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PubMed2004

Evaluating the Texas Statewide Family Practice Preceptorship Program, 1992-2000.

PURPOSE: Since 1979, the Texas Statewide Family Practice Preceptorship Program (TSFPPP) has conducted ambulatory preceptorships to increase the number of medical students selecting family practice residencies. The authors describe the evaluation of the TSFPPP's efficacy in terms of four evaluation questions and outcome measures identified by program users from eight Texas medical schools. METHOD: The authors compared the proportion of 10,081 Texas medical school students graduating from 1992-2000 who chose family practice or other primary care residencies following participation or nonparticipation in the TSFPPP's preclinical and clinical programs. RESULTS: The proportion of students choosing family practice residencies among TSFPPP participants was significantly greater than among nonparticipants. Participation in the TSFPPP was associated with an increased choice of a family practice residency for students who were involved in the TSFPPP at the preclinical level (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.41-1.87); the clinical level (OR, 2.31; 95% CI, 1.99-2.68); and both levels (OR, 4.98; 95% CI, 3.75-6.68) compared to non-TSFPPP participation. There was a 44% increase in preceptors willing to teach medical students. CONCLUSIONS: Participation in the TSFPPP is associated with a greater likelihood of students selecting a family practice residency. The interinstitutional approach to analyzing effects of the preceptorship on students' specialty choices focuses attention on primary care issues that, in the long run, may affect an entire state's health care delivery system.

Adult↗
PubMed1989

Graded exercise stress test training in family practice and internal medicine residencies.

A mail survey of upper Midwest family practice and internal medicine residency program directors was performed to determine the prevalence and characteristics of exercise stress test training. Two mailings provided a 68% response rate for the 184 programs surveyed. Internal medicine programs were significantly more likely to offer exercise stress test training than family practice programs (57% vs 34%). Overall, an estimated 31% of family practice and internal medicine residency graduates are performing exercise stress tests in their practice. Programs provided an average of 7.3 hours of didactic instruction and 32.7 stress tests per resident. A minority (43%) had an established minimum number of exercise stress tests recommended for competency. Programs with and without exercise stress test training did not differ significantly with respect to age, size of program, or size of community. There were some interstate differences in the extent of exercise stress test training provided by family practice residency programs. Internal medicine programs were more likely to require a minimum number of treadmill tests. Otherwise there were few differences between family practice and internal medicine program instruction in exercise stress test training. Family practice program directors were more likely to believe that their residents should be taught this procedure and to include family physicians in their panel of instructors. Specific guidelines should be created to assure adequate stress test training for interested residents.

Exercise Test↗
PubMed1981

A process group approach to stress reduction and personal growth in a family practice residency program.

A family practice residency experience presents both stress and the opportunity for personal growth. One approach to focusing on these issues is a process oriented group. This paper describes the evolution of such a group. Content areas that emerged in the group are discussed in terms of the variety of stresses experienced by residents, especially those engendered by changing and conflicting role expectations. Changes in group process over time are described. Outcome is discussed in terms of individual stress reduction, personal growth, improved interpersonal relationships, increased ability to comfortably interact with patients, and knowledge gained about dynamics relevant to the treatment of families as groups.

Family Practice↗
PubMed1996

Curriculum goals for the training of osteopathic family practice residents for the year 2000.

The osteopathic family practitioner of the future will play a larger role in the delivery of healthcare under managed care. To prepare for this role, osteopathic family practice residents must develop skills in direct medical care, medical education, and healthcare administration. Likewise, these residents need to become familiar with the clinical setting in which these skills are needed, specifically, ambulatory, rural, hospital, and minor emergency care environments. We propose the development of a curriculum designed to promote these skills and clinical experiences. This curriculum would expand family practice experiences; replace the current required rotations in specialty medicine with longitudinal rotations designed to develop specific family practice skills; include block rotations in hospital care, minor emergency care, and rural medicine; develop model case assignments to teach residents to integrate their roles as provider, educator, and administrator; and entail clinical experiences in medical administration and education. An evaluation process that reflects the goals of the family practice curriculum is key to the success of such a program.

Clinical Competence↗
PubMed2000

Attendance to cervical cancer screening in family practices in The Netherlands.

BACKGROUND: The effectiveness of three different organizational approaches to cervical cancer screening (community based, family practice based, and a combination) was evaluated in nationally representative family practices. METHOD: We selected 122 family practices with a computerized sex-age register from a database of 1, 251 family practices, representative of all 4,758 family practices in The Netherlands. Approximately 40 practices were linked with each approach. We measured the attendance, the reasons for nonattendance, and the influence of a reminder on the attendance of women invited for cervical screening in September, October, and November 1996. The patients were grouped according to age. A cross-sectional design was used for the study. RESULTS: For younger women, the total attendance rate, coverage (percentage of women "protected" against cervical cancer), and control rate (percentage of women with medical reasons for nonattendance or postponement of the smear) were highest in practices using the family practice-based approach (68, 77, and 90%, respectively) and lowest in practices with the community-based approach (53, 62, and 68%, respectively). For older women, the family practice-based approach and the combination approach were associated with attendance rates significantly higher than those for the community-based approach (approximately 60, 80, and 80% vs 47, 67, and 70%, respectively). A reminder sent by the family physician to women not responding to an initial invitation increased the attendance rate by 7 to 11% in both age categories, depending on who had sent the first invitation. CONCLUSION: A family practice-based cervical screening approach appeared to be the most effective at a national level, achieving the highest attendance rate, coverage, and control rate.

Adult↗
PubMed1989

Cost-benefit analyses of California family practice residencies.

Several national commissions have recommended that family practice residency training be subsidized, but without stating how much support is needed. Financial studies of graduate medical education have used the methods of cost allocation or joint-products cost analysis. Previous cost-allocation studies indicate that one third of family practice residency costs are met by extramural subsidy. Cost reports of eight California public hospitals with a single family practice residency program were evaluated for the 1984-85 fiscal year. Discrepancies in the education costs reported to Medicare and those reported in state hospital disclosure reports demonstrate the arbitrary nature of the cost-allocation method. The Medicare medical education reimbursement was an average of $20,444 per resident. State and federal grants provided an average of $5,190 per resident. The Medicare payments and grants met an average of 35.7% of the education costs reported to Medicare. A joint-products cost analysis was used to estimate the pure cost of education in an 18-resident family practice residency. Replacing the residency with salaried physicians would have decreased the hospital's net return by $143,534. If neither grants nor Medicare education payments had been received, elimination of the program would have increased hospital net return by $428,083.

California↗
PubMed1977

Choosing dermatologic instruction for students in family practice.

Sixty-three family practitioners responded to a special questionnaire designed to determine their judgment of what is most important to teach medical students and those residents headed toward careers in family practice. The ranking of emphases and specific diseases should be helpful to dermatologists responsible for the instruction.

Curriculum↗
PubMed1982

Prevalence and characteristics of frequent attenders in a prepaid Canadian family practice.

Frequent attenders in family practice represent a small proportion of the total population, yet they consume a large amount of services. A description of their characteristics and problems is needed in order to design a therapeutic intervention tailored to meet these needs. A comparative analytic survey of 9,313 patients was done in order to isolate three cohorts: 200 zero users in the previous year, 200 modal (one to two times per year) users, and 200 frequent users (nine or more times per year). It was found that frequent attenders (who represented 4.5 percent of the practice, yet generated 21 percent of the annual visits) differ from infrequent attenders in that they have twice the probability of being single; are more physically, socially, emotionally distressed; suffer from problems of self-esteem; show a slightly greater degree of family dysfunction; tend to be unemployed, retired, or mothers of infants; are externally controlled or tend to rely on others for help; receive low incomes, retirement pensions, or family benefits; tend to be high users of other physician, social work, nursing, and laboratory services; consume a significantly greater number of pills than their infrequent user counterparts; and tend to present more emotional and gastrointestinal complaints than their modal user counterparts.

Adolescent↗
PubMedDate not supplied

Obstetric care in family practice residencies: a 5-year follow-up survey.

BACKGROUND: The percentage of family physicians delivering babies decreased from 46% in 1978 to 32% in 1992. Some family practice leaders predicted that, by the turn of the century, training for family practice obstetrics would focus primarily on those planning to work in remote or rural settings. A 1993 study found three primary factors associated with an increased incidence of future maternity care. In 1997 the Residency Review Commission (RRC) stipulated that all family practice residencies have at least 1 family physician serve as an intrapartum attending physician for family practice resident deliveries. METHODS: Using an instrument similar to that used in 1993, we surveyed the directors of 462 family practice residencies in the United States. Sixty-four percent (295) of the program directors responded to one of two mailings. RESULTS: Compared with the survey published in 1993, program directors estimated a 16% increase in the number of residents who included obstetrics in their first practice after residency. Factors associated with increased obstetric participation included having only family physician faculty supervise uncomplicated deliveries and having family physician faculty who could perform other perinatal procedures. Programs that had 4 or more family physician faculty doing obstetrics and those that had more than 10 deliveries per month also produced more physicians who provided maternity care. Fifty-three percent of residencies that did not have family physician faculty attending deliveries before 1997 now meet this RRC requirement. CONCLUSIONS: This study shows that, according to their program directors' estimates, more family practice residents are including obstetrics in their first practice after residency compared with 5 years ago. The new RRC regulation was associated with more than 50% of previously noncompliant programs adding or retraining faculty who could attend resident deliveries within 12 months of the inception of the new policy.

Family Practice↗
PubMed1998

Orientation to community in a family practice residency program.

BACKGROUND: Family practice residencies are expected to include opportunities for trainees to learn about population-based approaches to health care delivery. METHODS: To prepare them for community projects later in training, first-year residents were introduced to a community-oriented primary care (COPC) curriculum by an interdisciplinary team with representatives from public health and academic family medicine. During their mid-year orientation month, the residents spent three afternoons in community settings, each year focusing on a different public health issue. The residents spent the first afternoon discussing principles of community medicine, the COPC model, and planning community interviews. The second afternoon, they interviewed in the community. The residents reported and evaluated on the third afternoon. RESULTS: During the 3 years described, most residents participated with enthusiasm, later reporting increased awareness and use of community resources. However, months after the third experience, a comparison of clinic records before and after the orientation showed no difference in the residents' inclusion of the health issue studied in managing their patients, although social workers and other non-physician faculty team members reported that residents consulted them more frequently following the community orientation. CONCLUSIONS: It is important to provide residents with an efficiently designed and attractive community orientation early in training. An interdisciplinary team should plan and coordinate their experiences, but all faculty should role model good community behavior. Although the 1996 residents described behavioral changes following this brief orientation, this was not documented by a chart review.

Adolescent↗
PubMedDate not supplied

Family practice residents' decision making regarding future practice of obstetrics.

BACKGROUND: This study assesses the attitudes of family practice residents toward their future practice of obstetrics. The decline of family practice obstetrics has resulted in problems of access to care for many areas. METHODS: Questionnaires were sent to 30 family practice residency programs and were distributed to 353 2nd- and 3rd-year residents; the overall response rate was 85 percent. Respondents were asked to describe factors contributing to their decision whether to practice obstetrics. RESULTS: Seventy-two percent of the respondents indicated plans for future obstetrics practice. Reasons for choosing to practice obstetrics included personal interest, believing that obstetrics is an important part of family health care, and desire for diversity in practice. Primary concerns included interference with personal life, fear of lawsuits, and insurance premiums. Those deciding not to practice obstetrics cited interference with personal or professional life and desire for limited practice as deterrents. Important demographic variables predicting future practice included female sex, geographic location, and type of practice desired. CONCLUSION: This study portrays a resurgence in the percentage of family practice residents planning to practice obstetrics and discusses aspects of the training system that merit support to increase the number of family physicians providing obstetric care.

Attitude of Health Personnel↗
PubMed1991

Effect of a year-long primary care clerkship on graduates' selection of family practice residencies.

This report compares the selection of family practice residencies from 1981 through 1989 by graduates trained at two campuses of the State University of New York (SUNY)-Health Science Center at Syracuse College of Medicine, at other New York State campuses, and at all U.S. medical schools. One of the SUNY-Syracuse cohorts comprised the students who had completed all their work at the Syracuse campus, while the other comprised those who had spent their third year at the campus in Binghamton, which has a year-long, half-day-a-week primary care clerkship that is not available at the Syracuse campus, which has no primary care clerkship. Comparison of the proportions of the graduates in the two SUNY-Syracuse cohorts who chose family practice residencies, and comparisons of the proportions of graduates from other New York state schools and from all U.S. schools who selected family practice residencies during the same nine-year period, indicate that the proportion of students trained during their third year at the Binghamton campus who selected family practice residencies was significantly greater (21%; p less than .001). Additional investigation is required to determine whether the year-long nature of the required clerkship affects graduates' choices more than does the primary care content of the clerkship.

Career Choice↗
PubMed1982

Interpractice variation in Barbados family practice.

The 11 practices of the Barbados Family Practice Morbidity Survey were analyzed according to the age and sex of the physicians. Male physicians had larger practice populations than did the female physicians but carried on fewer repeat encounters during the 12 months of the survey. The female physician practices recorded fewer domiciliary calls, more investigations and referrals, and a larger patient encounter female-male ratio than did the practices of male physicians. Younger physician practices recorded fewer domiciliary calls, investigations, and referrals than did those of their older counterparts. Statistically significant differences in morbidity between male and female practices were demonstrated. The results demonstrate the magnitude of interpractice variation according to the age and sex of family physicians and suggest its increasing importance at a time when more women are entering family practice.

Adult↗
PubMed1978

Family practice in evolution: progress, problems and projections.

Family practice has developed in direct response to the public need for primary care with the elements of comprehensiveness, continuity and accessibility. This specialty represents a re-emphasis of the generalist role in medicine, with particular concern for the family as the unit of care. Since the American Board of Family Practice was formed nine years ago, the first phase of development has been completed. Teaching programs in family medicine have been effectively established at undergraduate and graduate levels throughout the country in both university and community settings. Refinement of teaching programs and initiation of a strong ongoing research effort are now required. The continued successful evolution of family practice as a foundation of primary care in the United States is essential to extend the highest possible quality of care to the entire population at a cost that can be afforded in a society with limited resources for health care.

Curriculum↗
PubMed1991

Measuring health status: an approach for family practice researchers.

Research in family practice frequently involves the measurement of subjects' perceived health status. Those who are unfamiliar with this area may find the task difficult and frustrating. This paper offers an approach to the selection and assessment of measures of health status and specifically examines issues of feasibility, instrument content, appropriateness for subjects, instrument construction, reliability, validity, sensitivity to change, and measurement strategy.

Family Practice↗
PubMed2003

Comments heard by US medical students about family practice.

BACKGROUND AND OBJECTIVES: This study was conducted to explore the hypothesis that negative comments from faculty and residents about family practice are related to the recent decline in student selection of this specialty. METHODS: A questionnaire was sent to all family physicians and an equal number of other primary care physicians who graduated from one of 24 medical schools in 1997-1999. Twelve schools had increasing proportions of graduates choosing family practice in the study period, and 12 had decreasing proportions. The questionnaire asked about negative comments heard about family practice and other primary care specialties. RESULTS: Most graduates heard negative comments about family practice during medical school, and many students heard these comments often. However, the frequency and content of negative comments was not related to increases or decreases in the proportion of students choosing family practice. Negative comments were heard more frequently about family practice than about other primary care specialties. Negative comments increased in frequency during the study period. The negative comments on the questionnaire heard most often were that family physicians cannot master the content of the specialty and that they are not as smart as other physicians. Compared to other graduates, those with an initial interest in family practice who chose another specialty more frequently reported hearing that family physicians can't master the specialty content. There was an inverse relationship between the number of groups (students, residents, and faculty) that negative comments were heard from and ranking of family medicine faculty on respectability, influence, and competence. CONCLUSIONS: After 3 decades of being an officially recognized specialty, family practice is not recognized by some other medical school faculty as an equal to other primary care disciplines, and these faculty frequently express this view to students. While the frequency of these negative comments is increasing and is related to trainees' perceptions of family medicine faculty, it does not explain the recent decline in student interest in family practice. There is some evidence that students who change their career plans away from family practice might be concerned with their ability to master the specialty content. The prevalence of negative comments is related to trainees' perceptions of family medicine faculty.

Attitude↗
PubMed2003

Benchmarking the costs of residency training in family practice.

Financial and operational benchmarking data for family practice residency programs within the University of Washington Network were established for the year 2000. Data were systematically collected by standardized questionnaire, evaluated for quality and verified, and then analyzed. Revenues, expenses, faculty structures, productivity, and family practice center staffing models are reported, using program averages and ranges or standard deviations for individual data elements. Variations and data problems included data line definitions, difficulties obtaining data from sponsoring institutions, indirect program costs, and widely differing program structures. Limited conclusions can be made regarding "best practices," but the results contribute to the establishment of normative data for budgeting and operational evaluation of family practice programs.

Costs and Cost Analysis↗
PubMedDate not supplied

The faculty experience with the "troublesome" family practice resident.

BACKGROUND: Some family practice residents, by virtue of their behavior, generate discomfort, anger, and ambivalence in their supervising colleagues. These residents are labeled "troublesome." The purpose of this qualitative research was to identify and conceptualize characteristics of troublesome residents. METHODS: We retrospectively reviewed written evaluations of four residents who, out of a total of 111 residents in our program over five years, had been labeled "troublesome." Using the approach of constant comparisons, we identified a conceptual framework that described the troublesome residents. RESULTS: We were able to classify the comments in the residents' written evaluations into three categories. The first category was troublesome residents' discomforting behaviors. These included affronting, avoiding responsibility, and lack of initiative. The second category included ways in which the resident failed to meet faculty and program expectations, often manifest as lack of collaboration and commitment. The third category of comments involved the process of recognizing and dealing with the troublesome resident. This occurred in a three-stage process involving recognition, confrontation, and remediation. CONCLUSIONS: The classification of troublesome residents' performances into conceptual categories may be useful for helping faculty understand and deal with these learners.

Behavior↗