Tip Sheet Summaries May/June 2025

(Press-News.org) Editorial 

To Improve Screenings With Technology, Focus on People First

Background: This issue of Annals of Family Medicine includes four original studies that illustrate valuable concepts to consider when incorporating technology in screening to improve early detection and management of disease.  

Editorial Stance: These studies highlight the importance of centering any digital health intervention on the patient’s specific clinical needs. The authors emphasize that digital tools work best when they work with, rather than replace, clinicians. Additionally, the authors stress that we must remember the human element while integrating digital tools into clinical practice while addressing barriers like lack of care coordination that can still prevent follow-up.

Why It Matters: AI has the potential to improve patient experience, better outcomes, lower cost, clinician well-being, and health equity. 

Information Technology in Primary Care Screenings: Ready for Prime Time? 

Masahito Jimbo, MD, PhD, MPH, FAAFP, et al

Department of Family and Community Medicine, University of Illinois Chicago, Chicago, Illinois

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Original Research 

Fewer Ontario Family Physicians Provide Comprehensive Care

Background and Goal: This study examined long‑term shifts toward focused practice among family physicians in Ontario, Canada, as well as changes in the number of comprehensive family physicians relative to population growth.

Study Approach: Researchers linked multiple Ontario health‑administrative data sets to track practice patterns for every general practitioner or family physician from fiscal years 1993/94 through 2021/22. Analyses were stratified by physician sex and years in practice. 

Main Results:

The proportion of family physicians working in focused roles rose to 19.2% in 2021/22, up from 7.7% in 1993/94.

Emergency medicine accounted for 37% of focused doctors in 2021/22, followed by hospitalist care at 26.5% and addiction medicine at 8.3%.

Although the overall supply of family physicians climbed from 104 to 118 per 100,000 residents during the study period, the supply offering comprehensive care fell from 71 to 64 per 100,000. 

Of the additional 6,310 family physicians who entered the workforce during the study period, 39.5% were in focused practice.

In 2021/22, 60% of focused practice physicians were male and 40% were female. The focused practice group had fewer average days worked at 156 days compared with 196 days for the comprehensive practice group.

Why it Matters: Amid efforts to address current and impending challenges in access to primary care, findings from this study underscore the limitations of using family physician head counts in workforce planning. Knowing how many family physicians move into focused roles and how the proportion providing comprehensive care has declined can guide policy and practice changes, including better payments aligned with system goals, practice support, job flexibility, team-based care and cross-sectoral workforce planning to make comprehensive family practice the most attractive option to family physicians. 

Family Physicians in Focused Practice in Ontario, Canada: A Population-Level Study of Trends From 1993/1994 Through 2021/2022 

Hina Ansari, PhD, MSc, et al

MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada 

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Original Research 

Patients and Staff Identify Opportunities for Artificial Intelligence to Improve Primary Care eVisits 

Background and Goal: While remote or electronic visits (eVisits) can increase access to health care for certain groups of patients, their use can increase staff workload and patient demand. Artificial intelligence (AI) may mitigate these outcomes. This study explored the views of staff and patients in primary care to inform the development of artificial intelligence (AI) features for eVisits.

Study Approach: Researchers conducted interviews and focus groups with 16 primary care staff and 37 patients from 14 primary care practices in northwest England and London. Researchers asked interviewees about their views on the potential uses of AI during eVisits, risks, benefits, and challenges to its adoption into clinical practice. Transcripts were thematically analyzed to identify key themes.

Main Results:

Initial misconceptions and reservations: both groups were unsure what AI could or could not do. Patients worried that AI might diagnose or prescribe without input from their physician, and staff questioned safety.

Perceived benefits included faster responses for patients and lighter workload for staff if AI handled routine tasks. Perceived risks included depersonalized care, data‑privacy fears, and the possibility that patients would have to enter symptoms perfectly for AI triage to work safely.

Seven specific opportunities for AI during eVisits were identified and generally welcomed if they complemented (not replaced) clinician judgment: 

Workflow routing – AI could direct each request to the appropriate team member quickly.

Directing – AI could reroute emergencies to emergency services and send non-urgent issues to pharmacies.

Prioritization – Urgent requests could be flagged so clinicians see them first.

Follow-up questions – AI could automatically request photos, questionnaires, or clarification after a submission.

Writing assistance – AI could suggest editable response templates for common concerns like mental health.

Self-help information – Trusted educational links could be sent to patients without clinician effort.

Face-to-face booking – AI could automatically schedule in-person visits when a physical exam is needed.

Why It Matters: The results of this study may serve as guidance for developing and testing AI tools in primary care settings.

Seven Opportunities for Artificial Intelligence in Primary Care Electronic Visits: Qualitative Study of Staff and Patient Views

Susan Moschogianis, PhD, et al

School of Health Sciences, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom 

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Original Research

Rural Location and Racial Segregation Drive Gaps in Primary Care Access in Virginia

Background and Goal: This study aimed to identify geographic disparities of the primary care workforce in Virginia and factors associated with primary care physician (PCP) access. 

Study Approach: Researchers used the 2019 Virginia All-Payers Claims Database to identify PCPs and the number of patients seen by each physician. They then measured how many PCPs each census tract could reach within a 30‑minute drive, flagging tracts with too few as having poor access. Researchers then assessed associations between PCP access and predisposing (age, race), enabling (income, insurance), need and structural (rurality, segregation) factors. 

Main Results: 

Nearly half (44%) of Virginia’s census tracts lacked adequate PCP access.

Racial segregation and rurality had the greatest associations with PCP access. Tracts with higher proportions of Black residents had significantly greater PCP access than those with higher proportions of white residents, while rural tracts had significantly less access. 

Why It Matters: The findings of this study can guide policymakers in focusing incentive programs and clinic expansions on underserved areas to increase primary care physician access, which may in turn reduce preventable hospitalizations.

Neighborhood Determinants of Primary Care Access in Virginia

Hannah M. Shadowen, PhD, et al 

Department of Health Policy, Virginia Commonwealth University, Richmond, Virginia

Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia

Medical Scientist Training Program, Virginia Commonwealth University, Richmond, Virginia 

An accompanying episode of the Annals of Family Medicine Podcast, featuring study authors Hannah Shadowen, PhD, and Alexander Krist, MD, MPH, will be available here beginning 9am EDT May 28.

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Original Research 

Decision Involvement and Trust Shape Seniors’ Willingness to Cut Back Prescriptions

Background and Goal: This study explored older adults’ perspectives on proactive deprescribing, identified barriers and enablers, and developed a typology of patient attitudes to inform patient-centered deprescribing interventions.

Study Approach: In this qualitative study, researchers conducted semi structured interviews with 20 patients in Japan aged 65 years or older who were receiving 5 or more oral medications. 

Main Results:

Enablers

Negative valuation of medication: patients noted pill burden, possible harm and past success in stopping drugs.

Proactive decision making preference: a few patients wanted an active role and even started deprescribing talks.

Openness based on trust in the prescriber: many said they would cut back if a trusted clinician suggested it.

Barriers

Positive perspective on medication: satisfaction with current drugs or high expectations kept regimens unchanged.

Passive involvement and low perceived capability: patients deferred to doctors and felt unable to ask about deprescribing.

Caution driven by fear of change or comfort with the status quo: worry about symptom return discouraged stopping pills.

The researchers also developed a new typology with five types of patients: indifferent, satisfied and risk-averse, compliant, fearful but passive, and proactive.

Why it Matters: The findings from this study show that patients vary in their readiness to cut back on medications and underscore the importance of tailoring deprescribing discussions to each patient.

Proactive Deprescribing Among Older Adults With Polypharmacy: Barriers and Enablers

Kenya Ie, MD, MPH, PhD, et al

Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Japan 

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Original Research 

AI-Enabled Cardiovascular Screening Shows Promise in Identifying Heart Dysfunction in Women Considering Pregnancy 

Background and Goal: This study evaluated the performance of an artificial intelligence–enabled electrocardiogram (AI-ECG) and an AI-powered digital stethoscope to see how well they could detect early signs of heart dysfunction in women of reproductive age.

Study Approach: In this cross-sectional pilot study, researchers examined two groups of women aged 18 to 49 who were considering pregnancy. Women who were currently pregnant or within one year postpartum were also included. The first group included 100 women already scheduled for an echocardiogram. The second group of women with no indication for an echocardiogram were seen at a primary care appointment for routine care. All participants received two tests: a standard 10-second 12-lead electrocardiogram (ECG) and a digital stethoscope recording that captured a 15-second, single-lead ECG and phonocardiogram (heart sounds) from up to three locations on the chest. AI models analyzed the ECG and stethoscope recordings to estimate each participant’s risk of having left ventricular systolic dysfunction (LVSD), a type of heart dysfunction. 

Main Results: 

Group 1 (diagnostic cohort, women scheduled for echocardiograms):

Five percent of women had LVSD.

The AI-ECG showed a negative predictive value of 96.8% and the AI-stethoscope achieved 100%.

Among women who screened positive using the AI tools, 33.3% (using the AI-ECG) and 22.7% (using the AI-stethoscope) truly had LVSD.

Group 2 (screening cohort, women seen during routine primary care visits):

Using the AI-ECG, only 1% of women in this low-risk sample screened positive. A follow-up echocardiogram in that patient showed a normal ventricular ejection fraction. With the AI-stethoscope, 3.2% of the sample had a positive screen.

Why It Matters: The findings from this study highlight the potential of quick, low-cost AI tools to help detect early signs of heart dysfunction during regular primary care visits.

Artificial Intelligence Tools for Preconception Cardiomyopathy Screening Among Women of Reproductive Age 

Demilade Adedinsewo, MD, MPH, et al 

Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida

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Original Research 

App-Based Hearing Screenings in Family Practice May Improve Hearing Disorder Diagnosis 

Background and Goal: Pure-tone audiometry, the gold standard for assessing hearing impairment, is costly and time-consuming. This study evaluated the acceptability and feasibility of hearing screening in the routine practice of private family medicine using two self-tests.  

Study Approach: 516 consecutive patients aged older than 10 years attending three private French family-practice clinics wore calibrated Bluetooth headphones and completed two tablet-based hearing tests: SoTone, which measures pure-tone thresholds, and SoNoise, which assesses speech recognition in noise. 

Main Results: 

Of 516 patients eligible for screening, 219 (42%) completed  the screening.

On average, it took six minutes and eight seconds for consent, instruction, and completion of testing.

Of the 219 people screened, 59 (27%) screened positive for some hearing impairment and were referred to an ENT specialist. Only 16 patients ultimately followed up, 14 of whom had confirmed hearing loss, and 8 received a prescription for hearing aids.

Why It Matters: The findings from this study show that tablet-based hearing tests may help general practitioners improve the diagnosis of hearing disorders.

Hearing Screening in Private Family Practice Medicine Using Tablet Applications

Jean-Charles Ceccato, et al

Montpellier Neuroscience Institute, University of Montpellier, Montpellier, France

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Original Research 

Digital Cognitive Assessment in Primary Care May Enable Early Dementia Detection and Next Step Care

Background and Goal: Many adults aged 65 and older never receive a cognitive check during regular primary care visits. This study assessed the feasibility and acceptability of implementing a digital cognitive assessment for Alzheimer disease and related dementias (ADRD) screening into primary care. 

Study Approach: From June 2022 to May 2023, seven Indiana University Health clinics offered the five-minute Digital Clock & Recall test on an iPad to every patient 65 and older. Each site set its own rules on which visit types and which staffers would run the screen and upload results to the electronic record for the physician to review. In month three, researchers introduced a registered-nurse role to support patients for completing care pathways if they were flagged for cognitive impairment. Physicians retained discretion over follow-up.

Main Results

Of the 16,708 patients identified as eligible for screening, a total of 1,808 digital cognitive assessments (10.8%) were completed by 1,722 unique patients.

More than one-half (55.3%) of eligible visits never offered the digital cognitive assessment because PCPs declined or the encounter was deemed out of scope. 

Screening outcomes: Among 1,808 tests, 44.3% were categorized as unimpaired, 36.5% as borderline, and 13.7% as impaired.

During follow-up within 90 days for the impaired group, 2.1% received a new Alzheimer or related-dementia diagnosis. Additionally, 5.1% received a new mild cognitive impairment diagnosis, 16.9% had brain imaging ordered, and 62.7% were referred to the brain health navigator.

Why It Matters: Digital cognitive assessments may offer a feasible way to screen older adults during routine visits, helping identify those who may benefit from early diagnosis, treatment, and care planning. 

Feasibility and Acceptability of Implementing a Digital Cognitive Assessment for Alzheimer Disease and Related Dementias in Primary Care 

Nicole R. Fowler, PhD, MHSA, et al

Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana

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Original Research

Implementing a Digital Cognitive Screening Tool and Flexible Workflow Helps Primary Care Clinics Integrate Dementia Screening

Background and Goal: A previous study across seven primary care clinics found that many older adults who completed a digital cognitive assessment showed possible signs of cognitive impairment. In this companion study, researchers assessed how agile implementation, an approach based on iterative improvements and tailored clinic workflows, could support the integration of digital cognitive assessment screening into routine care for patients aged 65 and older.

Study Approach: Researchers conducted a pragmatic clinical quality improvement project with seven primary care clinics in Indiana. The agile implementation process involved eight key steps: identifying opportunities for improvement, selecting the screening tool through a structured stakeholder evaluation, developing an implementation evaluation plan, mapping existing workflows, testing changes through time-bound training cycles called sprints, monitoring performance through weekly check-ins and dashboards, assessing organizational impact, and formulating a standardized operating procedure.

Main Results

The intervention engaged 69 of 108 clinicians. 

The screening rate increased over the course of the 12-month period.

Four clinics fully adopted the program, each reaching a screening completion rate of at least 20%. Five clinics continued using the screening tool one year after implementation.

Each clinic adapted the process to fit its specific setting while maintaining alignment with a shared core model.

Why It Matters: The findings from this study demonstrate the successful implementation of a digital cognitive assessment tool in primary care using agile implementation principles

Agile Implementation of a Digital Cognitive Assessment for Dementia in Primary Care 

Diana Summanwar, MD, et al 

Department of Family Medicine, Indiana University School of Medicine, Indianapolis, Indiana

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Original Research

Study Examines Authorship Inequities in Global Health Research Published in Family Medicine Journals in High-Income Countries

Background and Goal: This study examined authorship inequities for research that was conducted in low- and middle-income countries and published in family medicine journals based in high-income countries.

Study Approach: Researchers analyzed journals listed on the World Organization of Family Doctors (WONCA) Global family doctor website that focused on low-income countries, lower-middle-income countries, and upper-middle-income countries. They selected journals with editorial offices in high-income-countries. Inclusion criteria included research conducted in low or middle income countries, available in English language, with human study participants. They summarized the proportions of first and senior authors by country income level and other publication characteristics.

Main Results: 431 of 1,030 articles met criteria for research conducted in low- or middle-income countries.

Over time, there was an increase in publication of research articles from low- and middle-income countries in the family medicine journals, with the majority of the studies conducted in upper-middle-income countries (55.9%). 

The proportion of senior authors from high-income countries was highest in articles with research conducted in low-income countries (50%) compared with those reporting research done in lower-middle-income countries (37%) and upper-middle-income countries (21%). 

There was a trend toward higher average citation rate for articles having high-income countries first and senior authors compared with articles having lower-middle-income countries first and senior authors. 

Why It Matters: Quantifying authorship inequities highlights systemic barriers to research leadership in low- and middle-income settings.

Authorship Inequity in Global Health Research Conducted in Low- and Middle-Income Countries and Published in High-Income Country Family Medicine Journals

Alyssa Vecchio, MD, et al 

University of New Mexico, Albuquerque, New Mexico

The Warren Alpert Medical School of Brown University, Providence, Rhode Island

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Theory

Nonadherence Labeling in Primary Care Often Results in Poorer Health Outcome: Ethical Risks of Diagnosing Nonadherence

Background and Theory overview: Promoting adherence to medical recommendations remains one of the oldest yet most persistent challenges of modern clinical practice. Traditional models treat nonadherence as an intrinsic patient behavior, which can undermine patients’ autonomy as well as blame them for poor health outcomes. The authors draw on sociological labeling theory to show that “nonadherent” is not a neutral clinical finding but a social judgment made by clinicians. 

What Is New: The authors name and model “adherence labeling” as the process by which clinicians produce “nonadherence” data rather than diagnose a patient trait. Rather than locating nonadherence solely in the patient, the authors show that the clinician’s decision to observe, interpret, and record behavior generates the label. This shift from patient fault to clinician choice reveals how labels can obscure structural barriers such as underinsurance or systemic racism, stigmatize vulnerable patients and skew care decisions. 

Why It Matters: The “nonadherent” label embeds stigma and clinician bias into patient records, often resulting in delayed therapy escalation, clinic dismissal, and poorer health outcomes. 

Adherence Labeling: Understanding the Origins, Limitations, and Ethical Challenges of “Diagnosing” Nonadherence

Sourik Beltrán, MD, MBE, et al

Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts

The Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts 

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Special Report

AHRQ’s National Center for Excellence in Primary Care Research (NCEPCR) Consolidates Primary Care Research 

Background and Goal: For more than two decades, support from the Agency for Health Care Research and Quality (AHRQ) for primary care research was dispersed across multiple centers, making it difficult to view the work as a unified effort. In 2022, the National Center for Excellence in Primary Care Research (NCEPCR) was funded to act as the home for primary care research at AHRQ. This special report aims to increase awareness of AHRQ’s NCEPCR among primary care clinicians, researchers, and partners. 

Key Insights: NCEPCR aims to strengthen the nation’s primary care system by sponsoring research to generate the evidence, tools, and other resources that can be used by researchers, clinical teams, health care organizations, and other stakeholders in their efforts to improve the quality and safety of care. An early accomplishment was developing a new NCEPCR website which features more than 60 curated tools, resources and data sets.  The center’s framework comprises six activities: coordinating primary care research, curating and synthesizing findings across the Department of Health and Human Services, communicating key results, cultivating a robust research workforce, convening stakeholders, and catalyzing innovative primary care studies.

Why It Matters: By connecting previously scattered programs under one roof and securing dedicated funding, NCEPCR can more effectively coordinate research efforts, curate and disseminate essential tools, and cultivate researchers to tackle critical challenges such as workforce shortages, rising costs and health access issues. 

AHRQ’s National Center for Excellence in Primary Care Research (NCEPCR): A New Home for Primary Care Research

Aimee R. Eden, PhD, MPH, et al

Agency for Healthcare Research and Quality, Rockville, Maryland

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Innovations in Primary Care

Little Free Library Use May Improve Rural Mental Health Access

Mental‑health disorders and suicide rates have risen steadily over the past 20 years, with rural areas seeing the sharpest increases. To broaden access to mental‑health resources for adults, physicians placed a little free library containing 10–15 books on anxiety, depression, post‑traumatic stress disorder, and related conditions near the entrance of a rural primary care clinic in Minnesota. A flyer with a QR code directs visitors to a community‑run webpage with additional resources. Patients who take a book are asked to complete a short survey capturing demographics, referral source, and the usefulness of the materials. The authors are still studying the intervention’s utility and impact. This low cost, patient-centered, community-informed innovation can be adopted by other primary care and community settings. 

Using a Little Free Library to Improve Access to Mental Health and Wellness Resources at a Primary Care Clinic

Marijo Botten, DO, and Erin Westfall, DO

Mayo Clinic Family Medicine Residency, Mankato, Minnesota 

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Essay 

Depth Over Speed Helps Build Patient Relationships 

Background: Dr. Emily Dollar describes how she mastered efficiency during residency by rushing through patient visits and administrative tasks but lost the ability to slow down. She reflects on her first job on the Navajo nation and the value of being present, patient, and mindful to build relationships with her new patients. 

Key Argument: Modern medical training emphasizes urgency and multitasking, but the act of deliberately slowing one’s pace by taking time to listen, sit face-to-face, and resist the pull of productivity metrics, yields richer patient narratives and stronger therapeutic relationships. She illustrates this through her encounter with an elderly patient whose life story, shared only when given space, provided critical context for his care. 

Why It Matters: The author challenges health systems and colleagues to value depth over speed and to build structures that honor the human side of medicine.

The Difficulty, and Power, of Slowing Down

Emily Dollar, MD 

Northern Navajo Medical Center, Shiprock, New Mexico

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Essay 

Considering Ethnicity and Genetic Ancestry Can Improve Patient Safety   

Background: Jaewon Yoon recounts how her Korean-American father suffered a severe drug reaction after starting allopurinol, a risk heightened by the HLA-B*5801 allele common in Koreans, information routinely used in South Korea but often overlooked in U.S. practice.

Key Argument: Yoon argues that although race is a social construct, self-identified ethnicity and genetic ancestry can signal real safety risks or treatment responses. Disentangling these from crude racial categories allows clinicians to target tests, such as HLA genotyping, to prevent harm.

Why It Matters: Ignoring ethnic and ancestral factors endangers patients and deepens health inequities. Respectful, standardized collection of ethnicity and ancestry data, coupled with trainee education, sharpens diagnostic precision and honors patient diversity. 

Drug Toxicity and My Dad’s Ethnicity

Jaewon Yoon 

Harvard Medical School, Boston, Massachusetts 

David A. Hirsh, MD

Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts 

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Essay 

Art Observation Teaches Self-Discovery and Patient Care to Medical Students 

Background: The author recalls visiting a museum to relax and reflect before returning to the community hospital and trauma center where she worked as a chaplain and had just witnessed three deaths. Viewing the paintings helped her process the loss and pain she’d experienced and shift from distress to calm. She later became a docent at the Philadelphia Museum of Art and developed Training the Physician’s Eye: Enhancing Clinical Skills Through Art Observation to teach medical students observational skills, emotional intelligence, and empathy.

Key Argument: The author argues that the habits trained by art observation translate directly into better clinical practice. By learning to describe what they truly see and feel in a painting, students build the same attentiveness, respect for difference, and communication skills essential to their future roles as physicians.

Why It Matters: Facilitated museum visits like those in the essay can help integrate compassion and clinical reasoning—bringing together heart and mind to enrich patient care.

How Looking at Art Teaches Self-Discovery and Patient Care to Medical Students

Florence Gelo, DMin, NCPsyA

College of Medicine, Drexel University, Philadelphia, Pennsylvania 

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Family Medicine Updates (PRE-EMBARGO LINK)

 National Institute for Program Director Development: Providing Foundations and Connections for 30 years

Association of Family Medicine Residency Directors

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Match Day 2025: Family Medicine Sets Another Milestone 

American Academy of Family Physicians

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STFM Launches Professionalism In Family Medicine Education

Society of Teachers of Family Medicine

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Broadening Inclusion of Primary Care: Trainee Insights and Commentary on Diversity, Equity, and Inclusion 

NAPCRG

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Furthering Vision, Voice, and Leadership in Academic Family Medicine Through the Leads and BRC Fellowships 

Association of Departments of Family Medicine

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