Jeffrey Borkan

• MD, PhD
• Chair at Brown University

Wars and conflicts appear to be a fact of life for populations across the globe, often in places where family medicine functions as the backbone of the health care system. In these situations, family physicians are frequently called on to serve in expanded roles and are witnesses to the enormous mental and physical suffering of individuals, familie...

Background: Hospital closures have become commonplace in the United States but remain controversial. Memorial Hospital of Rhode Island was a 294-bed hospital in a disadvantaged community that closed in 2018 amid falling patient volume and rising costs. Methods: Immersion/crystallization method of qualitative analysis was employed in reviewing se...

Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine, as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In ‘I: framing family medicine—history, values, and perspectives’, t...

Background: Primary care in Rhode Island is in crisis. The dearth of primary care providers is already affecting access to services and the situation is likely to worsen unless major steps are taken. There are inadequate numbers of trainees in primary care medical residencies, nurse practitioner (NP) and physician assistant (PA) training programs...

Objectives Low back pain (LBP) is the number one cause of disability world-wide. It is also the most expensive area in healthcare. Patient-centered innovations are needed. This paper uses medical storytelling to illustrate the common problems that often lead to unnecessary suffering for patients, and costs to society. We present innovative solution...

The Medicare Annual Wellness Visit (AWV) involves a personalized risk assessment and prevention plan to help prevent disease and disability among older adults. Though studies have shown that AWV uptake is suboptimal, little is known about the perspectives and experiences of patients completing it. Family medicine physicians are conducting AWVs at a...

Qualitative Research analytic tool

The foundations of medical education have drawn from the Flexner Report to prepare students for practice for over a century. These recommendations relied, however, upon a limited set of competencies and a relatively narrow view of the physician’s role. There have been increasing calls and recommendations to expand those competencies and the profess...

While the PCMH is the primary care model of choice for many healthcare systems, it is a relatively new area for college communities. The college health setting provides an important and challenging primary care platform because of developmental milestones that young adults face at this time of their lives. The Brown Primary Care Transformation Init...

Background: Integrated care is the coordination of general and behavioral health and is a highly promising and practical approach to improving healthcare delivery and patient outcomes. While there is growing interest and investment in integrated care implementation internationally, there are no formal guidelines for integrated care implementation a...

Background: Integrating behavioral and primary care practices improves quality of care, but limited data exists regarding the extent or attributes of such integration. We conducted a baseline evaluation of the level and characteristics of integrated practices in Rhode Island. Methods: The Rhode Island Department of Health 2015 Statewide Health I...

Objectives Patient-centered medical home transformation initiatives for enhancing team-based, patient-centered primary care are widespread in the United States. However, there remain large gaps in our understanding of these efforts. This article reports findings from a contextual, whole system evaluation study of a transformation intervention at ei...

Brown_provider_and_staff_interview_questions.pdf – Supplemental material for What matters in patient-centered medical home transformation: Whole system evaluation outcomes of the Brown Primary Care Transformation Initiative

Brown_Adult_patient_interview_questions – Supplemental material for What matters in patient-centered medical home transformation: Whole system evaluation outcomes of the Brown Primary Care Transformation Initiative

Brown_Process_evaluation_focus_group_questions – Supplemental material for What matters in patient-centered medical home transformation: Whole system evaluation outcomes of the Brown Primary Care Transformation Initiative

Background and objectives: The Warren Alpert Medical School of Brown University (AMS) recently implemented a novel dual degree MD-ScM program in primary care and population medicine (PC-PM) that enrolls up to 24 of its nearly 144 yearly matriculants. The overarching goal of this track is to train medical students to become physician leaders who fo...

In this Commentary, the authors make the case for medical schools to pursue more circumscribed solutions to curricular redesign for undergraduate medical education (UME) rather than whole system changes-at least as first steps and perhaps as ultimate solutions. While they focus primarily on the experience at the Warren Alpert Medical School of Brow...

Purpose: The authors performed a review of 30 Accelerating Change in Medical Education full grant submissions and an analysis of the health systems science (HSS)-related curricula at the 11 grant recipient schools to develop a potential comprehensive HSS curricular framework with domains and subcategories. Method: In phase 1, to identify domains,...

Educators, policy makers, and health systems leaders are calling for significant reform of undergraduate medical education (UME) and graduate medical education (GME) programs to meet the evolving needs of the health care system. Nationally, several schools have initiated innovative curricula in both classroom and workplace learning experiences to p...

Brown Family Medicine, funded by a five-year HRSA grant, facilitated PCMH transformation at primary care teaching practices in Rhode Island. Objective: To measure the transformation of primary care teaching practices in accordance with the PCMH model. Design: Mixed-method case series approach. Transformation facilitation was tailored to practices’...

Background and objectives: Between August 2013 and April 2014, eight family medicine organizations convened to develop a strategic plan and communication strategy for how our discipline might partner with patients and communities to build a new foundation for American health care. An outline of this initiative, Family Medicine for America's Health...

Background and objectives: Collaborating with patients, families, and communities is a core principle of family medicine. However, the health care system in the United States has grown increasingly complex, fragmented, and difficult to navigate. This system, focused on disease-specific care delivered by specialists, often treats patients as the ob...

Additional knowledge, attitudes and skills are required for the next generation of medical students as they expand the traditional focus on individual patients to include population-based health and scholarly investigation. The Warren Alpert Medical School of Brown University (AMS) is initiating a master's degree program as a key component of the n...

The United States healthcare system has been in a period of rapid evolution over the past decade, a trend that is anticipated to continue for the foreseeable future. Physicians are increasingly responsible for the quality of care they provide, and are being held accountable not just for the patient in front of them, but also for the outcomes of the...

There is a strong push in the United States to evaluate whether the patient-centered medical home (PCMH) model produces desired results. The explanatory and contextually based questions of how and why PCMH succeeds in different practice settings are often neglected. We report the development of a comprehensive, mixed qualitative-quantitative evalua...

The role of the medical assistant has been undervalued in the past. Many publications have detailed the integral role of the nursing staff and physicians, but the medical assistant role has come last in formal recognition. As healthcare settings move toward a more Patient-Centered Medical Home (PCMH) model, the attitudes of this model will need to...

Purpose: More than a decade ago the American Academy of Family Physicians, American Academy of Family Physicians Foundation, American Board of Family Medicine, Association of Departments of Family Medicine, Association of Family Practice Residency Directors, North American Primary Care Research Group, and Society of Teachers of Family Medicine cam...

Unlabelled: Use of chronic opioid therapy (COT) for chronic noncancer pain has dramatically increased in the United States. Patients seek compassionate care and relief while physicians struggle to manage patients' pain effectively without doing harm. This study explores the narratives of chronic noncancer pain patients receiving chronic opioid the...

As the US health care delivery system undergoes rapid transformation, there is an urgent need to define a comprehensive, evidence-based role for the family physician. A Role Definition Group made up of members of seven family medicine organizations developed a statement defining the family physician's role in meeting the needs of individuals, the h...

When assessing patients, clinicians use typologies developed through their own particular clinical experience. Our aim was to develop a typology, based on the patient's perspective and not specific to one illness, with the potential to enhance person-centred clinical follow-up of those living with chronic illness. We applied the qualitative compara...

The extension of universal health service insurance to national populations is a relatively new phenomenon. The Israeli National Health Insurance Law (NHIL) from 1995 provided universal health services to every resident, but the effect of this law on health and health services among minorities has not been sufficiently examined. The goals of this s...

Shaping messages to promote the interests of family medicine has a well-honored place in academic family medicine. Although serving a variety of purposes, the central goal of our messaging is to promote improvement in the health of the discipline and of our patients. Whether in catch phrases like “the future of family medicine,” or with key words a...

Study design: Survey report. Objective: To reassess an existing list of research priorities in primary care low back pain (LBP) and to develop a new research agenda. Summary of background data: Primary care LBP researchers developed an agenda of research priorities in 1997 at an international conference. In 2009, a survey was conducted to re-e...

Purpose: We compared physicians' self-reported attitudes and behaviours regarding electronic health record (EHR) use before and after installation of computers in patient examination rooms and transition to full implementation of an EHR in a family medicine training practice to identify anticipated and observed effects these changes would have on...

Abstract Complementary alternative health care presents fascinating challenges and opportunities for health policy and research - from issues of definition to training and licensing, to insurance reimbursement and evidence regarding clinical efficacy and outcomes. Complementary alternative health care is utilized by a substantial proportion of the...

Reflective writing (RW) curriculum initiatives to promote reflective capacity are proliferating within medical education. The authors developed a new evaluative tool that can be effectively applied to assess students' reflective levels and assist with the process of providing individualized written feedback to guide reflective capacity promotion. F...

PURPOSE We wanted to determine whether an intervention based on patient activation and a physician decision support tool was more effective than usual care for improving adherence to National Cholesterol Education Program guidelines. METHODS A 1-year cluster randomized controlled trial was performed using 30 primary care practices (4,105 patients)...

Synthesis and analysis of presentation and discussion highlights, with a focus on emerging trends and promising new directions in primary care research on low back pain (LBP). To present a summary of findings, themes, and insights from the Tenth International Forum on Primary Care Research on Low Back Pain, a meeting of researchers designed to shar...

To explore colorectal cancer risk perceptions among Latinos. Focus groups discussions among Spanish-speaking Latinos conducted between February and July 2007 with 37 men and women who were age-eligible for colorectal cancer screening. Predominant themes of perceived colorectal cancer risk included: general cancer risks, risks related to nutrition a...

current treatments for chronic low back pain (LBP) appear to be inadequate and there are growing calls for new approaches. This study explores the paired interviews of shared experiences among chronic LBP patients and their physicians with the ultimate goal of improving doctor-patient communication and clinical outcomes. in-depth interviews of a pu...

We aim to answer the question: How can we develop an evidence base that will assist tailoring health interventions to individual patients? Using social theory and interview data from people living with chronic illness, we developed a new approach to analysis. Individuals were considered as emergent complex systems, adjusting and adapting within the...

The study aim was the development of a method to further enhance the educational benefit of medical students' reflective writing. The setting is a Doctoring course at the Warren Alpert Medical School of Brown University, which includes reflective writing assignments, termed "field notes", combining students' reflective writing with ongoing individu...

From 1978 on, Spain rapidly expanded and strengthened its primary health care system, offering a lesson in how to improve health outcomes in a cost-effective manner. The nation moved to a tax-based system of universal access for the entire population and, at the local level, instituted primary care teams coordinating prevention, health promotion, t...

Although there is significant interest in implementation of electronic health records (EHRs), limited data have been published in the United States about how physicians, staff, and patients adapt to this implementation process. The purpose of this research was to examine the effects of EHR implementation, especially regarding physician-patient comm...

The fostering of reflective capacity within medical education helps develop critical thinking and clinical reasoning skills and enhances professionalism. Use of reflective narratives to augment reflective practice instruction is well documented. At Warren Alpert Medical School of Brown University (Alpert Med), a narrative medicine curriculum innova...

Many medical curricula now include programs that provide students with opportunities for scholarship beyond that provided by their traditional, core curricula. These scholarly concentration (SC) programs vary greatly in focus and structure, but they share the goal of producing physicians with improved analytic, creative, and critical-thinking skill...

An increasing number of medical schools have implemented or are considering implementing scholarly activity programs as part of their undergraduate medical curricula. The goal of these programs is to foster students' analytical skills, enhance their self-directed learning and their oral and written communication skills, and ultimately to train bett...

The purpose of this study was to evaluate differences in the management of cardiovascular disease (CVD) risk factors based upon the sex of the patient and physician and their interaction in primary care practice. We evaluated CVD risk factor management in 4,195 patients cared for by 39 male and 16 female primary care physicians in 30 practices in s...

The recent government decision to establish a new medical school, the fifth in Israel, is an opportune moment to reflect on the state of Basic Medical Education (BME) in the country and globally. It provides a rare opportunity for planning an educational agenda tailored to local needs. This article moves from a description of the context of Israeli...

Medical consultations are replete with conflicts, particularly in the current era of explicit and implicit rationing practices in health care organizations. Although such conflicts may challenge the doctor-patient relationship, little is known about them or their consequences. To systematically describe the nature of doctor-patient conflicts in med...

The proposed clinical curriculum in Years 3 and 4 provides the opportunity to complete the process begun with the reform of the pre-clerkship curriculum in 2007. The redesign should produce an educational process which not only more adequately prepares students for the future, but helps produce leaders in multiple fields of medicine and re-establis...

The promotion of reflective capacity within the teaching of clinical skills and professionalism is posited as fostering the development of competent health practitioners. An innovative approach combines structured reflective writing by medical students and individualized faculty feedback to those students to augment instruction on reflective practi...

The Association of Departments of Family Medicine (ADFM) is evolving. ADFM’s next phase is represented by our new logo with a tagline that captures our primary purpose: “Vision, Voice, Leadership.” This symbol of the organization is our way of saying that ADFM is increasing its engagement with the issues facing family medicine, academia, and health...

Review of oral and poster presentations and of workshop summaries from the Ninth International Forum for Primary Care Research on Low Back Pain held in Majorca, Spain, October 4-6, 2007. Summarize highlights of the conference. The International Forum for Primary Care Research on Low Back Pain has become the primary conference for presenting researc...

This article presents a framework for quality care that attends to culture and ethnicity. Tools and approaches for achieving cultural competency and humility are provided that may help improve the care of the patients, irrespective of their backgrounds or beliefs.

While e-health tools have been designed for patient/consumer empowerment and for decision support focusing on healthcare providers, they have had only modest success in primary care settings. Creating complementary e-health tools that provide patient activation and decision support for a common clinical problem such as hyperlipidemia using a behavi...

Objectives To measure knowledge of Israeli low back pain (LBP) clinical practice guidelines among different subgroups of primary care doctors, prior to designing an intervention programme to enhance guideline adherence in practice. Study design Confidential mailed survey questionnaire. Setting Family practices in the Haifa and western Galilee distr...

Despite the impact of high-visibility evidence-based clinical practice guidelines, physician adherence to guidelines remains low. This study explored primary care physicians' perceptions of barriers and facilitators in following the National Cholesterol Education Program guidelines. The authors conducted 9 focus groups and performed qualitative con...

The establishment of the Scholarly Concentrations Program represents an important aspect of overall curriculum reform, and of the institution's commitment to the education of medical students. This initiative has great potential to create knowledge and develop future leaders, and we look forward to its growth and evolution. We anticipate that the S...

Secrets and issues of confidentiality are critical concerns in doctor-patient communication and fundamental aspects of every medical encounter. Nevertheless, the nature, content, prevalence, impact, and consequences of secrets in medicine have largely been unexplored. This study investigates the role of secrets in primary care. It describes the int...

Current low back pain (LBP) clinical guidelines have helped to summarize the scientific evidence and research, but have failed to provide tools and guide family physicians (FPs). The purpose of this study is to identify barriers and facilitators for the implementation of LBP guidelines from family FPs' perspective. A qualitative focus group study o...

To describe a new tool designed to capture patients' perception of their low back pain (LBP) episodes-the patient perception scale (PPS) and test its ability to predict episode outcomes. Thirty-two family physicians recruited 526 low back pain patients during an office visit. Physicians completed a short questionnaire at the index visit, which incl...

Aggregation (i.e., meta-ethnography or meta-synthesis) of qualitative studies remains relatively rare and controversial. We have attempted this procedure within an investigation of patient priorities and evaluations of primary care in order to triangulate an instrument development process as well as explore associated dilemmas. The procedures inclu...

Multimethodenonderzoek (mixed methods research) verwijst naar onderzoeken of vraagstellingen waarbij een of meer kwalitatieve en kwantitatieve technieken voor gegevensverzameling en -analyse worden geïntegreerd.

Despite some recent improvement in knowledge about cholesterol in the United States, patient adherence to cholesterol treatment recommendations remains suboptimal. We undertook a qualitative study that explored patients' perceptions of cholesterol and cardiovascular disease (CVD) risk and their reactions to 3 strategies for communicating CVD risk....