BACKGROUND: Malpractice issues within the United States remain a critical factor for family physicians providing obstetric care. Although tort reform is being widely discussed, little has been written regarding the malpractice crisis from a risk management perspective. METHODS: Between 1989 and 1998, a 10-year risk management study at the UC Davis Health System provided a unique collaboration between researchers, a mutual insurance carrier and family physicians practicing obstetrics. Physicians were asked to comply with standardized clinical guidelines, attend continuing medical education (CME) seminars, and submit obstetric medical records for review. Feedback analysis was provided to each physician on their records, and the insurance carrier tracked interim malpractice claims. RESULTS: One hundred and ninety-four physicians participated, attending to 32,831 births. Compliance with project guidelines was 91%. Five closed obstetric cases were reported with only one settlement reported to the National Provider Data Bank. Physicians believed the project was beneficial to their practices. CONCLUSIONS: Family physicians practicing obstetrics are willing to participate in a collaborative risk management program and are compliant with standardized clinical guidelines. The monetary award for successful malpractice claims was relatively low. This collaborative risk management model may offer a potential solution to the current malpractice crisis.

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PubMedDate not supplied

An international physician education program to support the recent introduction of family medicine in Egypt.

BACKGROUND AND OBJECTIVES: There are few reports of systematic international physician development programs to create family medicine as a new specialty in a developing nation. This paper describes the process and outcomes of a large-scale effort to initiate new family medicine training through the Egyptian Ministry of Health and Population (MOHP) using a 12-week US-based program at the University of California, Irvine (UCI). METHODS: Generalist physicians (n=134) with 1 year of internship training, currently working under the MOHP in Egypt, were competitively selected to participate in a training program at UCI between 1998 and 2002. Participants were assessed before, during, and after the program using multiple measures of competencies in family medicine topics, practice, and teaching. Aggregate participant data, post-program quality surveys, and follow-up surveys of the program's influence on practice behaviors comprised the main measures used for program evaluation. RESULTS: Participants showed improvement in knowledge and skills for family medicine practice and teaching for topics covered in the program. After returning to Egypt, 98% reported continued use of their newly acquired skills and knowledge. Participants reported that the program advanced their careers, they taught family medicine to other physicians, and they were likely to pursue certification under a newly established Family Medicine Board of Egypt. Self-reported practice in family medicine increased to 69% after the program versus 16% before. CONCLUSIONS: Overseas training programs are a viable method of introducing family medicine as a new clinical specialty. Ingredients for successful implementation and barriers are discussed.

Clinical Competence↗

PubMedDate not supplied

The end of the beginning: the redesign imperative in family medicine.

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Delivery of Health Care↗