During the National Congress of Student Members held here as part of the 2018 AAFP National Conference of Family Medicine Residents and Medical Students Aug. 2-4, delegates adopted resolutions that addressed protecting the health and well-being of all people. They also called for additional training on topics ranging from dealing with patients' adverse childhood experiences to prescribing buprenorphine.
Bijan Ghaffari, of the University of Colorado School of Medicine, Aurora, Colo., testifies on a resolution he co-authored that calls for the AAFP to communicate to the Department of Homeland Security that it opposes the inclusion of health, housing and nutrition services when defining what constitutes a "public charge."
These and other resolutions students adopted will now move through the AAFP's policymaking channels for review and referral for further action, when appropriate, by Academy leaders.
Protecting Disadvantaged Populations
Students adopted a handful of resolutions during the Aug. 4 business session that focused on protecting U.S. populations that are particularly vulnerable.
One such resolution asked that the AAFP develop webinars, a newsletter and other communication methods to broadly disseminate the tools and work of the Academy's signature initiative, The EveryONE Project.
The EveryONE Project focuses on
- providing education and resources for family physicians and their practice teams,
- advocating for health equity,
- promoting workforce diversity, and
- collaborating with other disciplines and organizations to advance health equity.
- During the National Congress of Student Members held as part of the 2018 AAFP National Conference of Family Medicine Residents and Medical Students Aug. 2-4, delegates adopted resolutions on a diverse range of topics.
- A number of resolutions the student congress adopted on Aug. 4 focused on protecting vulnerable U.S. populations.
- Delegates also appeared to be thirsty for more training on a variety of topics, adopting measures related to that goal.
The resolution also charged the Academy with investigating the creation of a data registry for users of The EveryONE Project to inform primary care delivery, research and other areas of health care policy.
In its report, the reference committee that considered the measure noted that the AAFP is already in the process of creating a five-year strategic plan for the Center for Diversity and Health Equity, which oversees The EveryONE Project, that will include a newsletter, webinars, regional working groups and a speakers' bureau.
"The EveryONE Project has developed into this awesome web-based resource, including a screening tool for social needs, an implementation guide and evaluation plans," said resolution author Tiffany Ku, of the Loyola University of Chicago Stritch School of Medicine. "There needs to be some sort of additional training, webinar and networking tool to connect with folks using the resources."
Regarding the proposed data registry, Ku said, "This could allow people from around the country to bring their data into one place, so that down the line, in 10 years, we can use it to inform policy."
Another resolution delegates adopted addressed a Department of Homeland Security (DHS) proposal to change its "public charge" guidance, under which immigrants can be denied entry to the United States if they are determined to be potential public charges. In addition, immigrants already legally in the country can, in certain circumstances, be deported if found in violation of the public charge rule.
According to an Aug. 1 article(www.nejm.org) in the New England Journal of Medicine that was cited in the resolution, "Current guidelines define a public charge as a person who is primarily dependent on the government for more than half of personal income." To date, this dependence has generally been defined as the use of cash assistance for income maintenance or government-funded long-term care.
DHS' proposed rule would expand that definition to include immigrants who receive health, housing or nutrition services (e.g., Medicaid, Supplemental Nutrition Assistance Program, Section 8 housing vouchers or subsidized health insurance through the Patient Protection and Affordable Care Act [ACA]).
The authors called on the AAFP to communicate to DHS that it opposes the inclusion of health, housing and nutrition services in the definition of a public charge.
Co-author Bijan Ghaffari, of the University of Colorado School of Medicine, Aurora, said changing the definition in the rule would negatively leverage health and nutrition services to promote the agency's agenda, which is in contradiction to the belief that health care is a human right.
"This would instill fear among the immigrant community and potentially cause a public health crisis," he said. "I think it's important that the AAFP brings light to this strategy and directly opposes it."
A third resolution called for the AAFP to develop a toolkit for human-trafficking screening, including warning signs and resources for patients, to be used in clinical settings.
In addition, the authors asked for the Academy to develop "train-the-trainer" programs on human trafficking to help physicians better use assistance from community organizations to train their colleagues.
Co-author Diana Chen, of Michigan State University College of Human Medicine, Flint, said she is currently working with the human trafficking task force in her county and wanted to bring attention to this issue because it affects every state.
"Statistics recently have shown that 88 percent of trafficking victims see physicians during the time that they are being trafficked," she said. "Polaris Project(polarisproject.org) has also shown that physicians are in the top three points of access/care for those affected, only behind family and friends. What's really alarming is family and friends make up 50 percent of those who have gotten the victims into the human trafficking situation. So, family physicians really might be their first line of defense.
"If a toolkit is developed, it could be used by family physicians and residents to become more comfortable in handling human trafficking victim care," Chen concluded.
Finally, a substitute resolution students adopted asked the AAFP to endorse the inclusion of Adverse Childhood Experiences (ACE) education in medical school and family medicine residency training and to advocate for research to study the impact of ACE screening and treatment on long-term health outcomes.
Chen, who also co-authored this resolution, said ACE disproportionately affects disenfranchised communities of color.
"So, we would like to gather the AAFP's support in recommending routine education (about) ACE screening tools to help minimize and prevent the culture of blaming and judgment for these patients and improve their physical and mental health," she said.
Seeking Additional Training
Student congress participants also appeared to be thirsty for more training on a variety of topics.
First off, they adopted a substitute resolution that charged the AAFP with developing centralized resources for training residents and medical students on how to screen for and discuss gun safety with patients.
Pratiksha Yalakkishettar, of Zucker School of Medicine at Hofstra/Northwell - Hofstra University, Hempstead, N.Y., speaks about a resolution she co-authored that asks the AAFP to develop centralized resources for training residents and medical students on how to screen for and discuss gun safety with patients.
Co-author Pratiksha Yalakkishettar, of the Zucker School of Medicine at Hofstra/Northwell - Hofstra University, Hempstead, N.Y., said she and her co-authors discussed the extensive media coverage that has followed mass shootings in the past couple of years, and they thought it would be helpful to have resources in addition to the Academy's current offerings, which include its Prevention of Gun Violence position paper.
"I think we can take this a step further and provide materials and support to residency programs to incorporate into their curriculum to disseminate to new physicians," she said.
Another substitute resolution students adopted asked the Academy to provide more educational opportunities at AAFP National Conference and/or via online materials/modules for residents, medical students and physicians focusing on nutrition.
Author Ryan Paulus, of Ohio University Heritage College of Osteopathic Medicine, Athens, noted that a poor diet has been cited as one of the most significant risk factors for disability and premature death.
"Three-fourths of health care dollars are spent on chronic lifestyle-related diseases," he said. "Diabetes alone costs $245 billion per year. It could be argued that type 2 diabetes is a largely preventable disease. Diet and lifestyle are first-line treatments for a number of diseases."
Yet, Paulus said a survey of medical schools found that the average amount of time spent on nutritional education during medical school is only 19.6 hours. Only 27 percent of schools were meeting the minimum number of hours (25 hours) suggested by the National Academy of Sciences.
"With patients looking to us as providers of reliable source of nutrition information, I think it's vital that medical students, residents and physicians have a strong foundation in nutrition, and I look to the AAFP to provide more lectures at conferences or online modules to help bridge this large education gap," he said.
Students adopted one more education-related measure that asked for more training on using Suboxone (buprenorphine and naloxone).
The amended resolution directed the AAFP to work with the Association of Family Medicine Residency Directors and Society of Teachers of Family Medicine to explore the creation of a toolkit that family medicine residency programs could use to establish and maintain Suboxone training.
Co-author Anne Drolet, of Michigan State University College of Human Medicine, Grand Rapids, said the national opioid epidemic has hit that state particularly hard.
A 2018 survey of residency program directors asked how many residencies worked with patients who have substance abuse issues in their clinics; about 80 percent said they did.
However, when asked if their programs provided more than 12 hours of training on buprenorphine use or offered residents opportunities to qualify for a Drug Enforcement Administration waiver to prescribe the drug, only about 22 percent said they did.
"I'm asking the AAFP to encourage residency programs to provide buprenorphine training," Drolet said. "And working with residency programs that already are successfully providing this training to create a toolkit for other programs interested in offering it."
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