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PubMed2000

Lifestyle satisfaction of rural, South Dakota, family practice physicians.

South Dakota (SD) rural, family practice physicians were surveyed relative to their lifestyle satisfaction. Sixty-eight of 192 surveys were returned (45%), with 75% men and 22% women responding (3% no response). Forty-nine percent of respondents had attended the University of South Dakota School of medicine. Besides overall satisfaction, factor analysis grouped survey questions into four clusters: a) activities; b) community; c) income; and, d) time. As compared to other physicians, those physicians who were born in SD or had graduated from a SD high school, or had received their undergraduate education in either SD or a bordering state, reported significantly greater overall satisfaction as well as significantly greater satisfaction with both the community and availability of leisure activities. Interestingly, there was no significant difference in lifestyle satisfaction among physicians who attended medical school in either SD or a bordering state, as compared to physicians who attended medical school elsewhere. It does appear that the degree of "connectedness" to SD positively impacts the lifestyle satisfaction of SD, rural, family practice physicians.

Analysis of Variance↗
PubMed1993

Establishing a linkage between a family practice residency and a local health department.

BACKGROUND: Involvement in service-education linkages by family practice residencies is increasing. In the late 1980s, Swedish Hospital Family Practice Residency in Seattle sought to expand into a new site. At the same time, the Seattle-King County Department of Public Health (SKCDPH) identified the Denny Regrade area of Seattle as medically underserved. METHODS: A new clinic was established in the Denny Regrade area through a collaborative effort between Swedish Family Practice Residency and the SKCDPH. The clinic, Downtown Family Medicine, provides the family practice center training for six additional residents, expanding the Swedish Family Practice Residency from 18 to 24 residents. Swedish Hospital finances faculty and residents' salaries and capital equipment at the new clinic, whereas SKCDPH covers ancillary staff and overhead expenses. RESULTS: The new linkage clinic offers a unique educational setting, direct service to medically indigent patients, and shared financing. Problems encountered included cost, control, adequate staffing, and availability of specialty physician services. Through negotiation and flexibility, solutions were found to many of these problems. CONCLUSIONS: The present linkage demonstrates that training residents in a health department setting is a viable option for expanding a residency and providing care to underserved patients.

Career Choice↗
PubMed1995

Results of the 1995 National Resident Matching Program: family practice.

The 1995 National Resident Matching Program (NRMP) results broke records in the number of positions filled in family practice residencies, with an increase of 11.8% over 1994 figures (2,563 vs 2,293) and an increase of 12.5% in positions filled with US seniors (2,081 vs 1,850). This is the largest number of US seniors choosing family practice in the NRMP's history. In keeping with the trend that began in 1992, 7% more positions were filled on July 1, 1995, than were filled at the same time in 1994 (3,252 vs 3,040). Internal medicine residencies matched 74 more US seniors in 1995, and pediatric residencies matched 84 more US seniors. Given the anticipated career choices of students entering residency training in the generalist disciplines (95% of students matching in family practice, 60% of students matching in pediatrics, and 45% of students matching in internal medicine), it is expected that 33.5% of the class of 1995 (Liaison Committee on Medical Education-accredited medical schools) will practice as generalists. First-year positions offered in family practice through the NRMP increased 6%, and the number of Accreditation Council on Graduate Medical Education-accredited family practice residency programs increased 3% (421 vs 410). With continued increased interest in family practice as a career choice and the need for more family physicians, support for the nation's family practice residency programs continues to be of critical importance.

Adult↗
PubMedDate not supplied

Family practice residency behavioral science training: influence on graduate practice activity.

BACKGROUND AND OBJECTIVES: The educational efficacy of family practice residency behavioral science training and how various educational approaches might influence graduate practice activity are poorly understood. In this study, we compare a traditional didactic and clinical block rotation approach to a problem-based learning (PBL) and clinical, experiential behavioral science curriculum. METHODS: Surveys of pre- and post-intervention cohorts were used to assess graduates' perceptions of their understanding of broad behavioral science concepts, their competence to manage specific behavioral conditions, and their behavioral science practice activity. The two cohorts were University of California, Irvine family practice residency program graduates from 1984-1988 (58) and residency graduates from 1993-1995 (27). American Board of Family Practice (ABFP) In-service Training Examination scores were also compared. RESULTS: No significant differences were detected in self-perceived competence and ABFP examination performance. Residency graduates in the post-intervention cohort more often included depression, marital counseling, and eating disorders in their practice and reported more frequent practice activity for situational stress and sexual dysfunction. The post-intervention group reported less involvement with alcohol and substance abuse problems. This group also reported practice activity that exceeded perceived levels of competence for attention deficit disorder, learning disorders, and eating disorders. CONCLUSIONS: Participants in a PBL-clinical experiential curriculum reported higher levels of practice activity for several common behavioral problems. It seems unlikely that these differences were due to curriculum changes. Further investigation of the influence of educational and other factors on residency graduate practice activity is needed.

Adult↗
PubMed2004

Training family practice residents in HIV care.

Although family physicians are likely to encounter patients at risk for or diagnosed with HIV, they rarely are trained in prevention and treatment techniques. From 1997 to 2000, the University of Minnesota developed and evaluated a longitudinal curriculum to train family practice residents in the prevention and comanagement of HIV disease. Five residency programs participated. The core curriculum was based on 18 teaching modules incorporated into the standard 3-year residency program and covers topics in prevention, diagnosis, and treatment of HIV disease. Residents were encouraged to participate in elective rotations of HIV clinical care, service, and research, as well as attend a Sexual Attitude Reassessment Seminar. Baseline and postcurriculum attitude and knowledge surveys were performed and scores were compared before and after completion of the curriculum, as well as between the participants and a historical control group of residents who graduated in 1997. During the 3 academic years from 1997 to 2000, 214 residents participated in the study. Entering classes did not differ in baseline knowledge. Residents' knowledge about HIV disease, attitudes, confidence, and intention to treat HIV-positive patients improved (p < 0.01). The yearly number of HIV enzyme-linked immunosorbent assay (ELISA) tests performed at the residency sites increased from 1145 to 1665 by the project's end. The HIV Curriculum Project provides a useful model of an interdisciplinary program for training family medicine residents in HIV/AIDS. The evaluation data provide an assessment of the curriculum itself and an important look at family practice residents' knowledge, attitudes, and performance related to HIV over time.

Adult↗
PubMed1986

The effect of clinical pharmacy services on family practice residents' attitudes: a nationwide study.

A nationwide study investigated the attitudes of family practice residents toward: interdisciplinary health care teams in family practice; the clinical pharmacist as a member of the health care team; and the utility of clinical pharmacist involvement in private family practice offices. A random sample of 174 family practice residency programs was selected for study. First-year residents comprised the sample population. Based on the response of the directors, programs were assigned to experimental (programs offering clinical pharmacy services) or control (no clinical pharmacy services) groups. Completed attitudinal instruments were received from 158 resident respondents in the experimental group and 153 resident respondents from the control group. The reliability coefficient of the returned questionnaires was 0.901 by the split-halves method. Residents in the experimental group had significantly more favorable attitudes than those residents in the control group on several scales. These scales included the clinical pharmacist's participation on the health care team, utility of a clinical pharmacist in a private practice setting, desirability of hiring a clinical pharmacist, and the desirability of practicing with a multidisciplinary health care team. These results support the hypothesis that exposure to clinical pharmacy services can significantly affect physician resident's attitudes toward clinical pharmacy.

Attitude of Health Personnel↗
PubMed1996

Family practice instructional development models in Taiwan, review and prospective.

The National Health Insurance Program began in March 1995 in Taiwan. The success of the program depends largely on the operation of "Regionalization Medical Networks" which rely on family practice to provide cost-effective medical care. Instructional development activity needs to be addressed as the highest priority, to meet the impelling needs of family practice training. The acute shortage of family practice educators in Taiwan draws attention for a need of family practice faculty development programs, including short-term seminars and long-term fellowships. Continuing education programs in family practice help keep abreast the scientific as well as the social developments in familiarizing new guidelines of the National Health Insurance Program. Residency training programs that are community-based and ambulatory-oriented will prepare family practice resident physicians to make contributions for the future of "Regionalization Medical Networks". As well, the undergraduate family practice education programs will prepare future physicians with the adaptations and the challenges of the National Health Insurance Program. The allied health education programs are fundamental to build family practice teams to meet community health needs. Lastly, public education programs designed to familiarize the public with the National Health Insurance Program will help give the public an understanding and appreciation of the contributions of family practice in the health care delivery.

Education, Continuing↗
PubMed1996

Unlocking patients' records in general practice for research, medical education and quality assurance: the Registration Network Family Practices.

General practitioners (GPs) possess a wealth of information on the health of their patients. Hence, they are in a unique position to gather information for research, education or management. The chief goal of the Registration Network Family Practices is to establish a computerized database containing certain patient characteristics and all relevant health problems excluding minor, temporary illnesses. The database can be seen as a dynamic population sampling frame of chronic and/or severe morbidity, also including risk factors and psychosocial problems. The best way to make use of the Registration Network Family Practices is by researchers identifying and sampling patients with particular health problems. The database contained patient characteristics and problemlists of 61,887 persons, on September 1, 1995. At that time 214,389 health problems had been entered in the database. The database is increasingly being used as a source of information for studies by researchers and students. Researchers find the database a useful tool, but they have to keep in mind that data on the process of care are not directly available. Furthermore, there is a limit to the number of studies which can be performed in the network practices, due to time limitations and the burden on the doctors and patients.

Data Collection↗
PubMed1998

Russian family practice training program: a single step on a long journey.

BACKGROUND AND OBJECTIVES: Since 1992, when the Russian government recognized family practice as a medical specialty, efforts have begun to progress from the idea stage to the delivery of patient care via family practice methods. We describe an educational effort to help teach Russian physicians family practice skills. METHODS: Five young Russian physicians were selected from an initial pool of 15 candidates on the basis of standardized testing, English language skills, and their potential to teach future Russian family physicians. Clinical, teaching, and business curricula were developed and used during the 6-month training period for the five selected physicians. Trainees were evaluated by mentors' and preceptors' written evaluations and by the American Board of Family Practice In-training Examination before, during, and at completion of the training. Subsequently, a fully equipped family practice office was opened in St Petersburg to serve as an on-site training facility. RESULTS: The trainees' self-perceived knowledge in community medicine, geriatrics, medical decision making, patient education, behavioral science, preventive medicine, and general family practice topics improved over the course of training. The composite scores on the in-training examinations improved from baseline (30 versus 308). Preceptors noted the greatest improvements in the use of clinical instruments, proficiency in physical exams, accessing medical information, and formulating differential diagnoses. The St Petersburg family practice office opened on October 1, 1996. The trainees now participate in the care of patients in this office and teach a new class of family medicine interns. CONCLUSION: The training program we describe has allowed Russian physicians to acquire new skills and knowledge that they can use and adapt to training future Russian family physicians.

Curriculum↗
PubMed1989

Utilization of hospital services. A comparison of internal medicine and family practice.

Five hundred twenty new patients were randomly and prospectively assigned to receive care in the Internal Medicine Clinic or Family Practice Clinic of a large university hospital. Previous analyses of outpatient data demonstrated that the frequency of visits to the clinic of primary care, acute care clinic, emergency room, and consultant clinics were all significantly higher for patients randomized to internal medicine compared with family practice. In the present study, patients' charts were reviewed for information regarding hospitalizations. During the 3.4-year study period, there were a total of 61 hospital admissions for internal medicine (35 of 249 patients), and 58 for family practice (27 to 271 patients). Age (mean 47 years) and sex of patients in both groups were equivalent. The average total cost of hospitalization for each patient was greater for those randomized to the Internal Medicine Clinic: $7,193 for internal medicine patients as compared with $5,764 for family practice patients. The professional costs per hospitalization showed greater variation: $913 for Internal Medicine Clinic patients and $629 for Family Practice Clinic patients. Internal Medicine Clinic patients had a longer mean length of hospitalization (7.5 days) when compared with that of Family Practice Clinic patients (6.3 days). It can be concluded that in this clinical environment the hospitalization patterns are different for patients assigned to the Internal Medicine Clinic compared with the Family Practice Clinic: both cost and length of care for hospitalization are less for those followed by the Family Practice Clinic.

Adult↗
PubMed1996

A curriculum for teaching family practice residents how to manage skin lesions.

BACKGROUND AND OBJECTIVES: A curriculum was developed to teach family practice residents how to manage skin lesions as part of an outpatient rotation during which family practice residents are taught procedures by family medicine faculty. The curriculum can be used as a template for teaching and assessing competency for any family practice outpatient procedure. METHODS: The curriculum was pilot tested by eight second-year family practice residents and evaluated by experts in curriculum design and the methods for teaching outpatient procedural skills. Procedure checklists were used to evaluate competency. RESULTS: The residents scored higher on their posttests than on their pretests. The residents, implementing faculty, and outside reviewers rated the curriculum design highly. Performance of procedures did not require longer times when accomplished through this educational experience. CONCLUSIONS: This curriculum can be used to teach family practice residents how to manage skin lesions. Residents were deemed competent to perform a procedure if they successfully followed all of the steps on the procedure checklist. A specific minimum number of procedures was not required to establish competency.

Clinical Competence↗
PubMed2000

Patients' attitudes to comforting touch in family practice.

OBJECTIVE: To examine patients' attitudes to comforting touch in family practice. DESIGN: A survey was designed with statements and responses to proposed scenarios. SETTING: Twenty family practices throughout Ontario. PARTICIPANTS: Family practice patients; of 400 surveys distributed, 376 were completed (94% response rate). MAIN OUTCOME MEASURES: Patients responded to scenarios on a five-point Likert scale, ranging from strongly disagree to strongly agree. Results were analyzed using SPSS for DOS. RESULTS: Most patients in this population believed that touch can be comforting (66.3%) and healing (57.9%). Women were more accepting of comforting touch than men in all scenarios. Acceptance of comforting touch declined for both sexes as touch became proximal and more intimate. Men and women were more accepting of comforting touch from female doctors. Acceptance of all comforting touch declined markedly if a physician was unfamiliar to a patient, regardless of the physician's sex. CONCLUSION: Most patients surveyed believed touch is comforting and healing and viewed distal touches (on the hand and shoulder) as comforting.

Adolescent↗
PubMed1988

The rheumatology knowledge and skills of trainees in internal medicine and family practice.

Our study examines the rheumatology knowledge and skills of trainees in internal medicine and family practice residency programs. Site visits were made to 15 programs in the eastern half of the United States. Eighty-one trainees participated in the study, 53 in internal medicine and 28 in family practice. Each completed a 50-item rheumatology quiz and performed a clinical assessment of a trained patient evaluator. Trainees in internal medicine had quiz and clinical assessment scores of 52.4% and 72.9%, respectively, while scores for family practice trainees were 43.4% and 61.6% (p less than 0.004 for both). Regression analysis showed that having had a rheumatology elective had a significant effect on knowledge and skills. Trainees in family practice programs were 3 times less likely than internal medicine trainees to have taken a rheumatology elective. Family practice trainee scores in our study were comparable to scores previously documented in 4th year medical students. These results confirm the importance of a specific rheumatology experience for the development of rheumatology knowledge and skills in internal medicine and family practice trainees, and suggest that the rheumatology content of these training programs needs to be enhanced.

Clinical Competence↗
PubMed1978

A survey of students who chose Family Practice residencies.

This paper presents the results of questionnaires sent to medical students at Wayne State University who chose family practice residency programs. It discusses three main areas: (1) choice of family practice as a specialty, (2) choice of a particular family practice residency program, and (3) future plans. Role models, the student's family, student membership in the American Academy of Family Physicians, the student's hometown, and Family Practice Club meetings were all important factors in the decision to become a family physician. The current residents' opinions of their program, the residency director, the quality of the current residents, and the location of the program were rated as quite important in the choice of a particular residency program. Most residents served their residency in their home state. Economic factors and university affiliation were not felt to be influential in program choice. A typical student plans to pursue family practice in a group that employs physician's assistants or nurse practitioners. He/she would also like to practice in his/her home state in either a rural area or a small city. Very few students were interested in either solo practice or academic family medicine.

Adult↗
PubMedDate not supplied

The reading habits of family practice residents.

BACKGROUND AND OBJECTIVES: Little is known about the reading habits of family practice residents. This study describes the reading practices of family practice residents, including how much time they spend reading and what information sources they use, identifies factors that may be used by educators to stimulate resident reading, and identifies factors that may inhibit or discourage reading. METHODS: A questionnaire about reading habits was mailed to 613 randomly selected resident members of the American Academy of Family Physicians in March 1994. RESULTS: Of 613 questionnaires sent, 314 (51%) were completed and returned. Participants reported reading an average of 3.7 hours per week and were most often motivated to read to obtain information related to clinical cases or to prepare for an upcoming presentation. Pocket manuals were the most frequently read and original scientific research the least frequently read sources of medical information. Fatigue and family responsibilities were the factors most important in preventing reading. Year in residency, moonlighting hours, age, gender, or household size were not associated with reported reading time. CONCLUSIONS: Clinical cases and upcoming presentations may be the best motivators of resident reading. Training programs need to continue to develop strategies to minimize resident fatigue, which may lead to increased reading among trainees. The importance of original scientific research articles during residency training is unclear.

Adult↗
PubMed1993

[Continuity of care and hospital admission rates in a rural family practice].

Hospitalization data may be used as an indicator of the quality of care in family practice. There were marked differences between hospitalization rates in a rural family practice and the corresponding national rural rates, which raised questions about the reasons for these differences. All 309 hospital admissions recorded between 1987 and 1990 in a rural family practice were then studied to determine the hospital admission pattern. The crude hospitalization rate of this practice over the period studied was 74/1000 person-years at risk. After indirect standardization with the national Jewish rural hospitalization rate, the actual number of hospitalizations for the family practice (309) was 24% less than would have been expected (407) had the national rural rate applied to the family practice population during the study period. The decreases between actual and expected admissions were greater in the infant, adolescent and elderly age-groups. Continuity-of-care by a single provider in the study practice is presented as an important factor in determining the smaller number of practice hospitalizations recorded.

Adolescent↗