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PubMed1986

Ophthalmology training in US family practice residencies.

Training in office ophthalmology is important in family practice residencies, especially because ophthalmology problems are common in family practice and only one quarter of medical students take structured ophthalmology clerkships in US medical schools. A joint committee of the American Academy of Family Physicians (AAFP) and the American Academy of Ophthalmology (AAO) has developed for family practice residents a core curriculum in ophthalmology listing essential cognitive knowledge and psychomotor skills. A national study on the extent and type of training currently available in US family practice residencies was performed. Based on a response rate of 82 percent, structured ophthalmology training experiences are provided on a required basis by 93 percent of the programs. Of these, 63 percent offer block rotations normally of two or four weeks' duration. Although a majority of the cognitive areas and psychomotor skills recommended by the AAFP-AAO joint committee are likely to be covered in existing family practice residencies, gaps identified in both categories call for closer attention to improving the learning experiences of residents in this field.

Curriculum↗
PubMed1977

The effect of career change from private practice to full-time family practice faculty.

This study investigated the timing and extent of the emotional impact of the career change of 33 selected family physicians who, after at least 15 years in private practice, moved into full-time teaching and/or administration in a family practice residency program. Their intrinsic feelings of being enthusiastic, energetic, optimistic, and enjoying associates were all diminished during the first six months, dropped further in the second six months, but began to recover during the second year. Similarly the physicians' perception of their effectiveness in their new work -- confident, competent, and fulfilled -- was relatively low during the first six months, but began to rise during the second six months and again during the second year. A comparison is made between the responses of those who held positions as directors and those who were non-directors. Changes reported were less marked in those who became directors than in those who did not. Possible causes of this phenomenon are explored. Methods to soften the impact of the career change are suggested.

Career Choice↗
PubMed2000

Pod people. Response of family physicians and family practice nurses to Kosovar refugees in Greenwood, NS.

OBJECTIVE: To explore roles of family physicians and family practice nurses who provided care to Kosovar refugees at Greenwood, NS. DESIGN: Qualitative study based on individual interviews with family physicians and family practice nurses. SETTING: Family practices in Halifax, NS. PARTICIPANTS: Six family practice nurses, four physician faculty members, four community-based family physicians, and two family medicine residents were interviewed. Participants were purposefully chosen from the roster of service providers. METHOD: All interviews were conducted by one of the researchers and were semistructured. Interviews lasted approximately 30 minutes and were immediately transcribed. Key words and phrases were identified and compared with subsequent interviews until saturation was achieved. MAIN FINDINGS: Data yielded four analytical categories: the clinical encounter, expectation and experience, role and team functioning, and response. Participants reported how providing care in the context of a refugee camp was both similar to and different from their daily activities in family practice, as were their working relationships with other health care professionals. CONCLUSION: Primary care for refugees during complex health emergencies is often underreported in the literature. Yet family practice physicians and nurses recounted that they had the requisite skills to provide care in such a context.

Adult↗
PubMed1990

Restructuring a family practice obstetrics curriculum.

Maintaining a high-quality curriculum for family practice residency training in obstetrics has become increasingly difficult. In 1984 the faculty of the University of Vermont Department of Family Practice needed to upgrade its obstetric curriculum in a community where family practice obstetrics was nonexistent. The key steps to a new curriculum included the recruitment of family practice faculty with experience in obstetrics, expanded communication with the Department of Obstetrics and Gynecology, the development of baseline attending privileges in family practice obstetrics, the formation of educational tracks for residents, and the promotion of chart audits. Also important were faculty role modeling, intradepartmental meetings, intensive elective rotations, and community education. This case report of program development in family practice obstetrics may serve as a model to help other residency programs.

Curriculum↗
PubMed1999

Procedural skills training. Canadian family practice residency programs.

OBJECTIVE: To survey Canadian family practice residency programs to discover which procedural skills residents are expected to learn. DESIGN: Cross-sectional eight-item questionnaire. SETTING AND PARTICIPANTS: The survey was sent to all 92 program directors and site or unit directors of family practice residency programs across Canada. MAIN OUTCOME MEASURES: Information on procedural skills lists was solicited. We sought date of creation, date of most recent revision, and who was involved in creating the list. A copy of the most recent list available was requested. RESULTS: We received 65 responses, for a 71% return rate. Surveys were received from all provinces and from all Canadian universities offering family practice residency programs. We received 24 unique lists of procedural skills: the shortest listed only 10 procedural skills; the longest, 75 skills; and the average, 36 skills. Only five procedural skills were found on more than 80% of the lists; 30 skills were listed on half or more of the lists. CONCLUSIONS: Canadian family practice residency programs have widely varying expectations of procedural skills for their residents. This survey is a first step in examining the whole issue of procedural skills training in Canadian family medicine programs.

Canada↗
PubMed1983

Factors influencing program selection among family practice residents.

Factors on which family practice residents base their judgments about ranking programs are identified. Questionnaires were mailed to 1,810 first-year family practice residents who participated in the 1981 matching program; 830 (46 percent) responded. The questionnaire items were factor analyzed, and nine factors accounting for 59.4 percent of the variance emerged. Reliability for the questionnaire was estimated to be .82 using coefficient alpha. Factor scores for the nine subscales were computed and employed as dependent variables in several multivariate analyses of variance. Significant differences for sex, age, race, and geographical region were found on various factors; these findings indicated differences in what those groups considered important when selecting a residency.

Decision Making↗
PubMed1986

A proposal for a combined family practice--internal medicine residency.

Both family practice and internal medicine currently train graduates for primary care. A single, four-year program is proposed that combines the strengths of family practice and internal medicine, incorporates community needs into the curriculum, and addresses the physician's changed role in a revolutionized health care provision system. Specific training recommendations and the societal and professional advantages of such a program are detailed.

Delivery of Health Care↗
PubMedDate not supplied

An anthropological approach to community diagnosis in family practice.

Developing a community oriented family practice requires gathering information about the community, its health problems and resources, and organizing these data into a community diagnosis. Viewing the community from both the insider and outsider perspectives allows the clinician to use social indicator data as well as subjective data from residents in the community. This paper describes the application of anthropological concepts in the process of community diagnosis within an urban teaching family practice.

Anthropology, Cultural↗
PubMed2006

Is motivation enough? Responsiveness, patient-centredness, medicalization and cost in family practice and conventional care settings in Thailand.

BACKGROUND: In Thailand, family practice was developed primarily through a small number of self-styled family practitioners, who were dedicated to this professional field without having benefited from formal training in the specific techniques of family practice. In the context of a predominantly hospital-based health care system, much depends on their personal motivation and commitment to this area of medicine. The purpose of this paper is to compare the responsiveness, degree of patient-centredness, adequacy of therapeutic decisions and the cost of care in 37 such self-styled family practices, i.e. practices run by doctors who call themselves family practitioners, but have not been formally trained, and in 37 conventional public hospital outpatient departments (OPDs), 37 private clinics and 37 private hospital OPDs. METHOD: Analysis of the characteristics of 148 taped consultations with simulated patients. RESULTS: The family practices performed better than public hospital OPDs with regard to responsiveness, patient-centredness and cost of technical investigations (M-W U: p < 0.001). Prescribing patterns were similar, but family practices prescribed fewer drugs and were less costly than private clinics and hospitals (M-W U: p < 0.001). The degree of patient-centredness was not significantly different. Private clinics and private hospitals scored better for responsiveness. CONCLUSION: In Thailand self-styled family practices, even without specific training, provide a service that is more responsive and patient-centred than conventional care, with less overmedicalization and at a lower cost. Changes in prescription practices may require deeper changes in the medical culture.

Journal Article↗
PubMedDate not supplied

Procedural training in family practice residencies: current status and impact on resident recruitment.

BACKGROUND: Although procedural training in family practice has recently received greater emphasis, the current status of this training in residency programs has not been reported. Considerable variation in procedural training among family practice residencies is allowed by the American Board of Family Practice and accreditation requirements. This study was performed to report the current status of procedural training in family practice residencies and to determine whether a correlation exists between the number of procedures taught in family practice residencies and successful resident recruitment. METHODS: A one-page questionnaire was developed to determine availability of teaching and type of instructor for 24 selected procedures. This questionnaire was mailed to all 398 family practice residency directors in the United States. Data from the survey were compared with the published residency match results in 1993 and 1994. RESULTS: Questionnaires were received from 363 programs, for a response rate of 91 percent. The current status of training in these procedures, presented by program type and geographic region, reflects considerable regional variation. Training in colposcopy and in cardiac stress testing was reported to be available in a greater percentage of programs than in previous studies. A significant positive correlation was found between the number of procedures taught by family physicians and residency match results. CONCLUSIONS: The 91 percent response rate lends credibility to this status report and indicates that family practice program directors recognize procedural training as an important issue. The trend toward greater availability of procedural training in family practice residencies is confirmed for selected procedures. Emphasis on procedural training by family physicians has a positive correlation with successful resident recruiting. The impact on medical student interest in family practice deserves further study.

Family Practice↗
PubMed2003

A cohort study of family practice residency graduates in a predominantly rural state: initial practice site selection and trajectories of practice movement.

Limited information is available on long-term patterns of practice location choice among family physicians, although these patterns will significantly affect the quantity, quality, and continuity of health care provided in rural areas. From 1992 through 2000, five biennial surveys were administered to graduates of three family practice residency programs. Graduates were asked the location of their current and previous practice site locations, specific practice information, and global satisfaction with family practice. Identifiable practice sites were assigned a U.S. Department of Agriculture rural-urban continuum code based on the county in which the practice was located. The use of rural-urban continuum codes as a measure of rurality was believed to be particularly applicable to the small rural and frontier counties typical of the Great Plains region. For purposes of this study, practice locations were considered rural if they were in rural-urban continuum codes 7, 8, or 9. Of 593 graduates, 514 (87%) returned at least one questionnaire. Overall, about one-third of graduates had chosen their first practice sites in counties with rural-urban continuum codes of 7, 8, or 9. While most graduates remained in their initial practice site, almost half moved at least once. Those who left nonmetropolitan practices tended to move to less rural locations, though a few moved against this gradient. Moves away from the initial practice site occurred after a median of 3 years, and the likelihood of a first move decreased rapidly 5 to 6 years after graduation. Much remains to be learned about decisions to enter or leave practice in rural-urban continuum code 7, 8, and 9 counties.

Career Mobility↗
PubMed1992

Financial analysis of a family practice residency threatened with closure.

Family practice residency programs often find themselves needing to fiscally justify their existence to their sponsoring institutions. One such program in a community hospital was threatened with closure, to be replaced by salaried and/or fee-for-service physicians. We present an applied research methodology for comparing the residency budget and revenues with that of a replacement delivery system with no educational mission. The total expenses for nonresidency physicians were projected to be from 10.5% to 25.1% less than the residency budget. Revenues generated by nonresidency physicians were projected to be from 29.4% to 37.6% less than those of the residency, primarily due to the loss of grants and graduate medical education reimbursement through the Medicare program. Proposed reductions in grants and graduate medical education reimbursement threaten the budget/revenue balance of this and other family practice residency programs.

Budgets↗
PubMed1985

Six-year experience with graded exercise testing in a model family practice office.

The Office for Family Practice began in-office graded exercise testing utilizing the Bruce or Balke protocol in March of 1978. Over the past six years approximately 275 graded exercise tests have been done. The purpose of this paper is to outline the indications, results, complications, and follow-up of those patients who have had graded exercise testing done in the office over this six-year period. These results demonstrate (1) the various indications and utilization of a treadmill machine in the family practice office setting, (2) the results of graded exercise testing and complications in those graded exercise tests done in the office in comparison with those reported in the literature done by other health care providers, and (3) the usefulness and applicability of graded exercise testing in the residency training and private practice setting. In addition to the above-collected data, the results of a questionnaire sent to former residents show the benefits of having training in graded exercise testing and also the applicability of this training in their practice settings. The results support the concept that graded exercise testing should be taught in the residency program and that this can be done both safely and effectively in the model office setting.

Adult↗
PubMed1991

The value of a new family practice center patient to the academic medical center.

BACKGROUND: Family practice centers are important contributors to the financial viability of academic health centers, although they often are not the direct beneficiaries of their own labor. The greater time commitment and lower costs of most primary care creates significant financial hardships for departments of family medicine in university centers. This study describes the use of inpatient and outpatient health care services by new patients at a university family practice center. METHODS: A sample of 215 new adult enrollees at a university family practice center were examined for a 1-year period after their initial visit to the center. Total billings by the university hospital, specialty services, and the family practice center were tabulated by insurance type. RESULTS: Medicare patients generated the highest average charges (+2501 per patient per year); self-indemnity patients generated the lowest average charges (+301 per patient per year). The largest portion of health services charges was generated by the university hospital inpatient service, which was responsible for approximately 60 cents of every dollar billed to patients in this study. Conversely, the Family Medicine Department billings generated only 17% of the total charges. CONCLUSIONS: The findings of this study indicate that university-based family practice centers are significant contributors to the financial and educational base of the academic health center. If family medicine and associated primary care centers are forced to reduce their size or services because of financial difficulties, the impact will be felt by the university hospitals and by other specialty departments.

Academic Medical Centers↗
PubMed2000

Confidence of graduating family practice residents in their management of musculoskeletal conditions.

A study was undertaken to determine the confidence of graduating family practice residents in the management of musculoskeletal conditions and to determine the level of exposure of graduating family practice residents to fracture care. A 2-page questionnaire consisting of 50 items was sent to 680 graduating family practice residents at 100 randomly selected residency training programs throughout the United States. Family practice residents were questioned about their fracture care experience, including the number of fractures diagnosed, the number of fractures reduced, the number of fractures treated to healing, and the number of casts and splints applied. Residents were also asked about their training experience on an orthopedic surgery service. Residents were asked to rate their confidence on a scale of 1 (least confident) to 10 (most confident) in the physical examination, radiographic evaluation, diagnosis, and treatment of a variety of musculoskeletal conditions, including physical examination of the knee, lower back, ankle, wrist, cervical spine, shoulder, hand, and foot; radiographic evaluation of the lumbosacral spine, traumatic cervical spine, hand injuries, adult shoulder trauma, osteomyelitis, and pediatric elbow injuries; diagnosis of carpal tunnel syndrome, herniated lumbar disc, knee instability, rotator cuff tear, and shoulder instability; and treatment of ankle sprain, tennis elbow, olecranon bursitis, distal radius fracture (Colles), bimalleolar ankle fracture, hip avascular necrosis, knee dislocation, and pediatric elbow fracture. These results were compared with graduating family practice residents' confidence in the physical examination, radiographic evaluation, diagnosis, and treatment of a variety of nonmusculoskeletal conditions. Completed questionnaires were returned by 351 graduating family practice residents. The overall fracture care experience of graduating family practice residents was minimal. Seventy-nine percent of graduating residents had reduced 5 or fewer fractures during their entire residency training program. Experience with cast and splint application was also relatively limited. Graduating family practice residents reported an average of 5.1 weeks (range, 0-10 wk) of training experience on an orthopedic surgery service during their residency. Graduating family practice residents were significantly more confident in the physical examination, radiographic evaluation, diagnosis, and treatment of nonmusculoskeletal conditions than in those of musculoskeletal conditions (P = .0001). Family practice residents who had rotated on an orthopedic service for 8 weeks or more during their training reported significantly higher confidence for all 4 skills-physical examination (P = .003), radiographic evaluation (P = .003), diagnosis (P = .007), and treatment (P = .009). In conclusion, family practice residents show relatively low confidence in the management of musculoskeletal conditions and receive minimal exposure to all aspects of fracture care. Confidence can be improved with greater exposure to the musculoskeletal sciences--such as a rotation of 8 weeks or more on an orthopedic surgery service.

Adult↗
PubMed2002

Factors affecting the match rate of rural training tracks in family practice.

BACKGROUND AND OBJECTIVES: Rural training track (RTT) family practice residencies are designed to prepare family physicians for rural practice. Residents in these programs spend 1 year in an urban location, followed by 2 years in a rural setting. Anecdotally, one hears that some programs have problems filling their available positions for residents. No published studies have systematically evaluated this fill rate. This study determined the match rate of rural track family practice residencies and examined factors associated with higher rates. METHODS: Questionnaires were mailed to program directors of all 28 rural track residencies identified in 1998 by the Residency Review Committee for Family Practice. Five programs proved ineligible, and 22 of the 23 eligible programs responded (96%). Directors provided information on fill rates and program characteristics from 1996 through 1998. Programs' reported fill rates were compared to rates previously reported for family practice residencies as a whole. Descriptive statistics were used to compare rural track programs that did and did not fill through and after the National Resident Matching Program (NRMP) (the "Match "). We also report data recently updated to reassess the situation for the 2001 Match. RESULTS: Rural track residency programs offered 52 first-year positions in 1998. All positions were offered through the NRMP. From 1996 through 1998, programs had a mean Match rate of 61%, compared with a rate of 86% reported previously for all family practice residencies. RTT programs in more-desirable communities (as determined by location near a listing in Fortune Magazine's "Best Places to Live") and those in the western and northeastern United States filled more positions than programs in less-desirable locations and in the southern and central United States. There were no other differences in the characteristics of programs or their faculty between programs that filled their positions and those that did not. These same trends held true for the 2001 Match. CONCLUSIONS: In recent years, rural track residencies were less likely to match their first-year positions than other family practice residencies. Geographic and community characteristics seemed to influence the Match rate, whereas characteristics of programs and their faculty did not.

Education, Medical, Continuing↗
PubMed1981

Hospital privileges for graduates of family practice residency programs.

In 1979 the American Academy of Family Physicians, as the first phase of a long-range study of family practice residency outcomes, surveyed graduates for the years 1970 through 1978 who were diplomates of the American Board of Family Practice. This report is limited to an overview analysis of the hospital admission and practice privileges of the 3,021 respondents actively practicing family medicine in the United States. A higher percentage of respondents in census regions west of the Mississippi River were more likely to have privileges in obstetrics and surgery than were respondents in eastern regions. Respondents in nonmetropolitan areas were more likely to have hospital privileges than were respondents in metropolitan areas.

Family Practice↗