Implementing Integrated Behavioral Health (IBH) in a Resident-Led Primary Care Clinic: A Single Institutional Experience and Analysis of Trainee Perspectives

Equipping future physicians to recognize a palliative approach to care: A mixed methods study on palliative care training needs in internal medicine residency

Background A palliative approach to care emphasizes holistic assessment and treatment planning for individuals with life-limiting illnesses. Despite Canadian national frameworks and competency guidelines, internal medicine (IM) residents often report limited exposure and comfort with palliative care. Objective The purpose of this investigation is to assess the training needs of IM residents at McMaster University and inform future curriculum development. Design A sequential mixed-methods design was employed. Both quantitative survey and qualitative interview data were reviewed together to develop recommendations for internal medicine curriculum planning. Methods Phase 1 included an online survey distributed to post-graduate years (PGY) 1 to 5 IM residents, assessing exposure, comfort, and preferences regarding palliative care education. Phase 2 consisted of semi-structured interviews with PGY4–5 subspecialty residents to explore perspectives in greater depth. Quantitative data were analyzed descriptively, while qualitative data underwent thematic analysis using inductive coding. Results Twenty-four residents completed the survey. While 54% rated palliative care as “very important” to their future practice, only 50% were satisfied with current training. Residents reported comfort with symptom management and communication but discomfort with outpatient resources and discussing artificial nutrition. Interviews with five senior residents revealed appreciation for early exposure and experiential learning but noted barriers such as limited role modeling and scheduling conflicts. Suggestions included mandatory rotations, case-based learning, and integration of community-based care. Conclusions IM residents value palliative care education and support its integration into residency training. Findings highlight the need for a structured curriculum that balances didactic and experiential learning, addresses identified gaps and promotes longitudinal skill development. Such efforts are essential to prepare future specialists to deliver comprehensive, patient-centered care.

Systems thinking as the integrative competency in undergraduate Family Medicine education: a cross-sectional evaluation of an integrated primary care block

Background Family Medicine and Primary Health Care anchor effective health systems, yet undergraduate curricula have given them limited dedicated space. The COM353 Family Medicine and Primary Care block at Alfaisal University was created to give these areas more dedicated curricular space, combining didactic teaching, Primary Health Care Center (PHCC) visits, structured reflection, and explicit engagement with clinical uncertainty. Methods We conducted a single-institution, cross-sectional quantitative evaluation of third-year medical students who completed the block in January 2026. A 42-item Likert instrument, adapted from the Dundee Ready Education Environment Measure (DREEM) and the Groningen Reflection Ability Scale (GRAS) with block-specific items, captured perceptions across seven domains. Of 126 enrolled students, 96 responded (76.2%). Analyses included descriptive statistics, internal-consistency reliability, inter-domain correlations, and multiple linear regression. Reporting follows the STROBE guideline. Results Domain means ranged from 3.90 to 4.27 (of 5), with all domains exceeding the scale midpoint by large margins (Cohen’s d, 0.92 to 1.58). Agreement rates ran from 63.7 to 80.7%. Internal consistency was excellent (Cronbach’s alpha = 0.988 overall; 0.940 to 0.974 across domains). Family Medicine and PHC Competencies achieved the highest mean (4.27) and reflective practice the lowest (3.90). On a single global rating, 87.5% of students rated the block positively (mean 3.80, SD 1.13). Multiple regression with six domains predicting perceived block value explained 78.2% of variance; F(6, 89) = 53.25, p < 0.001. Three domains independently predicted overall evaluation: Systems Thinking (beta = 0.727, p < 0.001), Reflection (beta = 0.295, p = 0.002), and Learning Environment (beta = 0.293, p = 0.013). Despite producing the highest absolute scores, Family Medicine Competencies did not independently predict overall evaluation, likely reflecting shared variance with Systems Thinking (r = 0.874). Conclusion A purposefully integrated Family Medicine block joining community-based experience, reflective practice, and explicit work with uncertainty appears to produce favorable educational outcomes across multiple domains. Of these, perceiving healthcare as an interconnected system most strongly predicted students’ overall evaluation, suggesting that systems thinking acts as the integrative thread giving other curricular elements coherence.

Transforming quality of life and resident training with a self-managed group

ABSTRACT Introduction: The Brazilian Unified Health System (SUS) serves as a key setting for health education grounded in the principles of Continuing Education. Residency programs combine both care and educational elements and, despite existing regulations, they still face challenges that affect residents’ quality of life, high rates of Burnout Syndrome among medical residents being an example of these issues. To mitigate negative impacts on mental health within residency training, a strategy called the Self-Managed Group (Grupo Autogerido) was developed within a Family and Community Medicine Residency Program, providing a protected space dedicated to residents. Experience Report: Created in July 2022 and composed of all active first and second-year residents, the group held monthly meetings aimed at improving interpersonal relationships, sharing experiences, and discussing institutional matters not addressed in other spaces. Activities included group dynamics that resulted in reflecting upon issues identified by residents as collective needs. Discussion: The effects of these group meetings were depicted through residents’ reports, secondary products resulting from collective actions, and longitudinal comparison of outcomes through time. The group enabled the identification of previously invisible issues within the program that affected residents’ mental health. Through the strengthened bonds among residents and the development of individual and collective interventions, focused especially on self-care and institutional reorganization, noticeable improvements in quality of life were reported. Conclusion: The Self-Managed Group proved to be an innovative intervention tool with strong potential for replication in other educational contexts facing mental health crises by adapting characteristics of health groups to the residency training environment in Family and Community Medicine.

Building an Obesity Medicine Workforce: Implementation of a Comprehensive Resident Training Pathway in an Underserved Care Environment.

Communication and educational gaps in end-of-life care in Italian internal medicine wards: a cross-sectional study.

BACKGROUND End-of-life (EOL) care is a frequent and complex aspect of internal medicine, yet data on physicians' training, clinical practices, and perceived challenges are limited. This study aimed to explore current practices, knowledge gaps, and unmet needs in EOL care among Italian internal medicine physicians and residents. METHODS A cross-sectional survey was conducted under the auspices of the Piedmont-Liguria-Aosta Valley Section of the Italian Society of Internal Medicine (SIMI). The survey included 25 closed-ended questions addressing five domains: epidemiological, pharmacological, practical, psychological, and educational aspects of EOL care. Physicians actively involved in clinical care from multiple internal medicine wards participated voluntarily. Responses were collected anonymously via paper and online formats. Descriptive statistics were used to summarize data. Differences between groups (specialists vs. residents, oncology/hematology vs. non-oncology wards, low vs. medium vs. high clinical intensity wards) were assessed using the Mann-Whitney U and Kruskal-Wallis tests. Associations between ordinal variables were evaluated using Spearman's rank correlation coefficient. P-values were adjusted using the Benjamini-Hochberg procedure. RESULTS Of approximately 7,400 invited physicians, 619 completed the survey (response rate ≈ 8.4%; median age 38 years; 60.5% female; 70.8% board-certified internists). More than 88% reported facing terminal patients at least weekly, yet only 2.5% were aware of Advance Directives for > 25% of inpatients. Use of sedatives and analgesics during terminal sedation varied, while discontinuation of active therapies, total parenteral nutrition (TPN), and transfusions was widely accepted. Internal protocols and dedicated multidisciplinary discussions were infrequently used. Most respondents reported difficulties communicating with patients and families at EOL. Formal training in EOL care was perceived as largely inadequate during undergraduate, residency, and postgraduate education. Compared with residents, board-certified internists more frequently reported postgraduate/Master training, whereas residents more frequently reported undergraduate and residency training in EOL. Exploratory correlation analyses generated hypotheses linking communication difficulties with patients to those with family members and training experiences across educational stages. CONCLUSIONS The study highlights substantial gaps in training, communication, and organizational support, independent of clinical setting. Structured education and integration of psychological support are urgently needed. These findings can inform curriculum development, hospital policies, and future research to improve physician preparedness and patient-centered EOL care.

Factors Influencing Participation in the Formal Mentoring Program among Family Medicine Residents in Qatar: A Mixed-Methods Study

Background: The transition into residency is a demanding period. While mentorship programs aim to improve well-being, confidence, and career guidance, active engagement among family medicine residents often varies. This study aimed to systematically identify barriers and facilitators affecting participation in a formal mentoring program among family medicine residents in Qatar. Methods: A descriptive cross-sectional mixedmethods survey was conducted among 48 Family Medicine residents (PGY1-PGY4) at the West Bay Training Facility in Qatar. The survey captured quantitative data on mentoring frequency, satisfaction, engagement, and perceived effectiveness, alongside qualitative open-ended responses regarding barriers and facilitators. Quantitative data were analyzed using Kruskal-Wallis and Chi-square tests, while qualitative data underwent thematic analysis. Results: The study included 48 residents (12 per PGY level), of whom 77.1% were female and 70.8% were non-Qatari nationals. The response rate was 92.3%. Perceived mentorship effectiveness significantly declined as residents advanced in their training (H = 20.96, p < 0.001), with PGY1 residents reporting the highest effectiveness (median = 10.0) and PGY4 residents the lowest (median = 5.0). Despite this decline, overall mentorship satisfaction (p = 0.149) and self-reported engagement (p = 0.881) remained consistently high across all cohorts. Thematic analysis identified “Time Constraints” as the primary barrier (28 mentions), whereas “Emotional/ Interpersonal Support” (17 mentions) and “Structured Scheduling” (12 mentions) were the main facilitators of engagement. Conclusion: Formal mentorship is highly valued, but its perceived effectiveness diminishes in senior residency years. Addressing severe time constraints through protected meeting times and tailoring mentorship focus to align with the evolving career planning needs of senior residents are critical steps to optimizing mentorship engagement. Key words: participation. mentoring, family medicine residets, Qatar