Family medicine residents recently spent two days writing, debating and ultimately passing judgment on a wide variety of resolutions that reflect the problems and issues residents face every day as they care for their patients.
Joshua Henry, M.D., testifies during a reference committee hearing that residents could use some help in fielding "curve balls" that parents throw out during discussions about childhood vaccinations.
The residents' work was part of the National Conference of Family Medicine Residents and Medical Students held here on July 26-28. Resolutions adopted at the National Conference are pushed into the AAFP policymaking pipeline for review, referral, and, if appropriate, further action by Academy leaders and the AAFP Congress of Delegates.
The ability of residents to effectively communicate with patients and families was front-and-center in two measures voted on by delegates to the National Congress of Family Medicine Residents. Joshua Henry, M.D., of Jacksonville Beach, Fla., co-authored a resolution asking the Academy to promote the use of an existing vaccine safety communication curriculum in family medicine residency programs.
"What's beneficial is that this curriculum addresses the 'curve balls' that parents throw at you during discussions about vaccines," said Henry during a reference committee hearing. He added that the curriculum -- if used properly -- could help residents enhance their communication skills and perhaps defuse the passion with which some parents attack the topic of vaccinations. Use of the right words and tone sends a signal to parents that you're happy to have this discussion with them and pleased that they're interested in the health of their child, said Henry.
Danielle Carter, M.D., of Jacksonville, Fla., also a resolution co-author, pointed out that residents often get little or no training about how to discuss the benefits of vaccine administration with sometimes-anxious parents.
- Family medicine residents gathered in Kansas City, Mo., recently as part of the 2012 AAFP National Conference of Family Medicine Residents and Medical Students to discuss issues they'd like the AAFP to address.
- The delegates wrote, debated and adopted resolutions on topics such as use of vaccine safety curriculum, timing of end-of-life care discussions and pharmacists prescribing.
- Several resolutions on the appointment of additional residents and students to leadership roles inside the AAFP and beyond also were discussed.
The reference committee pointed out that the new curriculum was developed jointly by the California AFP and the American Academy of Pediatrics and is available(vaccinecommunicationresource.wikispaces.com) free of charge. Ultimately, resident delegates voted to adopt a substitute resolution that calls on the AAFP to make family medicine residency programs aware of the existing curriculum.
Resident delegates also adopted an amended substitute resolution dealing with end-of-life care that asks the AAFP to encourage family physicians to initiate discussions about advanced directives and end-of-life planning with patients during times of good health and as part of routine outpatient health maintenance.
Chaney Stewman, M.D., of Philadelphia, co-authored the original resolution and defended it during a reference committee hearing and again during the resident congress. "Yes, these conversations take place in the hospital, but arguably, the more important setting is in the practice setting when the patient is in a time of good health," said Stewman, adding that having these discussions in that setting would "result in enriched medical care for patients."
Although the substitute resolution offered by the reference committee focused only on promoting the incorporation of advance directive discussions, delegates voted to add back in a resolved clause from the original resolution that addressed advanced directive discussions and end-of-life planning during times of health.
Lively discussion ensued in conjunction with another resolution that asked the AAFP to continue to actively oppose an FDA proposal for a new "safe drug" classification that would give pharmacists limited independent prescribing rights.
Ruth Pitts, M.D., tells attendees at a reference committee hearing that an FDA proposal giving pharmacists limited independent prescribing authority would complicate patient care and confuse patients.
"I think this (proposal) is a game-changer," said Jessica Bowers, M.D., of Norfolk, Va., during reference committee testimony. She commended her pharmacist colleagues as an "amazing resource" but expressed concern for patients' well-being. "What about patient follow-up care for a urinary tract infection? Is your pharmacist going to get a urine culture?" asked Bowers.
Jacqueline Sequoia, M.D., M.P.H., of North Augusta, S.C., argued that pharmacists "don't look at the whole picture" when it comes to patients' health. She stated her concerns about continuity-of-care issues, as well as her understanding that there is no such thing as a "safe" drug.
Joseph Castro, D.O., of Pueblo, Colo., rose and said simply, "It's already hard enough to coordinate treatments. This would be a logistical nightmare."
Ultimately, the resolution was reaffirmed as lining up with existing Academy policy because the AAFP already is actively engaged in opposing the FDA proposal.
Several resolutions put forth by residents illustrated a desire to participate more fully in the AAFP and other organizations that make policy decisions.
For example, residents from West Virginia, California and Pennsylvania joined forces to introduce a resolution that asked the AAFP to investigate resident and student involvement with the FamMedPAC Board of Directors; that resolution was adopted.
Residents also asked for resident and student representation on the Center for International Health Initiatives (CIHI) advisory board. The resident delegates ultimately adopted a substitute resolution that directs the AAFP to request that the CIHI explore opportunities for such resident and student involvement.
In addition, delegates adopted a substitute resolution asking the AAFP Government Relations Division to create a one-month rotating student and resident health policy internship. The resolution states that interns should, among other things, learn about specific issues in health policy, develop legislative knowledge and grassroots advocacy skills, and understand how the government and its affiliated agencies affect the practice of medicine.
On the other hand, delegates followed the reference committee's recommendation to not adopt a resolution asking for one additional resident and one additional student member on the AAFP's Commission on Education. In its recommendation to not adopt the resolution, the reference committee noted its concern about the fiscal implications of adding members to the commission.
Katherine Jacobson, M.D., of Cantonsville, Md., one of four co-authors of the resolution, spoke in favor of it during a reference committee hearing. She noted that although several residents and students who are elected at the National Conference already serve on the commission, there are other students and residents who might be interested in serving but who are wary of the intricacies of an election and, in particular, of delivering a candidate speech.
In the recommendation to not adopt the resolution, the reference committee noted that the Commission on Education currently includes seven voting student and resident members.
Residents did adopt a number of other resolutions and substitute resolutions that dealt with a variety of issues. For example, delegates asked the AAFP to
- create social media guidelines for members;
- develop policy supporting parity in the number of months of graduate medication education required for international medical graduates and U.S. medical graduates to obtain a full and unrestricted state medical license;
- encourage Academy members to help develop and implement community health needs assessments conducted by nonprofit hospitals and health care systems;
- endorse support for universal access to contraceptives;
- support reasonable accommodation for medical students and residents who are breastfeeding;
- support civil marriage for same-gender couples; and
- encourage AAFP constituent chapters to appoint a task force to collect and maintain an online directory of community resources that address issues of wellness and healing.
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