerable populations. One area of medicine that both medical schools and residency programs lack exposure and training in is gender affirmation. According to a curriculum inventory by the American Association of Medical Colleges less than 65% of curricula offer some level of transgender-related education, and less than 80% of those programs do so in required courses. Roughly 0.4-0.6% of the US population identifies as transgender, which is equivalent to the amount of type I diabetics, and yet many physicians do not feel comfortable with initiating and monitoring gender affirming care. Northwestern Medicine offers a Gender Pathways program with many resources available in the central region, however growing demand in the Grayslake clinic and north region underscored a need to supplement our current residency training.

Methods: This was a cross-sectional study conducted over the course of the 2021-2022 academic year. Participants consisted of current residents at the Northwestern McGaw Lake Forest Family Medicine program. Surveys were administered before and after the implementation of a structured gender affirmation curriculum consisting of two interactive, virtual lectures. The main outcome measure was confidence in providing gender affirming care, and secondary outcomes looked at changes in medical knowledge regarding this important aspect of patient care. Confidence was measured using a likert scale with 1 being “very uncomfortable” and 5 being “very comfortable” and medical knowledge was based on responses to multiple choice and true/false questions in pre/post implementation surveys.

Results: A total 13 residents completed the pre-curriculum survey and 11 completed the post-survey. Paired t-tests were used to analyze self-reported confidence for providing gender affirming care as well as for differences in knowledge base. All residents showed an increase in confidence for providing gender affirming care, with no resident rating confidence less than a 3 on the above mentioned scale. Difference in confidence was statistically significant even with the small sample size. Despite increased confidence in providing care, there was not a concordant increase in correct responses to knowledge based questions.

Conclusion: The implementation of a formal, structured gender affirmation curriculum at an academically-affiliated community-based Family Medicine residency program resulted in an increase in confidence for providing gender affirming care, however did not result in a corresponding increase in medical knowledge based on the selected questions. Improvements to the curriculum and to strengthen its analysis would include additional didactic sessions to solidify the knowledge base of gender affirming care, use of case studies to put new knowledge to use in clinically applicable scenarios, in person didactic sessions instead of virtual lectures, and staggered cohorts for curriculum implementation throughout the year to provide continuity of learning for residents as well as improve the overall sample size.

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Applicant Satisfaction with Online Residency Interviews and Recruitment

Background: In 2020, general had shifted due to the COVID 19 pandemic. This disruption affected how daily life was conducted both on the personal and professional levels. As the shut downs were ongoing, many routine aspects of the residency and medical school application process had to rapidly shift from the traditional, in-person interview process to an explicitly long-distance, virtual interview. Many questions are easily thought up from this change in interview process. One of which is how applicants fell regarding this change. There have been relatively few such studies reported in the literature prior to the COVID19 pandemic, and this project aims to expand on these studies.

Methods: The Northwestern Family Medicine Residency as a whole has been distributing surveys to applicants for the last several years. From 2021 onward, these surveys have been modified to include applicants’ opinions on factors surrounding the virtual interview process. These REDCap surveys were sent out to applicants after the match process of 2021. Participants were not required to answer any question they did not wish to. No personal information was obtained from the participants.

Results and Conclusions: Overall, 31 applicants responded to at least 1 question on the survey. Responses were obtained for over 20 questions regarding the overall interview process for the 2020-2021 year. Preliminary results suggest several benefits of virtual interviews, with full analysis to be completed soon.

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Integration of Palliative Care Services in Heart Failure Patients

The specific aim of our study is to establish a reproducible protocol for implementation of early palliative care intervention in congestive heart failure patients, with the ultimate goal of reducing readmission rates, and also improving pain and symptom management, decreasing caregiver burden and establishing advanced care planning for end-of-life care. Palliative care in heart failure is often administered late in disease course and there is no standardized protocol. Our goal is to randomize patients with recent hospitalization for heart failure to receive either current palliative care or a standardized protocol over the course of one year to evaluate efficacy of palliative care in improving quality of life and symptom burden. This standardized course includes four visits with goals of educating patients, establishing treatment goals, involving a LCSW, re-evaluating symptom burden and needs, and finally establishing end-of-life goals. We use the KCCQ and PHQ as our primary metric, as well as analysis of hospitalization and re-admission rates. This procedure remains in progress. Response thus far has been very positive, with patients eager to benefit from palliative care interventions. We have developed a close working relationship with our cardiologists and our heart failure nurses and educators, which provides benefit to our patients.

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Towards a trauma-informed future: Analyzing the Need for and Impact of Trauma-Informed Care Training in a Family Medicine Residency Program

Objective: A growing body of research has demonstrated the importance of training in Trauma-Informed Care (TIC) during health professions education. Despite this trend, a relatively small amount of this research has focused on TIC training during medical residency.

Methods: This is a pretest-posttest study examining the impact of two 2-hour interactive sessions designed to train residents to understand and implement the basics of trauma-informed care as well as to recognize and manage signs of provider burnout and countertransference. We will conduct a pre-training survey of resident knowledge and comfort in these areas using both quantitative (Likert-scale) and qualitative assessments. A post-intervention survey will be distributed to residents to again assess resident knowledge and comfort with the curriculum as well as feedback for curriculum improvement.

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The Effect of a Novel Emergency Department-Initiated Buprenorphine Protocol on both ED Length of Stay for Patients with Moderate to Severe Opioid Use Disorder and ED Staff Wellness

Background: Since 2020, the COVID pandemic produced many healthcare-related disruptions, including 1) a significant exacerbation of the opioid drug crisis in the US and 2) operational challenges that affected Emergency Department (ED) provider wellness. While other studies that evaluated the effect of ED-initiated protocols using Medically Assisted Treatment (MAT) for Opioid Use Disorder (OUD) demonstrated positive benefits for patient participants, they were not dual-site studies with a control group of patients receiving non-MAT management. Even more, no previous literature explored the effect on staff wellness from an ED-initiated MAT protocol’s potential to decrease visit length and patient complexity.  

Methods: This dual-site, two-arm study explored the impact of an ED-initiated buprenorphine protocol at a suburban, academic-affiliated Level II trauma center relative to a comparable ED that did not have a buprenorphine protocol. One study arm was a retrospective chart analysis that assessed patients who presented to either ED with moderate to severe OUD (n=47) over a 4-month study interval for two primary outcomes: ED length of stay and visit complexity (via medications administered and quantity of security/behavioral documentation). A second study arm was a prospective analysis of the protocol’s effect of staff wellness over the same study interval. Eligible ED providers at both sites (n=37) who opted into pre/post-intervention surveys had responses measured in a mixed-assessment approach, using 1) a 3-question assessment of ED staff based on an 10-point Likert scale and 2) a free-form survey response via the protected survey driver REDCap. 

Results: Regression analyses of pre-survey responses (n=31) demonstrated no statistically significant difference between Likert responses based on either ED site or license level.

Conclusions: To be determined.

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The impact of COVID-19 on Family Medicine Residents

Background:The purpose of this study is to investigate the impact of COVID-19 on Family Medicine residents’ wellbeing and potential experiences of discrimination.

Methods: Study participants were recruited in March 2020 via snowball sampling methodology, utilizing several sources, including social media outlets and personal contacts. Inclusion criteria consisted of ability to provide informed consent and active enrollment in an accredited Family Medicine Residency Program. Exclusion criteria consisted of individuals who not in an 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: Of 75 participants, 62 completed the full survey. The group was geographically diverse, with representation from 17 states. Based on HERO survey, residents reported feeling tired (63%) and stressed (63%) in greater frequency than anger (15%) or physical pain (12%). The perception of discrimination scale demonstrated that the largest percentage of witnessed discrimination was a result of patient discriminating based on providers’ race (50%), gender (49%), ethnicity (34%), and/or sexual orientation (21%). The largest percentage of personal harassment/threatened discrimination reported by respondents was based on race (6%), gender (24%), ethnicity (2%), and/or sexual orientation (2%).

Conclusion: Health disparities and discrimination continue to exist. Unfortunately, given limitations of sample size it is difficult to make broad inferences in regards to discrimination experienced during the pandemic. However, the data provides a snapshot of resident wellness during the early stage of the pandemic and can potentially help tailor wellness interventions moving forward.

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Development of an Osteopathic Curriculum in a Community-Based Family Medicine Residency Program

The purpose of this study is to assess the integration of and attitudes toward an osteopathic curriculum in the setting of a community-based Family Medicine residency. This includes the process of developing didactics, workshops, and a clinic dedicated to Osteopathic Manipulative Medicine (OMT). The aim of this study is to gauge the consensus of the residents and faculty regarding their attitude towards OMT and to demonstrate the importance of application of OMT in a clinical setting. Two surveys distributed via REDCap evaluated the Osteopathic curriculum implemented at Delnor rated by a Likert scale. Final results and conclusions TBD.

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Comparing Meniscus Repair and Meniscectomy: A Healthcare Database Analysis in the United States

Background: Meniscal tears are among the most common musculoskeletal injuries in the US. Surgically removing (meniscectomy) or reapproximating (meniscal repair) the torn pathology is the mainstay of treatment for these lesions. The aim of this study was to examine outcomes in meniscus repair and meniscectomy by analyzing data from a large healthcare database.

Methods: The PearlDiver database was queried for patients who had undergone either meniscus repair or meniscectomy with a minimum follow up of 2 years. Patients who had undergone both procedures or concurrent ligament reconstruction were excluded. Propensity score matching was performed to compare characteristics, postoperative outcomes, and complications via Student’s t-testing (p < 0.05) in all patients that met inclusion and exclusion criteria.

Results: A total of 8,428 patients (5,594 meniscectomy, 2,834 meniscus repair) were included in this study. At 2 years, there were lower rates of knee osteoarthritis (p = 0.001 at year 1, p = 0.021 at year 2), need for palliative injections (p = 0.001 at year 1, p = 0.005 at year 2), and reoperation (p < 0.001 at year 1, p < 0.001 at year 2) following meniscus repair versus meniscectomy. At 30 days, there were higher rates of DVT (p = 0.002), but lower rates of infection (p = 0.012) and wound complications (p < 0.001) following meniscus repair in comparison to meniscectomy.

Conclusions: This database analysis suggests that meniscal repair leads to better overall outcomes for patients than meniscectomy and should be strongly considered whenever possible for meniscal tears.

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Addressing Vaccine Hesitancy in the African American Community

Background: It is no secret how important the doctor-patient relationship is to patients’ health outcomes. When the relationship isn’t built on trust, there is usually a decline in patients’ health. This unfortunate outcome is commonly seen in the African American community and what is not very well known is why there is so much mistrust in the African American community when it comes to the medical field. It’s important for physicians, especially ones serving the African American community to know what has led to medical distrust over the years. Given the current state of the pandemic, it is important to assess why COVID-19 vaccination rates are so low in the African American population. This project assessed the current knowledge and confidence level of Family Medicine Resident Physicians to address COVID-19 vaccine hesitancy in African American patients.

Methods: Resident physicians were taught the history of vaccine hesitancy in the African American community and the historical relationship between the medical community and African American community. Residents participated in two lectures that were 60- 90 minutes long and were presented methods and interventions that may be utilized to address COVID-19 vaccine hesitancy. A 10-item pre- and post-didactic survey was administered to assess Resident Physician knowledge about the history of vaccine hesitancy in the black community and their confidence in addressing COVID 19 vaccine hesitancy with black patients. Descriptive statistics including frequency counts and percentages were calculated for all quantitative survey items, and the Wilcoxon Signed Rank Test was used to detect pre- to post-curriculum gains.

Results: Seventeen resident physicians attended the didactic session and completed the pre- and post-didactic evaluation survey (100% response rate). At baseline, 88.2% (15/17) of residents indicated they experienced vaccine refusal in clinical encounters with African American patients, however only 52.9% (9/17) were fairly or completely confident discussing vaccine hesitancy. Following the didactic presentations, residents reported a better understanding of the causes of medical distrust among the black community (z=2.873, p=.004), and felt more confident addressing issues of vaccine hesitancy (z=3.176, p=.001) with the ultimate goal of improving vaccination rates.

Conclusions: Overall, the didactic presentations were well received. Given the improvement documented with residents, we hope this study can serve as a blueprint to further educate other medical physicians so that the medical relationship with the black community will improve along with health outcomes.

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Screening for Substance Use Disorder (SUD) in Primary Care

Background: Substance use disorder (SUD) is one of the most common causes of preventable death, injury, and disability globally and nationally, affects approximately 14.5 percent of our population age 12 and older. By gender, of those with SUD, around 9.5% were male and 5.6% were female. A recent study looking at SUD in female patients at Erie clinic sites has shown the prevalence to be significantly lower than the national average at around 2.2%. This bears the question of whether or not we as providers have been inefficiently screening and diagnosing SUD. Many organizations, including the United States Preventive Services Task Force (USPSTF) and the American Medical Association (AMA), recommend routine screening in adults age 18 and older, however, primary care providers have historically reported low levels of preparedness to recognize and help patients with SUD which is exemplified by irregular screening practices. Effective integration of screening is key to addressing SUD and its consequences. This study aims to assess the current SUD screening practices within the Northwestern Family Medicine resident programs to further investigate the discrepancy of SUD found in our patient population.

Methods: This was a cross-sectional survey. Participants were residents of Northwestern McGaw Family Medicine Resident Training Programs from three different primary sites; Lake Forest and Humboldt Park, both of which also work at an Erie clinic site, and Delnor. The survey consisted of 12 questions and sent to a total of 69 individuals via the protected survey driver REDCap.

Results: Survey response rate 49% (34 responses). When assessing how prepared a participant felt identifying substance use disorder, 6.5% felt very prepared, 74.2% felt somewhat prepared, and 19.4% felt minimally prepared. Most individuals were screening for SUD at annual exams (58.1%) and/or if there is concern or suspicion for substance abuse (54.8%), while 3.2% never screen. The three most used screening tools include basic social history questions, CAGE questions, and AUDIT. The most common barriers to screening were patients presenting with other acute concerns (80.6%) and patients with complex medical histories that take precedence (71%). 12.9% were unaware of solutions to help patients which precluded them from screening.

Conclusions: The results of the survey show further education outlining office-based screening approaches and strategies for managing and treating SUD could help enhance screening practices within the resident programs. Limitations of this study include the response rate. This survey was initially intended to analyze SUD screening practices within all primary care providers specifically at Erie sites given the discrepancy of SUD in female patients was identified within the Erie health system, however, research inquiries through Erie were held due to conversion to a new EMR system. We hope to extend this survey to the Erie health system as a next step in hopes of expanding SUD screening practices.

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Body surface area as a predictor of post-partum hemorrhage risk

Postpartum hemorrhage remains one of the most common contributors to maternal morbidity and mortality. In trauma and critical care, one factor that contributes to determining classes of shock is blood loss based on % volume, calculated based on body surface area. To date, there is only one study that has studied body surface area as it applies to post-partum hemorrhage. The purpose of our study is to study body surface area (BSA) as it applies to post-partum hemorrhage (PPH).

A retrospective analysis was performed using data accessible through EDW. We studied deliveries at Delnor Hospital from July 2019 to December 2020. Data points included age, gestational age, gravida/parity, method of delivery, height, weight, BMI, and quantitative blood loss. BSA was calculated using the Dubois formula. The BSA was further divided into quintiles to evaluate if a greater BSA resulted a greater percentage of blood loss.

Our data show that there is no relationship between body surface area and post-partum hemorrhage. We found that cesarean section deliveries had greater blood loss as compared to vaginal deliveries. Our study did show that pregnant patients lose about 8% of total blood volume with vaginal deliveries, whereas C-sections lose 15% of their total blood volume. One outlier, while not statistically significant, is that the patients with greater BSA at baseline did have less blood loss in C-sections compared to lower BSA patients.

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Addressing Vaccine Hesitancy in the African American Community

Background: It is no secret how important the doctor-patient relationship is to patients’ health outcomes. When the relationship isn’t built on trust, there is usually a decline in patients’ health. This unfortunate outcome is commonly seen in the African American community and what is not very well known is why there is so much mistrust in the African American community when it comes to the medical field. It’s important for physicians, especially ones serving the African American community to know what has led to medical distrust over the years. Given the current state of the pandemic, it is important to assess why COVID-19 vaccination rates are so low in the African American population. This project assessed the current knowledge and confidence level of Family Medicine Resident Physicians to address COVID-19 vaccine hesitancy in African American patients. 

Methods: Resident physicians were taught the history of vaccine hesitancy in the African American community and the historical relationship between the medical community and African American community. Residents participated in two lectures that were 60- 90 minutes long and were presented methods and interventions that may be utilized to address COVID-19 vaccine hesitancy. A 10-item pre- and post-didactic survey was administered to assess Resident Physician knowledge about the history of vaccine hesitancy in the black community and their confidence in addressing COVID 19 vaccine hesitancy with black patients. Descriptive statistics including frequency counts and percentages were calculated for all quantitative survey items, and the Wilcoxon Signed Rank Test was used to detect pre- to post-curriculum gains.

Results: Seventeen resident physicians attended the didactic session and completed the pre- and post-didactic evaluation survey (100% response rate). At baseline, 88.2% (15/17) of residents indicated they experienced vaccine refusal in clinical encounters with African American patients, however only 52.9% (9/17) were fairly or completely confident discussing vaccine hesitancy. Following the didactic presentations, residents reported a better understanding of the causes of medical distrust among the black community (z=2.873, p=.004), and felt more confident addressing issues of vaccine hesitancy (z=3.176, p=.001) with the ultimate goal of improving vaccination rates. 

Conclusions: Overall, the didactic presentations were well received. Given the improvement documented with residents, we hope this study can serve as a blueprint to further educate other medical physicians so that the medical relationship with the black community will improve along with health outcomes. 

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Resident Readiness to Address Intimate Partner Violence: Curriculum Development, Implementation, and Evaluation at a Family Medicine Residency

Background: Intimate partner violence (IPV) affects approximately 25% of women in the US and is associated with multiple poor health outcomes. The United States Preventative Health Task Force recommends screening for intimate partner violence in all reproductive-aged women and for clinicians to provide or to refer for appropriate ongoing support services to patients who are experiencing violence. Nevertheless, rates of screening for intimate partner violence among primary care providers remains low.

Methods: An intimate partner violence curriculum for family medicine residents was developed. It consisted of 1) a 2-hr didactic curriculum on intimate partner-violence, including local and hospital partner programs addressing interpersonal violence, using trauma-informed best practices and 2) intimate partner violence Observed Standardized Clinical Examinations (OSCEs) with standardized patients for residents to practice screening for and responding to reports of intimate partner violence. 24 residents at the Northwestern McGaw Family Medicine Residency at Humboldt Park participated in some part of this curriculum. Participants were asked to complete a survey, abbreviated from the validated PREMIS Survey, prior to and two months after the curriculum was implemented in order to assess its effectiveness.

Results: Post-survey data still in collection at time of abstract submission; final analysis on curricular impacts and next steps will be presented on Resident Research Day.

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Improving Bone Health Screening and Treatment in an Urban FQHC Setting

Osteoporotic fractures are a major cause of morbidity and mortality among elderly patients. Hip fractures in particular are a frequent cause of institutionalization for elderly patients, and are associated with reported one-year mortality rates ranging from 14 to 58%. Though less commonly lethal, vertebral and forearm fractures are common causes of chronic pain and impaired ability to perform activities of daily living. Screening tools, including clinical risk assessments and radiographic measurements of bone density, are available to assess individuals’ risk of osteoporotic fractures. The USPSTF recommends universal screening for osteoporosis among women greater than 65 years of age using DXA measurement of bone density. Chart review at an urban FQHC revealed that just 37% (41/110) of female patients aged 65-85 had either a bone density diagnosis in their chart or had completed DXA screening. Interventions to improve screening compliance are underway, including provider education, systematic chart review, and the use of EMR pop-up notifications to increase the rates of bone density screening and appropriate interventions for this patient population. Data collection to assess the impact of these interventions revealed a significant increase in rates of screening over the studied timeframe; however, these results are confounded by the impact of COVID-19 on provider habits and screening accessibility.

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Journal club curriculum: An evaluation of the ABFM National Journal Club Pilot Program

Background: Evidence based medicine (EMB) has become the effective approach to improve the health care quality and outcomes of patients. It is one of the core milestones/skills that residents work on during training and are periodically evaluated on as well. The goal is to develop a lifelong learning skill to provide the highest quality of care. Journal club has been a venue to improve EBM skills for many years. A few of the main common goals of journal club are developing critical appraisal skills, having an impact on clinical practice, and staying up to date with the current literature. In the Summer of 2021, the American Board of Family Medicine (ABFM) launched the National Journal Club pilot. It is a pilot program that provides 100 articles annually for Diplomates and residents to utilize to keep up with contemporary, practice-changing evidence.

The purpose of this project is to explore the correlation between the quality of articles chosen as a part of the pilot program and our journal club evaluation metrics to identify components of journal articles associated with better learning outcomes.

Methods: We performed a bibliometric analysis to describe the body of literature selected by the ABFM for its journal club pilot. Each article was scored using the Medical Education Research Quality Instrument (MERSQI) to assess methodological quality. This instrument includes 10 items grouped in 6 domains of study quality, including: study design, sampling (number of institutions and response rate), type of data, validity evidence (internal structure, content, and relationships to other variables), data analysis (appropriateness and complexity), and outcomes. The total MERSQI score ranges from a minimum possible score of 5 and a maximum possible score of 18, with higher scores indicating higher quality. Before our inaugural journal club session, we collected baseline survey data to document participants’ previous research experience and confidence critiquing journal articles. Following each journal club session, evaluation data were collected to assess learner satisfaction. We plan to explore correlations between MERSQI scores and evaluation data to guide article selection moving forward.

Results: 43 journal club articles from 25 journals were included in the ABFM Journal Club Pilot. MERSQI scores ranged from 13 to 18, with the average being 16.31. At baseline, a majority of residents indicated they had none or minimal experience evaluating journal articles (n=22, 52.4%). For instance, only a third of our residents were confident in critically evaluating a clinical research study and more than a third did not feel confident in their ability to interpret statistical methods, confidence intervals or study's power. Though the pilot is still ongoing, preliminary evaluation data indicates increased residents’ confidence in research appraisal skills.

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Impact of a Gender Affirmation Curriculum on Resident Confidence and Medical Knowledge

Background: Residency training provides an opportunity for new physicians to practice the art of medicine in a variety of capacities. The goals of training are often dictated by the patient population in which the residency functions, and sometimes new needs arise, especially amongst the most vulnerable populations. One area of medicine that both medical schools and residency programs lack exposure and training in is gender affirmation. According to a curriculum inventory by the American Association of Medical Colleges less than 65% of curricula offer some level of transgender-related education, and less than 80% of those programs do so in required courses. Roughly 0.4-0.6% of the US population identifies as transgender, which is equivalent to the amount of type I diabetics, and yet many physicians do not feel comfortable with initiating and monitoring gender affirming care. Northwestern Medicine offers a Gender Pathways program with many resources available in the central region, however growing demand in the Grayslake clinic and north region underscored a need to supplement our current residency training.

Methods: This was a cross-sectional study conducted over the course of the 2021-2022 academic year. Participants consisted of current residents at the Northwestern McGaw Lake Forest Family Medicine program. Surveys were administered before and after the implementation of a structured gender affirmation curriculum consisting of two interactive, virtual lectures. The main outcome measure was confidence in providing gender affirming care, and secondary outcomes looked at changes in medical knowledge regarding this important aspect of patient care. Confidence was measured using a likert scale with 1 being “very uncomfortable” and 5 being “very comfortable” and medical knowledge was based on responses to multiple choice and true/false questions in pre/post implementation surveys.

Results: A total 13 residents completed the pre-curriculum survey and 11 completed the post-survey. Paired t-tests were used to analyze self-reported confidence for providing gender affirming care as well as for differences in knowledge base. All residents showed an increase in confidence for providing gender affirming care, with no resident rating confidence less than a 3 on the above mentioned scale. Difference in confidence was statistically significant even with the small sample size. Despite increased confidence in providing care, there was not a concordant increase in correct responses to knowledge based questions.

Conclusion: The implementation of a formal, structured gender affirmation curriculum at an academically-affiliated community-based Family Medicine residency program resulted in an increase in confidence for providing gender affirming care, however did not result in a corresponding increase in medical knowledge based on the selected questions. Improvements to the curriculum and to strengthen its analysis would include additional didactic sessions to solidify the knowledge base of gender affirming care, use of case studies to put new knowledge to use in clinically applicable scenarios, in person didactic sessions instead of virtual lectures, and staggered cohorts for curriculum implementation throughout the year to provide continuity of learning for residents as well as improve the overall sample size.

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Does remote follow-up (via telehealth) after early medication abortion result in more adverse outcomes compared to in-person follow-up?

Background: During the Covid pandemic the FDA paused enforcement of the Risk Evaluation and Mitigation Strategy (REMS) and enabled abortions in parts of the country to be conducted via telehealth. ACOG and other professional organizations also endorsed the safety of telehealth abortions in a joint statement in March 2020.

Methods: A literature search of PubMed Clinical Queries was done with screening of initial identified records. Following the protocol of the FPIN HDA program three articles were identified. The population included in the search were patients undergoing medication abortion. Articles chosen compared remote follow up after medication abortion and in person follow up after medication abortion.

Results: Results were obtained using two prospective cohort studies and one retrospective cohort study. A 2017 retrospective cohort study (N=19,170) found that the difference in major adverse event (hospital admission, surgery, blood transfusion, death) prevalence was 0.13% (95% CI 20.01% to 0.28%; p-value= 0.07). A 2015 non-randomized prospective cohort trial (N=129) included adverse events of emergency rom and/or hospital visits with no statistical difference between remote follow up group and in person follow up group (3% vs 9%; p= 0.22). A 2011 non-randomized prospective cohort study (N=578) also found no statically significant difference in adverse events between groups.

Conclusions: Remote follow-up via telehealth after early medication abortion is not associated with more adverse outcomes compared to in-person follow up. (Strength of Recommendation [SOR]: C, based on 2 Prospective and 1 Retrospective cohort studies).

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Feedback on Feedback: Evaluating Satisfaction with Faculty Feedback of Residents

Background: Feedback is the cornerstone of medical education, yet inconsistencies in its application and delivery make it an active area of study and quality improvement. This study seeks to assess and improve resident satisfaction with faculty feedback in three Family Medicine residencies. Specifically, the study aims to determine current levels of resident satisfaction with the quality and/or quantity of faculty feedback, implement a new collection method to increase feedback opportunities, and assess improvement in satisfaction using a post-intervention survey.

Methods: Family medicine residents were surveyed on their satisfaction with faculty feedback, using both quantitative and qualitative assessments. All residents subsequently received a physical QR code linked to residents’ online assessment portal (New Innovations), where faculty members could provide in-the-moment feedback (using the ‘Anytime Evaluation’ form). Weekly reminder emails were sent over eight weeks to all faculty and residents, encouraging the use of the QR code system. The number and rate of QR code scans was tracked using an online portal. A post-intervention survey will be distributed after the intervention period to re-assess satisfaction with faculty feedback.

Results: While data collection is still underway, based on review of the literature I hypothesize that results of the pre-intervention survey will show a majority of residents with infrequent (50% or less of the time) and unsatisfying experiences with faculty feedback, regardless of the clinical location.

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Social Determinants of Health Training in Family Medicine: An analysis of a national survey of program directors

Social factors account for a majority of all health outcomes, underscoring the need to address social determinants of health (SDH) to eliminate health disparities. This study aimed to describe the scope of formal SDH curricula in family medicine residencies and to identify residency program characteristics associated with integrated core curriculum components to teach SDH. Survey items were included as one component of a larger, national survey of family medicine residency program directors conducted by the 2020 Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA). The sampling frame for the survey was all ACGME accredited US family medicine residency program directors as identified by the Association of Family Medicine Residency Directors (AFMRD). Overall, 41.2% of program directors reported significant formal SDH training in their residency program, though a majority (93.9%) agree screening for social needs should be a standard part of care. Most (58.9%) do not currently utilize standardized screening tools. The most commonly cited barriers to addressing SDH were lack of clinical resources (e.g social work, legal advocates, etc.), lack of community resources (e.g. food banks, SUD treatment, etc.), and inadequate SDH screening instruments or integration into the EMR. Availability of referral resources was associated with increased learner competency in addressing SDH. Additional research is needed to better train the next generation of physicians to identify and meaningfully address social needs. By surveying family medicine residency program directors, we present empirical explorations of factors associated with increased learner competency addressing SDH.

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Does the use of IV blood pressure medications to treat inpatient hypertension reduce the incidence of MI, stroke, or death?

Background: IV blood pressure medications are commonly used in the inpatient setting. However, outside of a few specific indications, there are no guidelines for this practice. It is not known whether these medications improve outcomes for patients, or if so, at what threshold of hypertension they should be initiated.

Methods: A literature search was performed following the protocol of the FPIN HDA program. Included studies examined nonpregnant adults who were admitted to hospitals and who did not have conditions for which blood pressure control is clearly indicated in guidelines (such as heart attack, stroke, hypertensive emergency, or aortic dissection).

Results: There are no systematic reviews or RCTs supporting the use of IV blood pressure medications to treat hypertension without end-organ damage for adults in the inpatient setting. A 2020 retrospective review (n=22,834) found that when patients received IV blood pressure treatments during their admission, they had a higher 30-day incidence of AKI (10.3% vs 7.8%, p<0.001) and MI (1.2% vs 0.6%, p=0.003), with no change in blood pressure control, stroke incidence, or mortality during one year of follow-up. Higher blood pressures were more likely to be treated, but there was no threshold of starting hypertension at which treated patients fared better than untreated ones.

Conclusions: The use of IV antihypertensives to treat inpatient hypertension without end-organ damage appears to be associated with increased rates of MI and AKI without any impact on stroke or death.

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Surveying Family Medicine Residency Applicants to Improve Virtual Interviewing

We attempted to evaluate the experiences of interviewees for Northwestern’s family medicine residency programs at both Lake Forest and Humboldt Park to investigate how our interview format (specifically our novel virtual platform amidst the Coronavirus pandemic) influences our applicants’ overall interview experience for the 2020-2021 application cycle. We achieved this by distributing via email an anonymous, multiple-choice survey to all applicants who had completed an interview at either of the aforementioned programs. Highlights of our results include that candidates greatly prefer interviewing with both the program director and with a current resident, while less so with the department chair. Furthermore, most respondents considered a total of four interviews built into the interview day as ideal. Although many respondents indicated that they experienced a reduced cost burden due to virtual interviewing, a slight majority indicated that they would prefer in-person interviews if given a choice. Finally, most candidates prefer Zoom as the video conference platform, compared to Microsoft Teams and “Other”. We realize we will likely need to adapt our survey questions in the future when we revert to in-person interviews; however, our results were nonetheless helpful in guiding us to adapt our interviewing process to improve the overall experience for interview candidates for future application cycles.

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Does providing opiate maintenance therapy during incarceration increase participation in community treatment programs after release?

Objective: A question was posed on the Family Practice Inquiry Network "Does providing opiate maintenance therapy during incarceration increase participation in community treatment programs after release?"

Methods: A literature search was performed using the research support of Northwestern Galter Library staff.

Results: A 2017 meta-analysis of 8 RCTs, 5 secondary-analyses of RCTs, and 11 quasi-experimental studies evaluated the efficacy of MAT within prisons on patient oriented outcomes, specifically focusing on whether opiate maintenance therapy during incarceration increased participation in community treatment programs after release. Through this meta-analysis, it was demonstrated that incarcerated individuals treated with methadone were significantly more likely to participate in community treatment compared to those without treatment (4 trials, n=407. [OR] = 9.0; 95% CI = 2.5 – 31, Q = 6.3, I 2 = 68%).

Conclusions: Opiate MAT during incarceration does increase participation in community substance use treatment programs following release (SOR: A, meta-analysis of RCTs and quasi-RCTs).

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Development of Medical Spanish Curriculum in Primary Care Residency Program

Background: Language barriers contribute to racial and ethnic disparities in health outcomes for limited English proficiency patients, 66% of which speak Spanish. Language concordance between health care providers and patients improves communication and patient experience. The Northwestern McGaw Family Medicine at Humboldt Park residency serves patients at Erie Family Health Center in the Humboldt Park neighborhood of Chicago, where approximately 60% of patients are primarily Spanish speaking. The need for competent Spanish speaking providers here is evident.

Methods: A multidisciplinary taskforce was created consisting of residents, faculty, an administrator, and a Spanish interpreter. Literature review was performed on medical Spanish curricula for residents. Starting 7/1/2018, interventions for residents were identified including a two-week intensive medical Spanish course, four-week international or domestic immersion rotation, bi-monthly didactic self-study time, a validated interactive online medical Spanish curriculum, and real-time evaluation and feedback by on-site Spanish interpreter during clinic. Effectiveness of these interventions was determined by subjective resident surveys and OSCE examination.

Results: Following one year of participation in curriculum, residents identified a subjective improvement in medical Spanish proficiency. Residents found patient encounters the most valuable teaching resource. They also identified international immersion rotations and the intensive 2-week Spanish language orientation as valuable.

Conclusions:
Intensive orientation course, international electives and exposure to Spanish speaking patients are the most effective teaching tools. Ongoing curriculum development includes incorporating longitudinal Spanish language teaching into didactics and increasing accessibility of Spanish electives. Future directions include identifying an objective measure of Spanish proficiency to assess resident longitudinal improvement.

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Proficiency in Cervical Cancer Screening in Substance Use Disorder Patients vs Non-Substance Use Disorder Patients

Background: Patients with diagnosed substance use disorders (SUD) are more likely to suffer from inequitable access to primary care resources. While there are multiple factors that play into this fact, some of the most prominent involve patient concerns of stigmatization and provider discomfort with screening and management of SUD. Regardless of the reason, the question is raised of how these constraints affect SUD patients’ healthcare outcomes, specifically those deemed preventable? Many studies around the world have shown poorer cervical cancer screening rates and higher prevalence of cervical cancer/cervical dysplasia in SUD patients. Oddly, some of these same studies have shown higher rates of healthcare utilization by patients with SUD. This study aims to examine the rate of cervical cancer screening in females with diagnosed SUD compared to those without SUD within a Federally Qualified Health Center (FQHC).

Methods: This was a retrospective chart review utilizing Erie Health’s electronic medical record (EMR) system, Centricity. Participants were female patients over the age of 20 receiving their care at Erie Health. Inclusion criteria for SUD categorization included patients in this age range with a history of Alcohol Dependence, Opioid Abuse, Opioid Dependence or Other Psychoactive Substance Use. Patients without these diagnoses were placed in the non-SUD category. Exclusion criteria included any patient with documented diagnosis or history of cervical cancer.
Results: Using the discriminants above, 13,869 charts were pulled from the Erie EMR. Of these female patients, 97.8% did not have SUD and 2.2% did have SUD. Of the women without SUD, 75.5% had been screened for cervical cancer compared to 71.8% of women with SUD.

Conclusions: There was no statistically significant difference in screening rates for cervical cancer between females with and without SUD. Interestingly, there was a statistically significant difference in screening rates between females with SUD over age 40 versus those 40 and younger. The prevalence of female patients with SUD was also noted to be significantly lower than the national average (about 5-7%). However, overall cervical cancer screening rates were comparable to national statistics (about 74-76%). This bares the question of whether or not we as providers have been inefficiently screening for SUD or if we are simply doing a poor job at screening for cervical cancer amongst all of our female patients? Further limitations in this study include the scarce number of diagnosis codes used to categorize SUD patients. An additional data pull request was submitted to include patients with Cocaine and Opiate dependence/abuse as well as those patients with a history of cocaine, opiate or alcohol dependence in remission. The results of this new data request is still pending.

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In communities that offer a needle exchange program, does intravenous drug use increase?

Background: Intravenous drug use (IVDU) is associated with increased risk of HIV, Hepatitis C, and other blood-borne viruses, mostly because of the propensity of sharing needles between participants. A needle exchange program is a harm reduction intervention designed to decrease the risk of contracting HIV, Hepatitis C., etc, by allowing participants to receive clean, sterile needles in exchange for used ones. However, there is concern that needle exchange programs increase the amount of IVDU in the area and that they increase the time needed for participants to achieve cessation of IVDU. The purpose of this review was to identify the research on the effects of needle exchange programs on IVDU.

Methods: A literature review was conducted to identify studies on needle exchange programs and their effects on IVDU. Inclusion criteria were 1) observational studies 2) published between 2000 and 2018, 3) primary outcomes included injection cessation and/or injection frequency.

Results: Many studies were identified mentioning effects of IVDU, but only two listed rates of IVDU as primary outcomes. One study shows that 33% of patients using intravenous drugs (IVDs) reported substantially fewer injections at follow-up encounters compared to initial enrollment at NEP. Those injecting every day were significantly more likely to reduce injection frequency (ARR= 3.44, 95% CL 1.46–8.09) (SOR B: cohort study). Another study comparing needle exchange program expansion to IVDU patterns of the surrounding community showed that the proportion reporting injecting cessation increased from 2.4% (95% CI: 0.0–7.0%) in 1996 to 47.9% (95% CI: 46.8–48.9%, P < 0.001) in 2010 (SOR: B, cohort study).

Conclusions: Communities with needle exchange programs (NEP) do not have increased intravenous drug use (IVDU). In fact, they may help decrease injection frequency and decrease the time to cessation. Many needle exchange programs including the ones in the studies above have additional services, such as addiction counseling, medication-assisted therapy, and other resources to aid patients with addictions. It is possible that those extra resources beyond just needle exchange contributed to the decreased rates of injection frequency and increases drug cessation. Because of these positive changes, more money and resources should be dedicated to needle exchange programs.

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Comparing Artificial Intelligence to Routine Monitors in Neonatal Evaluation: The CARE Trial

Purpose: Neonatal respiration is a pivotal marker in routine neonatal care. Continuous monitoring of respiration is critical in detecting early changes in breathing pattern and avoiding worsening outcomes such as apnea, hypoxia, or sudden infant death syndrome (SIDS). Classically, neonatal respiration is monitored by echocardiography (ECG) leads attached to the chest wall to determine thoracic impedance with increasing voltage on inspiration and decreasing voltage on expiration. However, this measurement is not perfect as body positioning and movement, as well as incomplete skin adhesion, can decrease the accuracy of these measurements. Moreover, continuous adhesive can be irritating and damaging to the neonate. Non-contact respiratory rate monitoring, using camera vision and artificial intelligence, offers a less invasive method to record these values in real time.

Methods: In the IRB approved CARE Trial, neonates admitted to the Lake Forest Hospital Neonatal Intensive Care Unit (NICU) were monitored with a camera connected to an artificial intelligence algorithm for analysis while simultaneously recording the respiratory rate display from classical ECG recording.

Results: This recorded data is under further review and algorithm refinement to determine non-inferiority when compared to the ECG monitor with results expected Spring, 2021. Preliminary results indicate that the camera vision was able to identify a reliable rhythm. Correlation to the ECG recording is currently underway.

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Implementation of an Osteopathic Manipulative Treatment Curriculum in an Allopathic Family Medicine Residency

Background: With the single graduate medical education accreditation system and the rising number of osteopathic physicians in the United States, there is a need to increase education dedicated to osteopathic philosophy, principles, and specific treatments. 

Purpose: This curriculum, led by osteopathic resident physicians, aims to educate allopathic resident physicians on the osteopathic philosophy, anatomy, and introductory manipulation techniques through didactic lectures and hands-on workshops.

Methods: A 9-item pre-curriculum survey was developed to gauge familiarity and comfortability of osteopathic manipulative treatment among the family medicine allopathic and osteopathic residents. A three lecture and three workshop series was presented to the residents during the scheduled didactics time, where each session lasted about 45 minutes. After completion of the lectures/workshops, a post-curriculum survey was conducted and pre/post curriculum survey answers were compared using a Wilcoxon matched-pair sign rank test.

Results: A total of two osteopathic residents and eleven allopathic residents completed the pre-curriculum survey. At baseline, 42.6% of residents were either uncomfortable or very uncomfortable diagnosing musculoskeletal complaints using palpatory skills. Only 30.8% reported they were likely or extremely likely to use OMT for their patients. Pending completion of the curriculum, full results will be presented at research day.

Conclusion: Preliminary data suggest residents are interested in OMT learning opportunities, and the curriculum was well received. Full evaluation findings will be used to refine and improve curricular content in subsequent academic years.

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An Evaluation of Provider Continuity In Relation to Diabetic A1c Control

Purpose: While there is copious research on the benefits of continuity of care on diabetic control, there is minimal data on the role of provider alignment in diabetic outcomes. This study aims to examine the impact of consistent provider alignment on glycemic control in Type II diabetic patients.

Methods: We conducted a multi-site, retrospective cohort study. Patient data was extracted from the thirteen FQHC sites that comprise Erie Family Health Centers, in Chicago, Evanston and Waukegan, Illinois. 4,478 patients met the following inclusion criteria: a) diagnosis of Type II diabetes mellitus (non-pregnant and without active substance misuse disorder) receiving care between 2008 and 2017. Our chart review assessed: a) hemoglobin A1C value at the time the diagnosis of DM was first used as the billing code for an office visit and 36 months after this index visit and b) provider alignment, defined as the number of different medical providers the patients saw for office visits related to diabetes during the 36 months after the DM diagnosis was first associated with an office visit. This study was reviewed by the Northwestern University Institutional Review Board (00210813).

Results:  Analysis of covariance (ANCOVA) was conducted to determine whether patients’ most recent A1C values are related to provider alignment after controlling for baseline A1C values. The overall model was significant (F=531.9, p<.001, r2=0.33), however the fixed factor representing provider alignment was not a significant term (F=2099.79, p=0.821). Baseline A1C was a significant predictor (F=.306, p<.001, partial eta squared=.323), suggesting a stronger association with final A1C than provider alignment.

Conclusion: Our retrospective review of a cohort of type II DM patients receiving outpatient services at urban FQHCs demonstrated a descriptive relationship between provider continuity and glycemic control, however this association was not statistically significant. More research would be beneficial to refine our understanding of these variables, and to determine not only the impact of provider consistency on hemoglobin A1c but the overall impact on quality of life.

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Evaluation of a Novel Newborn Feeding Assessment Tool to Increase Resident Comfort and Skill in Providing Basic Breastfeeding Support to Patients

Purpose:  The American Academy of Family Physicians, along with the AAP, recommends that all babies, with rare exceptions, be exclusively breastfed for approximately six months and continue breastfeeding with appropriate complementary foods for at least one year. Family physicians are uniquely positioned to champion breastfeeding efforts, as we provide comprehensive care to the whole family. Despite the growing evidence of the health risks of not breastfeeding, family physicians do not often receive adequate training about supporting breastfeeding. 

Methods: Study design: Cross-sectional survey. Participants: Family medicine residents at Northwestern Family Medicine at Humboldt Park, Lake Forest and Delnor campuses. Measures: Outcomes were measured through quantitative and qualitative survey items.

Results: Data collection and review is currently underway, however preliminary results suggest that the implementation of a Newborn Feeding Assessment Tool did improve resident comfort and skill in providing basic breastfeeding support to patients. Survey results also did illustrate remaining knowledge gaps in the area of breastfeeding medicine which support the argument that one training session is not sufficient. Residents, and subsequently their patients, would benefit from a longitudinal curriculum for breastfeeding medicine. 

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The Impact of a Structured Inpatient Medicine Curriculum on Volume of Formal Teaching and Resident Satisfaction

Background: Resident education takes place in a variety of settings and through myriad modalities.  At one academically-affiliated, community-based Family Medicine residency program, residents identified the Adult Inpatient Medicine rotation as an area of the curriculum with the most potential for improvement.  In the spirit of continued improvement, one proposed solution was a formal curriculum structured into the typical day on service as a way to limit barriers to teaching that had been identified by residents.  This project was intended to evaluate impact of a structured inpatient medicine teaching curriculum on the level of satisfaction of these Family Medicine residents regarding teaching on the Inpatient Medicine service.  Furthermore, the project will evaluate the contact time the residents spend in a structured teaching setting and if a formal curriculum affects this amount.
 
Methods: This was a cross-sectional study conducted over the course of Academic Year 2019-2020 and was extended to December of Academic Year 2020-2021 in light of curriculum interruptions in the setting of the COVID-19 pandemic.  Participants consisted of former and current Family Medicine residents at the McGaw Northwestern Lake Forest Family Medicine residency program.  Surveys were administered before and after the implementation of a structured curriculum.  The main outcome measures were time spent in a formal teaching setting and resident attitudes toward a formal teaching curriculum.
 
Results: A total of n=22 residents completed the pre-curriculum survey and n=10 completed the post-survey.   Of all residents who participated in at least one of the surveys, only 4.5% of respondents reported spending at least 30 minutes per week participating in formal teaching, compared to 83% of respondents at the time of the post-survey.  Likewise, after the implementation of the curriculum 70% of all respondents reported participating in 4-5 formal teaching sessions per week compared to 0% in the pre-implementation survey.

The Wilcoxon signed rank test was used to gauge improvement among matched pre/post pairs among the following domains: learning high yield topics (z=1.73, p=.083, n=6), sense of enhanced education (z=1.89, p=.059, n=6), improving skills as a teacher (z=1.89, p=.059, n=6), and adequate teaching on the inpatient service (z=1.89, p=.059, n=6). Though results were not significant at the .05 alpha level threshold, several tests were approaching .05 and thus a larger sample may provide more power to detect significant differences.
 
Conclusion: The implementation of a formal, structured teaching curriculum during the Adult Inpatient Medicine service at one academically-affiliated community-based Family Medicine residency program resulted in an increase in both the number of formal teaching sessions that occurred each week and the contact time spent in a structured teaching setting.  Furthermore, a positive trend was observed for resident perspectives regarding the amount of teaching, learning the necessary high-yield topics, and overall enhancement in their education.

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A 10,000 Foot View: A Spanish Immersion and Clinical Global Health Experience for the Family Medicine Resident in Quito, Ecuador

Background: This presentation is a review of a 4-week Spanish immersion elective in Quito, Ecuador through Child and Family Health International (CFHI) and Northwestern University. 

Methods: Objectives include 1. Fostering local partnerships, 2. Improving healthcare access, and 3. Increasing Spanish language proficiency.  Time was spent providing direct care to patients in clinic and observation in family medicine, inpatient obstetrics, and a rural indigenous clinic.  Daily Spanish lessons and home-stay were integral to the program.

Results: Twenty-four patients were examined in clinic. The resident’s medical Spanish competency increased from baseline.  All learning objectives were met and as a summary, a checklist was developed to guide medical residents planning similar immersion rotations. 

Conclusions: Based on this experience, key considerations for success include: an emphasis on local-partnership, medical supervision, bioethics, and continuity of care. This case highlights the value of global medical education and helps providers serve patients in increasingly diverse settings. 

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Development of Medical Spanish Curriculum in Primary Care Residency Program

Background: Language barriers contribute to racial and ethnic disparities in health outcomes for limited English proficiency patients, 66% of which speak Spanish. Language concordance between health care providers and patients improves communication and patient experience. The Northwestern McGaw Family Medicine at Humboldt Park residency serves patients at Erie Family Health Center in the Humboldt Park neighborhood of Chicago, where approximately 60% of patients are primarily Spanish speaking. The need for competent Spanish speaking providers here is evident.

Methods: A multidisciplinary taskforce was created consisting of residents, faculty, an administrator, and a Spanish interpreter. Literature review was performed on medical Spanish curricula for residents. Starting 7/1/2018, interventions for residents were identified including a two-week intensive medical Spanish course, four-week international or domestic immersion rotation, bi-monthly didactic self-study time, a validated interactive online medical Spanish curriculum, and real-time evaluation and feedback by on-site Spanish interpreter during clinic. Effectiveness of these interventions was determined by subjective resident surveys and OSCE examination.

Results: Following one year of participation in curriculum, residents identified a subjective improvement in medical Spanish proficiency. Residents found patient encounters the most valuable teaching resource. They also identified international immersion rotations and the intensive 2-week Spanish language orientation as valuable.

Conclusions: Intensive orientation course, international electives and exposure to Spanish speaking patients are the most effective teaching tools. Ongoing curriculum development includes incorporating longitudinal Spanish language teaching into didactics and increasing accessibility of Spanish electives. Future directions include identifying an objective measure of Spanish proficiency to assess resident longitudinal improvement.

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An Evaluation of Provider Continuity In Relation to Diabetic A1c Control

Purpose: While there is copious research on the benefits of continuity of care on diabetic control, there is minimal data on the role of provider alignment in diabetic outcomes. This study aims to examine the impact of consistent provider alignment on glycemic control in Type II diabetic patients.

Methods: We conducted a multi-site, retrospective cohort study. Patient data was extracted from the thirteen FQHC sites that comprise Erie Family Health Centers, in Chicago, Evanston and Waukegan, Illinois. 4,478 patients met the following inclusion criteria: a) diagnosis of Type II diabetes mellitus (non-pregnant and without active substance misuse disorder) receiving care between 2008 and 2017. Our chart review assessed: a) hemoglobin A1C value at the time the diagnosis of DM was first used as the billing code for an office visit and 36 months after this index visit and b) provider alignment, defined as the number of different medical providers the patients saw for office visits related to diabetes during the 36 months after the DM diagnosis was first associated with an office visit. This study was reviewed by the Northwestern University Institutional Review Board (00210813).

Results:  Analysis of covariance (ANCOVA) was conducted to determine whether patients’ most recent A1C values are related to provider alignment after controlling for baseline A1C values. The overall model was significant (F=531.9, p<.001, r2=0.33), however the fixed factor representing provider alignment was not a significant term (F=2099.79, p=0.821). Baseline A1C was a significant predictor (F=.306, p<.001, partial eta squared=.323), suggesting a stronger association with final A1C than provider alignment.

Conclusion: Our retrospective review of a cohort of type II DM patients receiving outpatient services at urban FQHCs demonstrated a descriptive relationship between provider continuity and glycemic control, however this association was not statistically significant. More research would be beneficial to refine our understanding of these variables, and to determine not only the impact of provider consistency on hemoglobin A1c but the overall impact on quality of life.

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Facilitators and Barriers to Family Medicine Resident Engagement in Global Health: A Secondary Data Analysis of a CERA Study

Background: Interest in global health has been increasing over the years. Many family medicine residency programs have been incorporating abroad training opportunities for their residents. An analysis was done to identify facilitators and barriers to resident engagement in global health.

Methods: A secondary data analysis of a cross-sectional, national family medicine residency program director survey was conducted (CERA Survey PD-6). Data were obtained from the Council of Academic Family Medicine Educational Research Alliance (CAFM) data clearinghouse. The sampling frame for the survey was all ACGME accredited US family medicine residency program directors as identified by the Association of Family Medicine Residency Directors (AFMRD). This project was approved by the American Academy of Family Physicians Institutional Review Board.

Results: The overall response rate for the survey was 60.62% (274/452), and a total of n=257 (56.9%) answered questions related to global health. Seventy four percent of respondents indicated their program offered global health experiences. No significant differences were detected between university-affiliated and community-based programs in regards to the principle goal of the program in offering a global health experience. Both identified preparing physicians to practice underserved medicine and teaching community medicine or public health as primary goals. Resident engagement in global health activities was significantly correlated with faculty engagement in global health activities (r=.52, p<.01).  The most common type of preparation residents received prior to going abroad was individual mentoring. Funding and time restraints were identified as primary barriers to implementing global health programs.

Conclusions: For family medicine residency programs, resident engagement in global health activities is correlated with faculty engagement in global health activities. Further work should examine whether this correlation leads to more ethical collaboration in global health practices as increasing numbers of residents engage in global health.

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From Chaos to Coordination: Strategies for Implementing and Residency Team-based Complexity Care Model

Background: Providing effective primary care to complex patients is a critical component of an effective healthcare system, yet teams struggle to effectively manage these patients. There are emerging innovative models of complexity care that incorporate social determinants into biopsychosocial models of healthcare. These innovative models are in the beginning stages of evaluating best practices. Our model prioritizes the service-oriented education and training of resident physicians within a complexity care model. The purpose of this study is to evaluate the team process and patient outcomes of a residency-based complexity care initiative.

Method: Our protocol includes bi-monthly multidisciplinary case conference reviews for our high-risk patients. These patients are identified by Medical Home Network’s algorithm and provider identified complex patients. These patients are reviewed by the team using a risk assessment framework that focuses on the patient’s barriers and assets. Data is collected on patient characteristics and interventions, team attendance, and team communication. The individualized care plans are regularly reviewed.

Results:  Number of conferences, team members in attendance, patient characteristics, treatment plans, and team communication will be shared. Successful protocols, systemic obstacles and the evolution of our model will be discussed through a qualitative lens.

Discussion: Key stakeholders are engaged and committed to our case review process. Residents feel more prepared to treat complex patients. Case conferences are successfully used to generate treatment plans for the identified patients. Efficacy of these plans are still being evaluated. We have identified problems: duplicate documentation, lack of protected time, scheduling barriers, and inconsistent treatment plan implementation. 

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Implementation of an Osteopathic Manipulative Treatment Curriculum in an Allopathic Family Medicine Residency

Background: With the single graduate medical education accreditation system and the rising number of osteopathic physicians in the United States, there is a need to increase education dedicated to osteopathic philosophy, principles, and specific treatments. 

Purpose: This curriculum, led by osteopathic resident physicians, aims to educate allopathic resident physicians on the osteopathic philosophy, anatomy, and introductory manipulation techniques through didactic lectures and hands-on workshops.

Methods: A 9-item pre-curriculum survey was developed to gauge familiarity and comfortability of osteopathic manipulative treatment among the family medicine allopathic and osteopathic residents. A three lecture and three workshop series was presented to the residents during the scheduled didactics time, where each session lasted about 45 minutes. After completion of the lectures/workshops, a post-curriculum survey was conducted and pre/post curriculum survey answers were compared using a Wilcoxon matched-pair sign rank test.

Results: A total of two osteopathic residents and eleven allopathic residents completed the pre-curriculum survey. At baseline, 42.6% of residents were either uncomfortable or very uncomfortable diagnosing musculoskeletal complaints using palpatory skills. Only 30.8% reported they were likely or extremely likely to use OMT for their patients. Pending completion of the curriculum, full results will be presented at research day.

Conclusion: Preliminary data suggest residents are interested in OMT learning opportunities, and the curriculum was well received. Full evaluation findings will be used to refine and improve curricular content in subsequent academic years.

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An Evaluation of Provider Continuity In Relation to Diabetic A1c Control

Purpose: While there is copious research on the benefits of continuity of care on diabetic control, there is minimal data on the role of provider alignment in diabetic outcomes. This study aims to examine the impact of consistent provider alignment on glycemic control in Type II diabetic patients.

Methods: We conducted a multi-site, retrospective cohort study. Patient data was extracted from the thirteen FQHC sites that comprise Erie Family Health Centers, in Chicago, Evanston and Waukegan, Illinois. 4,478 patients met the following inclusion criteria: a) diagnosis of Type II diabetes mellitus (non-pregnant and without active substance misuse disorder) receiving care between 2008 and 2017. Our chart review assessed: a) hemoglobin A1C value at the time the diagnosis of DM was first used as the billing code for an office visit and 36 months after this index visit and b) provider alignment, defined as the number of different medical providers the patients saw for office visits related to diabetes during the 36 months after the DM diagnosis was first associated with an office visit. This study was reviewed by the Northwestern University Institutional Review Board (00210813).

Results:  Analysis of covariance (ANCOVA) was conducted to determine whether patients’ most recent A1C values are related to provider alignment after controlling for baseline A1C values. The overall model was significant (F=531.9, p<.001, r2=0.33), however the fixed factor representing provider alignment was not a significant term (F=2099.79, p=0.821). Baseline A1C was a significant predictor (F=.306, p<.001, partial eta squared=.323), suggesting a stronger association with final A1C than provider alignment.

Conclusion: Our retrospective review of a cohort of type II DM patients receiving outpatient services at urban FQHCs demonstrated a descriptive relationship between provider continuity and glycemic control, however this association was not statistically significant. More research would be beneficial to refine our understanding of these variables, and to determine not only the impact of provider consistency on hemoglobin A1c but the overall impact on quality of life.

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Same Day Antiretroviral Therapy Initiation in a Chicago Federally Qualified Health Center

Over the past few decades, HIV incidence in the Unites States has down trended. However, in recent years, reductions in new HIV cases have remained somewhat stagnant. Additionally, several parts of the country demonstrate disproportionately high HIV incidence including the southern United States having an estimated 52% of new HIV diagnoses in 2018. Similarly, HIV incidence rates that have historically affected non-Hispanic Black and Latinx patients are stably elevated; specifically Black and Latinx patients demonstrated rates of 42% and 27% of new diagnoses.  Populations in these areas are key demographics to benefit from efforts to reduce HIV incidence. In keeping with the aims of the current U.S. Ending the HIV Epidemic: A Plan for America initiative, efforts must continue to address the disparities in HIV acquisition in the Unites States. To address these disparities, investigations have been conducted and demonstrated new antiretroviral therapy (ART) regimens involving rapid initiation and linkage to care have shown promise in the campaign to reduce HIV incidence.

This study proposes that the newer same day start ART initiation strategy will achieve viral suppression faster than convention methodology and that it will improve HIV retention in care. This retrospective chart review study will review data from January 1, 2015-January 1, 2021 comparing rates of HIV suppression and retention in care at Erie Family Health Centers.

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