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PubMed1996

Postgraduate training for rural family practice. Goals and opportunities.

PROBLEM BEING ADDRESSED: The continuing shortage of rural family physicians in Canada. PURPOSE OF PROGRAM: To further develop training for rural family practice so that adequate numbers of rural family physicians will be appropriately prepared. MAIN COMPONENTS OF PROGRAM: All family medicine residents should have the opportunity to experience the joys and challenges of rural family practice. Rural family medicine training streams provide the best education for family medicine residents who are planning a career in rural family medicine. Integrated training for rural family practice should be high-quality, academically sound, needs-driven, evidence-based, learner-centered, and outcome-measured. This involves comprehensive development of curricula that provide specific skills and appropriate core subjects in rural practice as well as a solid family medicine foundation. contextual and experiential learning in areas similar to or in actual areas where there is a need for rural physicians, and appropriate hospital rotations to learn skills for the hospital role of many rural family doctors, are important components of rural family medicine training. CONCLUSIONS: Postgraduate rural family medicine training programs can be further focused and developed to train more physicians with the knowledge, skills, and attitudes required for rural practice.

Canada↗
PubMedDate not supplied

Competency-based education in family practice.

BACKGROUND AND OBJECTIVES: Since their inception, family practice residency programs have been designed on a rotation-based format. It has been assumed that by having residents rotate through a series of educational experiences, they would assimilate the skills necessary to effectively serve as a family physician. An alternative approach is based on the attainment of competency, rather than on the completion of a set of experiences. This method of education is known as competency-based education, mastery learning, or, more recently, outcomes-based assessment. Within family medicine, there is a strong interest in the application of competency-based education to family practice residency training. In response to the growing need to discuss these and other related issues, the Society of Teachers of Family Medicine (STFM) Board created the Task Force on Competency-based Education. Its mission is to disseminate this educational theory to STFM's membership. This article reviews the theory of competency-based education, describes development of a competency-based curriculum model, and discusses the academic issues surrounding adaptation of this form of education to family practice residency programs.

Clinical Competence↗
PubMed2002

Family practice in the United States: a status report.

Since family practice was first recognized as a specialty in the late 1960s, considerable intellectual and organizational change has occurred in medicine, especially during the 1990s. To reflect on and reconsider the role of family practice in US health care, this article reviews the development of family practice as a specialty, provides a current assessment of the status of family medicine in the United States, and comments on issues that are of ongoing importance to family practice.

Family Practice↗
PubMedDate not supplied

Rural-urban and gender differences in procedures performed by family practice residency graduates.

OBJECTIVE: We compared the types of procedures performed and obstetrical care provided by family practice residency graduates, by practice location and physician gender METHODS: We conducted a cross-sectional questionnaire survey of 702 graduates who completed family practice residency programs in Alberta, Canada, from 1985 to 1995, inclusive. Graduates were asked to indicate which of 28 procedures and 7 obstetrical care practices they performed. The data were analyzed by gender and current practice location. RESULTS: A total of 442 (63%) of the graduates responded to the survey. The top five procedures performed by family practice graduates were minor office surgery, foreign body removal (eye), joint aspiration, joint injection, and anterior nasal packing. There was a declining trend in the number of procedures performed by family practice graduates from rural, to regional, to metropolitan areas. Relatively more males performed procedures; however, more females did IUD insertion and obstetrical care practice. Except for a few exceptions, a similar proportion of male and female graduates in rural practice performed procedures. CONCLUSIONS: The procedural and obstetrical care pattern of practice differs between family practice graduates in rural and urban areas, as well as between male andfemale graduates. Family practice residency programs should consider additional training in procedural skills for those planning to practice in rural areas, as well as encourage females to become skilled at performing procedures relevant to family practice.

Adult↗
PubMed1977

Profile of full-time family practice educators.

This paper presents the first study of characteristics of full-time family practice educators in the United States. The majority of family practice educators entered the teaching field within the 1972 to 1975 time period, having done so after a period of ten to 20 years in the private practice of family medicine. Group practice (124) marginally outnumbered solo practice (102) with internal medicine and pediatrics representing the greatest percentage of patient care in all previous practice settings. A large majority of family practice educators have had two years of graduate training and are diplomates of the American Board of Family Practice. The respondents expressed a high degree of personal and professional satisfaction in their present positions, but many desired continuation of personal patient contact.

Adult↗
PubMed1997

Colonoscopy experience at a family practice residency: a comparison to gastroenterology and general surgery services.

BACKGROUND AND OBJECTIVES: Colonoscopy training is receiving greater emphasis in family practice residencies. However, no standards have been established to measure the adequacy of this training. This study assessed the colonoscopy experience of family practice residents at Louisiana State University Medical Center at Shreveport (LSUMC-S). METHODS: We included all colonoscopies performed by the family practice service between August 1992 and December 1994 and matched them by gender and age with cases from the gastroenterology (GI) and general surgery (GS) services performed during the same time period. Family practice and GI were compared using 143 cases from each service; 166 cases were used to compare family practice to GS. RESULTS: The cecum was intubated in 87% of patients on all services. The average time to complete the procedure was 35 minutes by the family practice service, 44 minutes by GI, and 25 minutes by GS. No significant differences were found between family practice and GI in the number of patients with polyp, normal colon, or biopsy performed. In comparison to GS, there were significantly fewer patients on the family practice service with normal colon and more with multiple polyps and biopsy performed. Significantly more cancers were found by the family practice service than by either GI or GS. There were no complications reported for any of the services. Results compared favorably with data in the current literature. CONCLUSIONS: The colonoscopy experience available to family practice residents at LSUMC-S is acceptable within the parameters studied.

Biopsy↗
PubMed1996

Trends along the debt-income axis: implications for medical students' selections of family practice careers.

PURPOSE: To examine whether medical students' levels of debt have an influence on selection of family practice careers, independent of other factors. METHOD: Data from the Jefferson Longitudinal Study were analyzed for 1,350 graduates from the classes of 1987-1993 at Jefferson Medical College of Thomas Jefferson University; a focused analysis for 326 graduates from the classes of 1992 and 1993 was specifically performed to identify recent trends. A binary logistic regression equation was used to predict the probability of a graduate's entrance into a family practice residency based on first-year preference for family practice, income expectation, debt level, age, and gender. RESULTS: A high level of indebtedness (at least $75,000) was a significant independent predictor of specialty choice (away from family practice); first-year preference for family practice and income expectation were also significant independent predictors. Combining these three factors (debt, specialty preference, and income expectation) led to a greater than 12-fold difference in specialty selection of family practice. Notably, 36% of the students graduating in 1992-1993 had debts of at least $75,000, more than three times the percentage in the classes graduating in 1987-1989. CONCLUSION: High levels of debt had a significant negative effect on family practice specialty, choice among recent Jefferson graduates. An increase in the number of students with such debt carries strong implications for the selection of careers in family practice.

Career Choice↗
PubMed1997

Esophagogastroduodenoscopy training in family practice residency program.

BACKGROUND AND OBJECTIVES: Esophagogastroduodenoscopy (EGD) is a procedure that has been gaining interest among family physicians. To determine the extent of EGD training at family practice residences, we surveyed all US family practice residency directors. METHODS: In late 1994, we mailed a questionnaire to the residency directors of all ACGME-accredited family practice residency programs. RESULTS: A total of 359 programs responded to the questionnaire (87.7%). Eighty-seven (24.2%) programs reported that their residents receive training to perform EGD. At the majority of these programs, residents perform 10 or less EGDs during their residency experience. Programs on the East and West coasts were less likely to provide this training than were programs in other regions of the country. Residents at programs in the South performed significantly more EGDs than did residents in programs in other regions. Southern residents also were more likely to perform these procedures in family practice centers rather than gastroenterology (GI) labs. Those programs whose residents perform more than 25 EGDs were more likely to have family physicians as trainers of this procedure and also were more likely to offer this training at family practice centers instead of GI labs. CONCLUSIONS: EGD training is now offered by a relatively large number of family practice residency programs. However, concern could be raised as to whether these programs provide adequate quantitative experience. Strong regional differences were noted in the availability of this training.

Endoscopy, Digestive System↗
PubMed1982

Utilization and cost effectiveness of a family practice center.

In a prepaid group practice setting, a group of 45 Family Practice Center patients, carefully matched by age, sex, and employment, were compared with a group of 63 patients attending medical and pediatric clinics. Utilization rates for physician and nonphysician visits and costs of laboratory and x-ray services during a period of 33 months were examined. Despite a 25 percent greater prevalence of significant chronic medical problems, the family practice group used specialist care less than one half as much as did the matching group and made one extra physician visit per patient per year. Costs for laboratory and x-ray procedures did not differ significantly. Satisfaction expressed in responses to telephone interviews of both groups was found to be somewhat greater among the family practice patients. The findings of this study provide some support for greater cost effectiveness and patient satisfaction of family practice compared with alternative modes of primary care.

Ambulatory Care Facilities↗
PubMedDate not supplied

Interpreting office radiographs: a research-based curricular prototype for training family practice residents.

Radiographic film interpretation is one area of the family practice residency training curriculum that has been given little focused emphasis. Starting with a series of studies into the office practice of radiology by family physicians to define need, content, and interpretation skill level, and following a systematic curriculum design process, the authors developed a comprehensive curriculum for teaching office X-ray interpretation to family practice residents. The final curricular prototype consists of: 1) a complete set of curriculum objectives; 2) a written monograph; 3) a set of instructional X-rays; and 4) a set of evaluation films. This research-based curriculum development process may serve as a model for developing other educational components for family practice residency training.

Curriculum↗
PubMed1977

The family practice resident as sexual counselor.

Little research has been done on family practice residents and their sexual counseling attitudes, knowledge, and abilities. This study sought answers to five broad questions about family practice residents' perceptions of sexual counseling. Subjects were 132 residents and 21 faculty members from eight family practice training units in Minnesota, which were affiliated with the University of Minnesota. Residents regard sexual counseling as important and say they desire more training to deal with sexual problems encountered in family practice. They tend to raise the subject of sex with patients not routinely but only if there appears to be a psychosocial problem. Respondents indicate a lack of ability as well as discomfort with several areas of sexuality, notably frigidity and homosexuality. Family practice residents need to develop their skills in specific areas of sexual counseling. While these findings are most applicable to the eight units involved, the diversity in respondents' backgrounds and differences between units suggest that the results may be relevant to other residency programs.

Attitude of Health Personnel↗
PubMed1988

A survey of fourth-year medical students' decisions regarding family practice as a career.

With a decline in the proportion of medical students pursuing family practice careers, it is necessary to better understand the factors influencing their career decisions. The Fishbein model of attitude formation was used as a framework for developing a questionnaire to measure students' attitudes toward a career in family practice and the social support students perceived they had for that career. The questionnaire was administered to fourth-year-medical students a short time before residency match day. Both the attitude and social support scales had excellent psychometric characteristics. The usefulness of these scales in discriminating between career choices of family practice and other clinical careers was tested. The social support scale did not discriminate well, whereas the attitude scale discriminated quite well. The students who chose careers in family practice differed from students who chose other careers in 14 of 19 values about characteristics of family practice but differed from them in only two of 19 beliefs about family practice. The implications for advising medical students about careers in family practice are discussed.

Attitude↗
PubMedDate not supplied

Resident attrition from family practice residencies: United States versus international medical graduates.

BACKGROUND: Attrition of residents from family practice residency programs may cause significant problems for faculty, residents, and patients. The objective of this study was to determine international medical graduates' attrition rate from family practice residencies, compared with US medical school graduates. METHODS: Surveys were sent to all family practice residency program directors asking them to calculate their attrition rate for a 10-year period. RESULTS: The overall response rate was 56.6%, but interpretable responses were received from 45% of all civilian, continental US family practice residencies. Responding programs did not differ from all family practice programs with respect to program overall. Of those residents leaving, 63% did so to enter other specialties. The attrition rate was 18.5% for international graduates, compared with 7.8% for US graduates (P < .0001). International graduates enrolled outside of the National Resident Matching Program (NRMP) were most likely to leave programs before completion. CONCLUSIONS: Attrition rates from family practice residency programs are higher for international medical graduates than for US graduates. International graduates enrolled outside of the NRMP were most likely to leave a program.

Data Interpretation, Statistical↗
PubMed2001

EKG analysis skills of family practice residents in the United Arab Emirates: a comparison with US data.

BACKGROUND AND OBJECTIVES: Concern has been raised about the electrocardiogram (EKG) analysis skills of family practice residents in the United States. This study examined EKG analysis skills of family practice residents, medical students, interns, and general practitioners (GPs) in the United Arab Emirates (UAE), a different environment. METHODS: The measurement instrument was a set of 10 EKGs, used in a study of US family practice residents. Two of the EKGs were normal, and there were 14 clinical abnormalities in the remainder. RESULTS: There was no significant difference in the correct diagnosis of acute myocardial infarction between US family practice residents and UAE family practice residents, medical students, or GPs. Interns' diagnoses were significantly poorer. The mean score for correctly identifying acute myocardial infarction and both normal EKGs was not significantly different between groups: 2.50 medical students, 2.35 interns, 2.58 UAE family practice residents, 2.67 FD, and 2.55 US family practice residents. However, the US family practice resident mean score of 11.26 for all 16 clinical findings was significantly higher than any group in the UAE: 5.35 medical students, 5.87 interns, 6.08 UAE family practice residents, 5.69 family physicians. CONCLUSIONS: Difficulty in EKG interpretation transcends geographic boundaries, suggesting that new approaches to teaching these skills need to be explored. Improved EKG reading skills by family physicians are generally needed in both the United States and the UAE.

Clinical Competence↗
PubMed1996

Interest in different types of patients. What factors influence new-to-practice family physicians?

OBJECTIVE: To identify factors that influence new-to-practice family physicians to be particularly interested in certain types of patients. DESIGN: Qualitative study and cross-sectional survey. SETTING: Ontario family practices. PARTICIPANTS: Seven focus groups involved a volunteer sample of 34 physicians who completed family medicine residency training between 1984 and 1989. A convenience sample of 43 physicians who had completed their residencies between 1990 and 1992 were interviewed. All certificates of the College of Family Physicians of Canada currently practising in Ontario who received certification between 1989 and 1991 were surveyed. MAIN OUTCOME MEASURES: Physician interest as determined by scores on two scales: one labeled "Chronic/Older Patient," designed to assess special interest in geriatric patients, chronic pain patients, palliative care patients, and chronically ill patients, and one labeled "Young Patient," designed to assess special interest in young families and adolescents. RESULTS: In general, new-to-practice physicians had little interest in caring for older or chronic patients; older physicians and male physicians had greater interest in caring for chronic or older patients. Women physicians, physicians rating higher on the "empathy" and "interest in counseling" scale, and physicians receiving primarily fee-for-service remuneration showed greater interest in caring for young families and adolescents than other physicians. CONCLUSIONS: Physicians' age, sex, attitudes to patient care, method of remuneration, undergraduate and postgraduate schools of medical training, and the age and sex composition of their practices all influenced their interest in caring for different types of patients.

Adult↗
PubMedDate not supplied

Perceived characteristics of successful family practice residency maternity care training programs.

BACKGROUND AND OBJECTIVES: This study determined the perceived characteristics of family practice residency training programs that produce a high percentage of graduates who provide maternity care. METHODS: We surveyed a Delphi panel of 28 family practice maternity care experts. RESULTS: Consensus was reached after the third survey. The characteristics of the family medicine faculty and teaching service were rated as most important. Other essential characteristics were an adequate obstetrical training volume; mutual respect between obstetric and family medicine faculty and residents; support for family practice maternity care from obstetricians, administration, and nursing staff; and family physicians being accepted in the community as maternity care providers. CONCLUSIONS: Family practice residency programs that produce a high percentage of graduates who provide maternity care have a unique, family practice maternity care-friendly environment. Residency programs wishing to increase the percentage of their graduates who provide maternity care should ensure that their faculty support family practice maternity care, are competent in maternity care, and model maternity care in their own practices. They should strive to ensure an adequate volume of obstetrical cases for resident education and work toward educating patients and local obstetricians, nursing staff, and hospital administration regarding family practice maternity care.

California↗
PubMed1975

Evaluating family practice residents with a problem category index.

Using a standard ambulatory coding system as a base, an index of 42 problem clusters encountered in family practice was developed by two Pennsylvania family practice residency programs. Comparisons of frequencies with which these index problems were encountered by physicians in the Family Practice Centers were used to identify the practice patterns of family practice residents and faculty. Analyses of these displays, while largely subjective, produced some interesting general and specific results. The initial study indicates that many problems known to be common in family practice are not identified as such by the physician. When this type of information can be simplified, it is welcomed and found useful by residents and faculty in family practice training programs. A simplified index can be developed and used by any physician without any special equipment.

Ambulatory Care↗
PubMed1985

Full clinical departments of family practice: their relationship to hospital privileges in university hospitals.

All 52 family practice residency programs that hospitalize patients at a university hospital were surveyed to determine how many have full clinical departments of family practice and what effect having a full clinical department has on hospital privileges. A full clinical department is defined as one in which all hospital privileges for family physicians are reviewed and recommended by the family practice department without need for review by other specialties, even when the requested privileges overlap with another specialty. Responses were received from 100 percent of the surveyed hospitals. At 16 hospitals (30.8 percent) there is a full clinical department of family practice. When these hospitals were compared with the 36 (69.2 percent) at which there is no full clinical department, it was found that in every area of patient care, hospital privileges for family physicians are more extensive at hospitals with full clinical departments. The American Academy of Family Physicians is currently promoting the formation of full clinical departments of family practice as a method for improving hospital privileges for its members. The results of this study suggest that promoting the formation of full clinical departments will be an effective intervention.

Family Practice↗