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PubMed1999

Number of deliveries performed during family practice residency training.

BACKGROUND AND OBJECTIVES: We conducted a study of family practice residency programs to investigate the number of deliveries performed by residents during training. METHODS: A one-page questionnaire was mailed to family practice residency program directors, requesting an estimate of the number of deliveries performed by each resident. In addition, information on residency characteristics was taken from the American Academy of Family Physicians Directory of Family Practice Residency Programs. RESULTS: Responses were received from 316 programs, for a response rate of 70%. Residency directors estimated that residents did a mean of 18 continuity and 24.5 obstetrics block month deliveries. On the average, residents delivered 93.9 babies in 3 years of residency. The number of continuity deliveries was related to location of the program and type of program. Total deliveries related to the presence of a competing obstetrics program, faculty who were doing their own deliveries, location of the program, and number of required months of obstetrics. On multivariate analysis, only the latter two variables predicted the number of total deliveries. CONCLUSIONS: Family practice residents deliver an average of 94 babies in 3 years of residency training. Programs that want to increase deliveries can best do so by increasing the number of required months of training.

Delivery, Obstetric↗
PubMed1995

Family practice bashing as perceived by students at a university medical center.

BACKGROUND AND OBJECTIVES: Medical schools are being asked to produce more family physicians, but it is not always clear how this can be accomplished. Previous research has focused on students' characteristics and attitudes that predict specialty choice but has paid less attention to feedback they receive in the academic medical center environment. METHODS: In early 1993, a self-administered questionnaire was mailed to 160 students from all classes of the University of California, San Francisco Medical School who had previously shown interest in family practice. Data are shown for the 138 respondents. RESULTS: Most students from all years had received positive feedback about their interest in family practice, usually from family physicians. By the fourth year, 95% of students had received negative feedback, usually from physicians in other specialties. Many students gave poignant examples of pejorative comments about family practice by faculty and house staff. Negative feedback seemed strongest at the time students were making decisions about residency. By the fourth year, only 39% of these previously interested students chose family practice. CONCLUSION: Serious efforts to encourage students to enter family practice must address the problem of negative feedback from other specialties. To promote positive feedback, contact with family physicians should be increased, especially in the third and fourth years.

Academic Medical Centers↗
PubMedDate not supplied

Continuity of care for family practice patients in a university hospital-based residency program.

In the present study, conducted in a university hospital-based family practice residency program, 271 new patients to the family practice clinic were followed for a mean length of 3.4 years. During that time 27 (10 percent) patients were hospitalized at least once. Of a total of 58 hospitalizations, lasting an average of 6.3 days, only eight were made from the family practice clinic and only four family practice patients were actually admitted to the family practice ward service. Furthermore, more than half of the admissions were to the internal medicine or the obstetrics and gynecology services. This would appear to be inappropriate, given the fact that family physicians are trained to care for acutely ill adult patients and many obstetrical and gynecological patients. A review of hospital admissions records revealed a variety of issues in continuity of care. Recommendations are made regarding possible solutions and further research in this area.

Adult↗
PubMed1979

Graduate education in family practice: a ten-year review.

Assessment of the progress of graduate education in family practice after ten years shows that the original goals established for residency training in this specialty are being effectively met. There are now more than 360 approved family practice residencies in the United States with over 6,000 residents in training. Student interest in these programs has remained at a high level, and attrition has been low. Graduates of these programs have favored partnership and group family practice, and are well distributed in rural, suburban, and metropolitan areas. Heavy emphasis has been placed upon quality control mechanisms for both internal and external review of family practice residency programs. This paper outlines some concerns regarding the present status of family practice residencies, and suggests some directions for future development of these programs.

Curriculum↗
PubMed2004

Frequent attenders in family practice in Croatia: retrospective study.

AIM: To determine the number of "frequent attenders" in family practice offices in Croatia according to the number and proportion of frequent attender visits in the total number of visits, and to follow up the frequent attenders and the number of visits they made over a period of three years. METHODS: The retrospective study involved 8 family practice offices in Northern Croatia. The number of visits to family practice was determined for 4,312 patients aged over 18 years. There were 1,826 men (42.3%) and 2,486 (57.7%) women. The follow up period lasted from January 1, 1997 to December 31, 1999. The borderline value that divided the frequent from non-frequent attenders was the value at the third quartile of the number of visits in a single age-sex group of patients. RESULTS: We recorded a total of 58,088 visits of patients older than 18 years to 8 family practice offices in the three-year period. In 1997, out of 4,312 patients who made a total of 17,938 visits, 944 (22%) frequent attenders made 11,257 (63%) visits. In 1998, there were a total of 20,350 visits made, with 966 (22%) frequent attenders making 12,145 (60%) visits. In 1999, a total of 20,725 visits were made, with 988 (23%) frequent attenders making 12,259 (59%) visits. The differences in the distribution of frequent vs non-frequent attenders according to age and sex were not statistically significant in any of the three study years (chi-square, p=0.727). Older men and older women were not more often frequent attenders than younger men and younger women, respectively. Out of 4,312 patients, 1,714 (40%) were frequent attenders in one of the three study years. Of these, 884 (21%) were frequent attenders in one year, 476 (11%) in two years, and 354 (8%) in all three subsequent study years. Out of 4,312 patients, 1,762 (41%) patients in 1997, 1,139 (26%) in 1998, and 1,116 (26%) patients in 1999 did not make a single visit to a family physician. CONCLUSION: Frequent attender visits make a great proportion of the total number of visits to family practice offices in Croatia, a country with a health care system in transition. Eight percent of patients remained being frequent attenders during all three study years.

Croatia↗
PubMed1991

Liability insurance for moonlighting by family practice residents.

BACKGROUND: Moonlighting is a widespread practice among residents in family practice programs. It is thought that many residents fail to appreciate the problems that moonlighting may pose with respect to liability insurance. METHODS: A survey regarding liability insurance instruction and moonlighting insurance was sent to the chief resident of each family practice residency program (380) in the United States. An overall response rate of 78.7% was achieved. RESULTS: Chief residents appear to have limited knowledge about liability insurance, believe that education about liability insurance in the residency program is inadequate, and are not well informed regarding liability insurance issues related to moonlighting. CONCLUSIONS: Information regarding professional liability insurance and its implications for the resident who chooses to moonlight should be a part of the practice management curriculum of every residency program.

Awareness↗
PubMed1986

Family practice and internal medicine clinical judgment in a university setting.

There were no significant differences between family practice and internal medicine residents in the proportion of total diagnoses that were reasonable (72 percent and 77 percent, respectively) and unreasonable (14 percent and 15 percent, respectively) or average number of consultations requested per examination (.15 and .16, respectively). There was a significant difference between the two types of physicians in the average number of laboratory tests requested per examination (1.42 per family practice and 1.88 per internal medicine) and average number of x-ray examinations requested per examination (0.35 for family practice and 1.02 for internal medicine). The average length of examination for internal medicine tended to be longer than for family practice. Although generalizability of this study is limited, the results suggest that there may be important differences in the practice patterns of family practice and internal medicine with implications for training programs.

Clinical Laboratory Techniques↗
PubMed2003

Nutrition education in family practice residency programs.

BACKGROUND AND OBJECTIVES: Nutrition is a required part of family practice residency training. Unfortunately, little is known about the quality or effectiveness of this nutrition training. This study evaluated the current status of nutrition training in family practice residency training programs. METHODS: We surveyed 100 randomly selected US family practice residencies about their nutrition education curriculum. Surveys were sent by e-mail, mail, fax, or administered by phone to individuals identified as responsible for nutrition teaching. A response rate of 66% was obtained. RESULTS: Programs varied greatly in their emphasis on nutrition. Identified barriers were similar across most programs. The presence of at least a part-time faculty member dedicated to nutrition was correlated with perceived effectiveness of nutrition education efforts. CONCLUSIONS: If family physicians are to be prepared to inform their patients regarding nutrition and to make appropriate referrals, improvements in the nutrition curriculum offered in many family practice residency programs will be required. Readers can evaluate their program's nutrition education efforts and see how they compare to our sample. Specific recommendations for potential changes are included.

Clinical Competence↗
PubMed1976

A study of thyroid disease in family practice.

Thyroid disease is relatively common in family practice, yet is often undiagnosed or poorly managed. This study examines several aspects of thyroid disease in a large, semirural family practice setting and exemplifies the type of practical clinical research that can be done in family medicine. An overall prevalence of approximately one percent was determined for thyroid disease in this practice. In a series of 85 patients, the ratio of hypothyroidism:hyperthyroidism:euthyroid goiter was 9:2:1 respectively. Initial signs and symptoms recorded for these patients conformed closely to the findings in other large series. Eighty percent of the patients with idiopathic hypothyroidism never had enlarged glands, whereas 100 percent of the patients with hypothyroidism associated with Hashimoto's thyroiditis had enlarged glands. Laboratory aids such as serum thyroid stimulating hormone (TSH), anti-thyroid antibodies, and radioactive iodine uptake (RAIU) and scans were inadequately utilized. Medical and/or surgical consultation was obtained in 17.5 percent of patients with hypothyroidism, 80 percent of patients with hyperthyroidism, and 63 percent of those with euthyroid goiter. Currently 95 percent of the hypothyroid patients and 100 percent of the hyperthyroid patients are euthyroid.

Adolescent↗
PubMed2002

The accelerated residency program: the Marshall University family practice 9-year experience.

BACKGROUND: In 1989, the American Board of Family Practice (ABFP) approved the first of 12 accelerated residency programs in family practice. These experimental programs provide a 1-year experience for select medical students that combines the requirements of the fourth year of medical school with those of the first year of residency, reducing the total training time by 1 year. This paper reports on the achievements and limitations of the Marshall University accelerated residency program over a 9-year period that began in 1992. METHODS: Several parameters have been monitored since the inception of the accelerated program and provide the basis for comparison of accelerated and traditional residents. These include initial resident characteristics, performance outcomes, and practice choices. RESULTS: A total of 16 students were accepted into the accelerated track from 1992 through 1998. During the same time period, 44 residents entered the traditional residency program. Accelerated resident tended to be older and had more career experience than their traditional counterparts. As a group, the accelerated residents scored an average of 30 points higher on the final in-training exams provided by the ABFP. All residents in both groups remained at Marshall to complete the full residency training experience, and all those who have taken the ABFP certifying exam have passed. Accelerated residents were more likely to practice in West Virginia, consistent with one of the initial goals for the program. In addition, accelerated residents were more likely to be elected chief resident and choose an academic career than those in the traditional group. Both groups opted for small town or rural practice equally. CONCLUSIONS: The Marshall University family practice 9-year experience with the accelerated residency track demonstrates that for carefully selected candidates, the program can provide an overall shortened path to board certification and attract students who excel academically and have high leadership potential. Reports from other accelerated programs are needed to fully assess the outcomes of this experiment in postgraduate medical education.

Data Collection↗
PubMed2001

The effect of families on the process of outpatient visits in family practice.

OBJECTIVES: Our goal was to describe how physician knowledge of patients' families affects the processes of patient care in family practices. STUDY DESIGN: Using a multimethod comparative case study design, detailed dictated field notes were recorded after direct observation of patient encounters and the office environment as part of the Prevention and Competing Demands in Primary Care Study. We identified domains of outpatient visits in which patients were accompanied by a family member or in which family-oriented content was discussed. POPULATION: Outpatient encounters with 1637 patients presenting in 18 family practices in the Midwest were analyzed using an editing style. OUTCOMES: We developed a typology for ways in which family context affects outpatient visits. RESULTS: Patients were accompanied during 35% of all outpatient visits, the vast majority of these visits involving children. Family history or a family member's problems were discussed during 35% of visits during which no family member was present. An analysis of these "family-oriented" visits resulted in a typology of 6 ways that family context informs and affects the outpatient visit: (1) using family social context to illuminate patient disease, illness, and health; (2) using family to discover the source of an illness; (3) discussing and managing the health and illness of family members; (4) family concern for patient's health; (5) using the family as a care resource and care collaborator; and, (6) giving family members unscheduled care. CONCLUSION: Family context is an important feature of family practice that influences the processes of patient care. Since family-oriented care is an essential feature of family practice, outcomes of this largely hidden part of care deserve further study.

Adult↗
PubMed2000

Accuracy of electrocardiogram reading by family practice residents.

OBJECTIVES: This study evaluated the electrocardiogram (EKG) reading skills of family practice residents. METHODS: A multicenter study was carried out to evaluate the accuracy of EKG reading in the family practice setting. Based on the frequency and potential for clinical significance, we chose 18 common findings on 10 EKGs for evaluation. The EKGs were then distributed to residents at six family practice residencies. Residents were given one point for the identification of each correct EKG finding and scored based on the number correct over a total of 18. RESULTS: Sixty-one residents (20 first year, 23 second year, and 18 third year) completed readings for 10 EKGs and were evaluated for their ability to identify 18 EKG findings. The median score out of 18 possible points for all first-, second-, and third-year residents was 12, 12, and 11.5, respectively. Twenty-one percent of residents did not correctly identify a tracing of an acute myocardial infarction. Data analysis showed no statistically significant difference among the three groups of residents. CONCLUSIONS: We evaluated the accuracy of EKG reading skills of family practice residents at each year of training. This study suggests that EKG reading skills do not improve during residency, and further study of curricular change to improve these skills should be considered.

Clinical Competence↗
PubMed2002

Addressing the unique challenges of inner-city practice: a direct observation study of inner-city, rural, and suburban family practices.

Previous research on geographic variations in health care contains limited information regarding inner-city medical practice compared with suburban and rural settings. Our main objective was to compare patient characteristics and the process of providing medical care among family practices in inner-city, suburban, and rural locations. A cross-sectional multimethod study was conducted emphasizing direct observation of outpatient visits by trained research nurses involving 4,454 consecutive patients presenting for outpatient care to 138 family physicians during 2 days of observation at 84 community family practices in northeast Ohio. Time use during office visits was assessed with the Davis Observation Code; satisfaction was measured with the Medical Outcomes Study nine-item Visit Rating Scale; delivery of preventive services was as recommended by the US Preventive Services Task Force; and patient-reported domains of primary care were assessed with the Components of Primary Care Instrument. Results show that inner-city patients had more chronic medical problems, more emotional problems, more problems evaluated per visit, higher rates of health habit counseling, and longer and more frequent office visits. Rural patients were older, more likely to be established with the same physician, and had higher rates of satisfaction and patient-reported physician knowledge of the patient. Suburban patients were younger, had fewer chronic medical problems, and took fewer medications chronically. Inner-city family physicians in northeast Ohio appear to see a more challenging patient population than their rural and suburban counterparts and have more complex outpatient office visits. These findings have implications for health system organization along with the reimbursement and recruitment of physicians in medically underserved inner-city areas.

Adult↗
PubMedDate not supplied

Medical school financial support, faculty composition, and selection of family practice by medical students.

OBJECTIVE: This study examines the relationship between the choice of family practice by medical students in the 1986-1987 academic year and nine variables: ownership of school, weeks of required family medicine clinical training, age of school, and six variables related to medical school financial support and faculty composition. METHODS: In multivariate analysis, three variables were found to be significantly related to choice of family practice (R2 = .441): weeks of required family medicine clinical training, proportion of faculty in family practice, and ownership of the school. A cluster analysis was performed using nine variables. RESULTS: Along with the multivariate analysis, the resulting nine clusters demonstrate that additional variables need to be identified to explain the variance in percentage of students choosing family practice at different schools.

Career Choice↗
PubMed2003

Entry of US medical school graduates into family practice residencies: 2002-2003 and 3-year summary.

This is the 22nd report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family practice residency programs. Approximately 10.3% of the 15,810 graduates of US medical schools between July 2001 and June 2002 were first-year family practice residents in 2002, compared with 10.9% in 2001 and 12.8% in 2000. Medical school graduates from publicly funded medical schools were more likely to be first-year family practice residents in October 2002 than were residents from privately funded schools, 12.3% compared with 7.3%. The Mountain and the West North Central regions reported the highest percentage of medical school graduates who were first-year residents in family practice programs in October 2002 at 16.3% and 15.9%, respectively; the Middle Atlantic and New England regions reported the lowest percentages at 6.1% and 5.6%, respectively. Nearly half of the medical school graduates (48.6%) entering a family practice residency program as first-year residents in October 2002 entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. This article reports the average percentage for each medical school for the last 3 years. Also reported are the number and percentage of graduates from colleges of osteopathic medicine who entered Accreditation Council for Graduate Medical Education-accredited family practice residency programs, based on estimates provided by the American Association of Colleges of Osteopathic Medicine.

Education, Medical, Graduate↗
PubMedDate not supplied

Entry of US medical school graduates into family practice residencies: 1991-1992 and 11-year summary.

This is the 11th report prepared by the American Academy of Family Physicians on the percentage of each medical school's graduates entering family practice residency programs. Approximately 10.3% of the 15,499 graduates of US medical schools between July 1990 and June 1991 were first-year residents in family practice in October 1991. This compares to 10.7% the previous year. The West North Central region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in October 1991 at 15.3%; the Middle Atlantic and New England regions continued with the lowest percentages. Graduates from publicly funded medical schools were more than twice as likely as those from privately funded schools to be first-year residents in family practice in October 1991, 12.9% compared to 6.2%. Approximately half of medical school graduates entering their first year of family practice residency training in October 1991 selected a program in the same state as their medical schools. This report includes the average percentage for each medical school for the last 11 years, as well as the number and percentage of graduates from osteopathic schools who entered ACGME-accredited family practice residency programs.

Family Practice↗
PubMed1994

Entry of US medical school graduates into family practice residences: 1993-1994 and 3-year summary.

This is the 13th report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family practice residency programs. Approximately 12.3% of the 15,564 medical school graduates between July 1992 and June 1993 were first-year family practice residents in October 1993, compared with 10.8% the previous year. This is the highest percentage since 1983-1984. Medical school graduates from publicly funded medical schools were more than twice as likely to be first-year family practice residents in October 1993 as were residents from privately funded schools, 15.9% compared with 7.1%. The Mountain region again reported the highest percentage of medical school graduates who were first-year residents in family practice programs in October 1993 at 19.1%; the Middle Atlantic and New England regions continued with the lowest percentages at 7.7% and 6.6%, respectively. At least one in four graduates from nine medical schools during the reporting period was in a family practice residency program in October 1993; only two medical schools had this distinction in 1992. Approximately one in two medical school graduates entering a family practice residency program as first-year residents in October 1993 entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. The average percentage for each medical school for the last 3 years is reported.(ABSTRACT TRUNCATED AT 250 WORDS)

Career Choice↗
PubMed1997

Results of the 1997 National Resident Matching Program: family practice.

The 1997 National Resident Matching Program (NRMP) results reveal all-time highs for the number of positions filled in family practice residencies (2,905) and the number of positions filled with US seniors (2,340). This is the largest number of US seniors choosing family practice in the history of the NRMP. Of the 65 additional positions filled through the NRMP, compared with 1996 (2,905 versus 2,840), 64 were filled with additional US seniors (2,340 versus 2,276). Continuing a trend begun in 1992, the 1997 results showed more positions filled in family practice residencies on July 1 than in the previous year, with 3,570 in 1997, compared with 3,494 in 1996. Internal medicine residencies matched 128 more US seniors in 1997, and pediatric residencies matched 63 more US seniors. Of the US seniors matching through the NRMP, only 37.5% are predicted to practice as generalists. In the past 5 years, family practice has been the choice of 71.5% of additional US seniors choosing primary care. The continued record increased interest in family practice as a career, coupled with the nation's need for more family physicians, demands increased support for the nation's family practice residency programs.

Career Choice↗