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PubMed1994

Attitudes toward and subsequent career choice of family practice: a weak relationship.

BACKGROUND & OBJECTIVES: This study examined longitudinal relationships between attitudes and career choice in family practice from admission to medical school through the end of internship. METHODS: The sample included medical students graduating in 1990 and 1991. Surveys completed at the beginning of each year of medical school, at graduation, and at the end of PGY1 included measures of attitudes toward family practice and stated career choice at the time of each survey. Regression examined the relationship between attitudes and choice; repeated ANOVA measures examined changes over time. RESULTS: Positive attitude scores toward family practice increased over the first 2 years, then declined; women's scores were higher. The proportion of students stating a preference for family practice also increased initially but declined overall; women chose family practice more frequently. Relationships between attitudes and choice were weak over time and neither attitude scores nor change in scores predicted specialty choice. CONCLUSIONS: Although attitudes toward family practice remained positive throughout the 5-year study, student interest in family practice declined during the clinical years. Women maintained stronger interests in family practice than men; the reasons for this are not clear. Attitudes were poor predictors of choice. Care is needed in interpreting cross-sectional studies reporting significant relationships. We need to develop more sensitive attitude measures to improve the predictive validity of attitude measurement scales.

Analysis of Variance↗
PubMed1982

Pediatric training in family practice: a core curriculum.

Official residency guidelines for pediatric training of family practice residents focus on the number of months of block time on pediatric rotations and the percentage of pediatric patients in the resident's model practice. These guidelines do not ensure competence in pediatrics. Family practice residencies need a competency-based curriculum derived from actual pediatric experience in family practice. Such a curriculum should define specific knowledge, skills, and attitudes required, define the family physician's role in handling each issue or condition, be used on a daily basis, and form a basis for evaluation of residents and curriculum. This paper describes the development and implementation of such a pediatric core curriculum at the University of Colorado Family Practice Residency.

Clinical Competence↗
PubMed1995

Influences on teaching colposcopy and treatment modalities in family practice programs.

BACKGROUND: Colposcopy and related therapeutic modalities are taught in many family practice residency programs. The role of the following two factors in a family practice residency program's decision to teach these procedures was evaluated: 1) the coexistence of an obstetrics and gynecology (OB-GYN) residency program at the affiliated hospital and 2) the perceived attitude of community obstetrician-gynecologists toward family physicians performing the procedures. METHODS: In 1993, all 399 accredited family practice residency programs were surveyed, with a response rate of 86.5%. RESULTS: Ninety-three percent of responding programs taught colposcopy. All programs that rated community obstetrician-gynecologists' attitudes as positive taught colposcopy, and 91% taught cryotherapy. In programs rating local obstetrician-gynecologists' attitudes as negative, 85.5% taught colposcopy, and 71% taught cryotherapy. A co-located OB-GYN program did not influence a family practice program's likelihood of teaching colposcopy or treatment modalities. CONCLUSION: A perception that community obstetrician-gynecologists have negative attitudes about family physicians performing colposcopy may dissuade some family practice programs from teaching colposcopy and related treatment modalities. This influence was not seen in programs with a co-located OB-GYN residency.

Clinical Competence↗
PubMed1997

Medications that may contribute to sexual disorders. A guide to assessment and treatment in family practice.

Approximately 15% to 25% of family practice patients have concerns about sexual function and are most comfortable discussing these issues with their family physician. While many physicians have avoided this topic in the past, citing lack of knowledge and skill, the family practice setting is ideal for a preliminary evaluation of sexual dysfunction and treatment for certain etiologies. This especially is true for changes in sexual function secondary to medication effects. This article provides basic guidelines designed to assist physicians in evaluating the effects of medications and other substances on sexual function. Also included are lists of medications known or suspected to have adverse effects on sexual function. Physicians are encouraged to address the sexual concerns of their patients and to incorporate these guidelines and the medication lists into their evaluation.

Antihypertensive Agents↗
PubMed1993

The Family Practice Residency in Baton Rouge: practice patterns of graduates.

One hundred twenty-four physicians have completed the Baton Rouge Family Practice Residency since 1973. Eighty-two percent of the graduates who are currently active physicians are practicing medicine in Louisiana. Most are practicing family medicine. The graduates were sent questionnaires asking about practice characteristics, office procedures performed, hospital privileges held, and career satisfaction. Responses were received from 74 family physicians serving small, medium, and large communities. Most reported they are satisfied with their career choices. The respondents perform a variety of procedures in their offices. This finding was not affected by community size. Hospital privileges were affected by community size. The residency is meeting its principal mission: (1) training family practitioners for Louisiana, and (2) training doctors to practice in any sized community.

Certification↗
PubMed1991

Experience with colposcopy in a family practice center.

The experience of a family practice center that performed colposcopy for one year was reviewed to provide insight into the appropriateness of this procedure to a family practice clinic. Almost three thousand Papanicolaou smears were performed, which prompted 97 colposcopy clinic appointments involving 68 patients. Dysplastic Pap smears accounted for 1.82% of the total. Atypical Pap smears occurred in 3.91% of the tests, and 16.1% of a sample of these demonstrated dysplasia. Controversy concerning the atypical Pap smear is discussed. The colposcopy service was convenient for the patients and was at least revenue neutral while providing a new professional opportunity for selected family practitioners. A referral base of at least 1,000 Pap smears might justify a colposcopy program, depending on referral strategies.

Ambulatory Care↗
PubMed1978

Issues in family practice: medical student and practicing physician perspectives.

The elevation of Family Medicine to the status of a recognized specialty is designed, at least in part, to enhance the attractiveness of family practice as a career alternative for physicians. This paper examines the attitudinal orientations of group of medical students and physicians toward family practice in an attempt to highlight some of the issues that might be anticipated as this new specialty develops. Based on the results, it is concluded that fundamental change in the nature of the medical education experience will be needed if greater numbers of physicians are to be involved in primary care.

Attitude of Health Personnel↗
PubMed2000

Management of laboratory test results in family practice. An OKPRN study. Oklahoma Physicians Resource/Research Network.

BACKGROUND: Ineffective management of laboratory test results can result in suboptimal care and malpractice liability. However, there is little information available on how to do this important task properly in primary care settings. METHODS: We used a questionnaire guided by a literature review to identify a conceptual model, current practices, and clinicians who reported having an effective method for at least one of 4 steps in the process of managing laboratory test results. Clinicians with differing methods were selected for each of the steps. Practice audits and patient surveys were used to determine actual performance. On the basis of these audits, we constructed a unified best method and conducted time-motion studies to determine its cost. RESULTS: After auditing only 4 practices we were able to identify effective methods for 3 of the 4 steps involved in the management of laboratory test results. The unified best method costs approximately $5.19 per set of tests for an individual patient. CONCLUSIONS: By identifying effective practices within a family practice research network, an effective method was identified for 3 of the 4 steps involved in the management of laboratory test results in primary care settings.

Clinical Laboratory Techniques↗
PubMed1975

The intellectual basis of family practice.

Although progress is being made toward defining the family physician and the specialty of family practice, there remains a need to describe more clearly a conceptual base for family medicine as an academic discipline. This paper explores common misconceptions and fallacies which have confused or prevented greater understanding of the intellectual basis for family practice. A thesis is presented and defended which holds that patient management is the quintessential skill of clinical practice and the unique field of knowledge of family physicians. The sine qua non of family practice is the knowledge and skill which allow the family physician to confront relatively large numbers of unselected patients with unselected conditions and to carry on therapeutic relationships with patients over time.

Family Practice↗
PubMed1978

The St John's randomized trial of the family practice nurse: health outcomes of patients.

From June 1975, to May 1976, in a large family practice in St. John's, Newfoundland, a randomized controlled trial was conducted to assess the effectiveness of a family practice nurse. Effectiveness was assessed using standardized health outcome measures of physical, emotional, and social function which could be applied easily and objectively by non-clinicians to the two groups of patients under study: patients receiving conventional care and patients receiving care from the family practice nurse. After establishing the comparability of these two groups of patients at the beginning of the study, these measurements showed similar levels of physical, emotional, and social function in the two groups after 1 year of receiving either family practice nurse or conventional care. These results agree with previous controlled trials of family practice nurses which have indicated that family practice nurses are effective and safe.

Adolescent↗
PubMed1979

The nature and management of telephone utilization in a family practice setting.

Study of the telephone practice in four family practice settings reveals a complex interaction between patients, physicians, and receptionists. Patients present a limited number of complaints--80 percent of complaints represent 25 common chief complaints, and 95 percent represent 50 chief complaints. Little difference was observed between the symptoms reported by patients to the physicians as compared to those received by the receptionist staff. Physicians are more likely to use the telephone contact to treat the patient's complaint with home care advice or a prescription. Receptionists are more likely to use the telephone contact for scheduling an office visit.

Adolescent↗
PubMed1994

Pregnancy care in family practice: medical student perspectives on specialty and residency selection.

BACKGROUND AND OBJECTIVES: The purpose of this study was to determine the effect of pregnancy care within family practice on medical students' choices of family practice as a career and to determine the effect the degree of emphasis on pregnancy care has on students' choices of specific residency programs. METHODS: Eight hundred and ten randomly selected student members of the American Academy of Family Physicians (AAFP) and 805 randomly chosen members of the American Medical Student Association (AMSA) were sent an 11-item survey that asked how their career (specialty) and specific residency program choice would be affected if family practice residencies included more (or less) training in pregnancy and delivery management. RESULTS: Fifty-one percent of AAFP members and 37% of AMSA members would be less likely to enter family practice if pregnancy care was eliminated from the specialty. Six percent of AAFP members and 9% of AMSA members stated that they would be more likely to enter family practice if the specialty ceased this training. Students who plan to enter family practice favor a residency program with a stronger pregnancy care experience over a residency program with less emphasis on this training by a 10:1 ratio. CONCLUSION: This study shows significant medical student interest in a high level of pregnancy care experience in family practice training programs.

Attitude of Health Personnel↗
PubMed2003

Structure and duration of consultations in Estonian family practice.

OBJECTIVE: To study the influence of age, gender and the nature of the patient's problems on length of time of consultation in the practices of newly trained family doctors in a recently reconstructed health care system. DESIGN: Video-recordings of consultations with consecutive patients in family practice were studied for duration of consultation in relation to age, gender and nature of the problem(s). SETTING: Primary health care. SUBJECTS: 405 consecutive consultations were video-taped in the practices of 27 family doctors. MAIN OUTCOME MEASURES: Length of time of consultation and its segments was analysed using the Statistical Package for the Social Sciences. The problems were classified according to the ICPC. RESULTS: The average consultation lasted 9.0 min (+/- 4.9). Physical examination was 2.0 min (+/- 1.9) and was performed in 79% of all consultations. Respiratory and circulatory problems were the most common. More than one reason for the encounter was given in one-fourth of cases. Consultation time was longer for older age groups and for patients with psychological problems. CONCLUSION: Video-recording allows consultations to be evaluated directly and is acceptable to patients. The high participation rate of patients in our study can be explained by the individual approach and by the family doctor system. The period of consultation was dependent on patient age and on the number and nature of the problems, but was not influenced by gender.

Adolescent↗
PubMedDate not supplied

Effects of training in patient education on attitudes and behaviors of family practice residents.

The attitudes of 24 family practice residents toward patient education and perceptions of their own efficacy as patient educators were measured before and after they underwent a special patient education training program. Their scores were compared to those of 34 family practice residents who did not have access to the program. Study group residents showed positive changes in attitudes, reported behaviors, and problems, while the comparison group showed no changes in any of the categories. The differences were statistically significant for the behaviors and problems but not for the attitudes data.

Analysis of Variance↗
PubMedDate not supplied

Obstetric care in family practice residencies: a national survey.

BACKGROUND: Supervision of obstetric care by family practice faculty increases the likelihood that family practice residents will choose to practice obstetrics. METHODS: A survey instrument was developed to obtain information about practice faculty and the educational setting in which residents learn family physician obstetric care. Questionnaires were sent to all family medicine residency directors and all full-time family physician faculty. RESULTS: Two hundred eighty-four program directors and 1396 faculty members responded. The mean percentage of recent graduates estimated to be practicing obstetrics was 30 percent. Factors independently associated with an increased likelihood of resident graduates practicing obstetrics included supervision of resident deliveries by family physicians, increasing number of family practice center deliveries, regional differences, and availability of training to perform Cesarean sections. Sixty-four percent of the responding family physician faculty were currently supervising deliveries, but only 5 percent had Cesarean section privileges. Seven percent of the faculty reported denial of obstetric privileges. Eighty-nine percent of all respondents supported the mandatory inclusion of obstetrics in family medicine residencies. CONCLUSIONS: Residency programs in family practice can increase the number of their graduates practicing obstetric care by focusing on the family physician supervision model, faculty development that supports this model, and clinical privileges of faculty.

Career Choice↗
PubMed1988

Comprehensive family practice clerkship in a minority institution.

A comprehensive family practice clerkship program at Howard University College of Medicine has been conducted since 1970. This institution is one of three predominantly black institutions offering a family practice program. The senior clerkship is mandatory and at least 20 to 25 percent of each class elect to participate in a four-to six- week family practice preceptorship. As a result of the clerkship's success, over 50 percent of the program's graduates actively practice in primary medical manpower shortage or medically underserved areas.

Black or African American↗
PubMed1978

Obstetrics in family practice: a model for residency training.

Family physicians have a unique service to offer families at the time of their reproduction, and have a role to play that cannot be duplicated by an obstetrician-gynecologist or pediatrician. The process of a family integrating a new member is a natural concept to family practice and lends itself to a family-centered model of care seldom seen in medicine. Practicing obstetrics has a positive effect on a family physician's practice for without obstetrics a practice largely of episodic adult internal medicine develops. Obstetrical care provided by a family physician is a natural answer to the currently articulated public need for personalized, sensitive, family-centered, and expert childbirth care. Obstetrical training in the family practice residency needs to include a longitudinal pregnancy care experience in addition to block rotation on hospital services to teach residents skills of good obstetrical practice and to develop an attitude of family-centered health-care advocacy. A detailed program of family-centered patient education classes practical for a private group practice has been developed to extend throughout the entire course of pregnancy and includes classes after delivery.

Curriculum↗
PubMed1979

Concerns and challenges facing social workers in family practice.

Twenty-five social work members of the Society of Teachers of Family Medicine responded to a survey in which they identified their chief concerns and challenges encountered in family practice. Of nine areas of concern to social workers in interdisciplinary practice identified from the literature, respondents viewed as most important the achievement of acceptance and regard among other disciplines for the social worker and the value of his/her contribution to family practice. This was followed closely by the associated challenges of developing interdisciplinary relationships and fostering an accurate understanding of the role functions of the social worker in family practice. To confront these and other concerns, careful attention to three major needs suggested by the survey results is advocated: (1) the need for social workers to maintain high standards of performance in family practice, (2) the need for family physicians and other health care personnel to understand the role functions of the social worker and examine their attitudes toward collaboration with social workers, and (3) the need for regular and constructive dialogue between all personnel in family practice.

Comprehensive Health Care↗