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PubMed2002

Teaching the teachers: helping faculty in a family practice residency improve their informatics skills.

Faculty members in family practice residencies are increasingly being asked to help residents develop skills in the use of informatics and evidence-based medicine (EBM). In order to do this successfully the teachers themselves must be skilled in the use of these tools. Recognizing the need for such training, the Maine Medical Center Family Practice Residency Program designed a faculty development project to increase knowledge and skills in the use of information technology. This project, which was carried out in 1999-2001, utilized a multifaceted approach that included improving the residency's technology infrastructure, conducting two instructional workshops, and offering EBM mentoring for preceptors. Faculty members also designed and carried out independent informatics projects. Pre- and post-project assessments of faculty members demonstrated a significant improvement in computer and EBM skills, and informal feedback from residents indicates that these skills have been successfully applied to the faculty members' teaching of residents and their practice of family medicine. This project had a positive impact on the faculty members in the residency program, increasing both their ability to employ information technology in individual and group teaching sessions and their use of EBM in clinical practice. Also, the culture within the residency program has been changed to one of utilizing computers and the Internet as principal resources for up-to-date information.

Curriculum↗
PubMed1981

The current status of neurology of family practice residency programs.

The status of neurology in family practice residency programs was determined. Of 373 programs surveyed by questionnaire, 266 responded (71.3%). Neurology is a required rotation in 48% of the programs, most frequently done during the second year of residency. Preceptors are mainly neurologists in private practice. There is a need for cooperation between neurologists and family practitioners to develop appropriate educational experiences for family practice residents.

Curriculum↗
PubMed1976

A network model for decentralized family practice residency training.

The organization of departments and divisions of family practice in a majority of medical schools in the United States has facilitated a recent trend toward increasing numbers of university affiliations with family practice residency programs in community hospitals. Many difficult issues arise when such affiliations are explored and developed. To date, the literature is meager on this important subject. This paper describes the elements of a network model for decentralized family practice residency training which has been in operation at the University of California Davis for over four years. Common issues are outlined, together with the various advantages of affiliation to the community hospital and the university. An active partnership between the medical school and community through a network of affiliated residency programs can effectively contribute to the quality of medical education and patient care on a regional basis and at the same time directly address the problem of physician maldistribution.

California↗
PubMed1976

An in-training examination for residents in family practice.

An in-training examination for family practice residents has been developed and used in a regional network residency program over the past three years. The most striking result has been the strong preference expressed by residents for question-specific feedback in order to facilitate learning after taking the examination. A well-designed in-training examination has the potential to meet both individual resident and program goals as an additional measure of resident performance and growth, as well as of the effectiveness of teaching in the various curricular areas. In-training examinations for residents are in use by 12 other specialties in medicine, and have been well-accepted by program directors and residents. A nationally-sponsored in-training examination for family practice residents is needed which includes maximal teaching capability through comprehensive and specific feedback.

California↗
PubMed1997

Entry of US medical school graduates into family practice residencies: 1996-1997 and 3-year summary.

BACKGROUND AND OBJECTIVES: This is the 16 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 15.9% of the 16,029 graduates of the US medical schools between July 1995 and June 1996 were first-year family practice residents in October 1996, compared with 14.6% in 1995 and 13.4% in 1994. This is the highest percentage since 1980-1981 (12.8%), when this series of studies began. Medical school graduates from publicly funded medical schools were almost twice as likely to be first-year family practice residents in October 1996 than were residents from privately funded schools, 19.1% compared with 11.2%. The Mountain region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in October 1996 at 24%; the Middle Atlantic and New England regions reported the lowest percentage at 11.4% and 9.9%, respectively. Nearly half of the medical school graduates (48.4%) entering a family practice residency program as first-year residents in October 1996 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.

Career Choice↗
PubMed1987

Health promotion talk in family practice encounters.

The model of family medicine advocates a view of the patient as a psychosocially grounded person, and stresses the value of a preventive approach in maintaining health. Given such principles, it is expected that in the expression of this model--in actual family practice encounters--physicians will regularly introduce topics about health promoting behaviors in their interactions with patients. Examination of a sample of typical and unrehearsed encounters between family physicians and patients, however, reveals a striking absence of such topics. Where they do occur, there is conversational evidence that both parties find the topics troublesome, and employ conversational strategies which tend to distance these topics from the rest of the interview. The conversational features of these distancing strategies, as well as their possible sources and implications, are discussed. Physician participants in the research express no reluctance to introduce topics related to health promotion behavior, and in fact report that they do so regularly: the latter is contradicted by empirical conversational data. Difficulties that physicians evidence in managing these topics--in the absence of any conscious dispreference--suggest that shared interpretive frames operating for the remainder of the medical encounter do not work well for these topics. Physicians desiring to communicate effectively in this area may need to rethink health promotion talk as a special conversational task, which differs in key ways from more conventional topics introduced in medical encounters.

Communication↗
PubMed1977

Prevention of complications in initial development of family practice residency programs.

The development of a family practice residency program involves a complex process that requires careful attention to a wide range of factors, such as educational, clinical, attitudinal, economic, and administrative. Although there are many requisites in common with all such programs, each developing program must be adapted to the particular resources and needs of its own community. The initial planning phase is perhaps the most critical period in a program's development. There are many potential pitfalls that must be avoided in starting a program, any one of which can jeopardize its accreditation and future successful operation. This paper presents a hypothetical case of a developing family practice residency program which illustrates a number of serious pitfalls. Common pitfalls are described, and ten basic principles are presented which are useful in planning and will help to prevent complications in developing programs.

Continuity of Patient Care↗
PubMed1994

Changes in medical students' perceptions of family practice resulting from a required clerkship.

BACKGROUND: Career choice research has shown that exposing medical students to family medicine, through a special medical school emphasis or a required clerkship, correlates with an increased rate of selection of family practice. It has been hypothesized that actual exposure to family medicine mitigates the negative stereotypes held by many medical students. METHODS: This study used a qualitative strategy to examine how a family medicine clerkship altered medical students' perceptions and attitudes toward this specialty. A series of 12 focus groups were conducted with the students who had just completed a required family medicine junior core clerkship at our institution. RESULTS: Focus group findings confirmed the existence of negative stereotypes about family practice among medical students and provided additional information on their nature and origins. In addition, student comments indicated that a third-year family medicine clerkship experience dispelled this negative stereotyping and instilled in students a greater respect for and interest in family practice. CONCLUSION: Third-year clerkships can enhance students' perceptions of family practice by dispelling negative stereotypes and by providing medical students with a more accurate portrayal of the nature of this primary care specialty.

Attitude of Health Personnel↗
PubMed1980

A Balint seminar in the family practice residency setting.

British psychoanalyst Michael Balint made important theoretical and pragmatic contributions to family practice, through the seminars of general practitioners he led at the Tavistock Clinic. A weekly Balint seminar, modeled on the Tavistock groups, was held in a family practice residency. The group of second and third year residents, co-led by a behavioral scientist and a family practice faculty member, met for 12 weeks and then re-evaluated topics and discussion format. Issues covered included physician-patient relationships, ethical dilemmas, group therapy concerns, and coping with clinic pressures. Objective evaluation of these seminars, where the goal is attitudinal rather than behavioral change, presents some difficulty. The conclusion is that residents benefited from the seminar, and that some aspects of psychoanalytic theory and technique are applicable to the teaching of behavioral science in family practice residencies.

Behavioral Sciences↗
PubMed1999

Adult medicine training experiences in a small-town family practice residency.

PURPOSE: To document the adult medicine experiences of family practice residents training in a small rural hospital. METHOD: The authors tracked all inpatient admissions and consults for the first year of a newly accredited family practice residency program, located in a small-town, 80-bed hospital. They analyzed the data for volume of admissions, sources of admissions, diagnoses, lengths of stay, and ICU experience. RESULTS: The residents saw a significant volume of patients, encountered a wide variety of diagnoses, and had ample opportunities for learning, in spite of the small number of occupied beds. CONCLUSION: Family practice residents in small hospitals can have sufficient inpatient training experiences in adult medicine. The authors believe that the Accreditation Council for Graduate Medical Education should encourage the development of residency programs in rural communities by simplifying the accreditation documentation requirements for smaller hospitals.

Adult↗
PubMed1999

Review of University of British Columbia Family Practice Resident Research Projects 1990-1997.

BACKGROUND: Resident research projects can be an important component of building a strong and diversified research presence in family medicine. One of the requirements for graduation from the University of British Columbia (UBC) Family Practice Residency Program is that family practice residents complete a scholarly piece of work. METHODS: UBC family practice resident projects from 1990-1997 were reviewed and classified by methodology. A survey was sent to 251 former residents to determine 1) if their project was published, 2) if not, was there any interest in publication, and 3) what were the main reasons for not pursuing publication. Fifteen projects were selected as suitable for publication and were, with permission of the resident, submitted to medical journals. RESULTS: Sixty-nine percent of the resident projects involved data collection and hypothesis testing, and 40% were cross-sectional, of which patient surveys were the most common method. A total of 190 former residents (71%) have responded to our survey. Seven percent of respondents stated that their project had been published, and 55% would have liked to have tried to publish their project. Of the 15 resident projects we submitted for publication, seven were accepted. CONCLUSIONS: Family practice residents are capable of producing a wide variety of research projects. Only a minority of projects are being published despite the fact that the majority of residents are interested in pursuing publication. Greater assistance by faculty can increase publication of research projects.

Academic Medical Centers↗
PubMedDate not supplied

Family practice residencies in community health centers--an approach to cost and access concerns.

An inadequate number of trained primary care clinicians limits access to care at Community Health Centers. If family practice residents working in these centers can provide care to patients at a cost that is comparable to the center's hiring its own physicians, then expansion of Family Practice Residency Programs into community centers can address both cost and access concerns. A cost-benefit analysis of the Family Practice Residency Program at the Fresno, CA, community center was performed; the community center is affiliated with the University of California at San Francisco. Costs included (a) residents' salaries, (b) supervision of the family practice residents, (c) family practice program costs for educational activities apart from supervision at the community center, and (d) administrative costs attributable to family practice residents in the community center. Benefits were based on the number of patients that residents saw in the community center. Using this approach, a cost of $7,700 per resident per year was calculated. This cost is modest compared with the cost of training residents in inpatient settings. The added costs attributable to training residents in community health centers can be shared with agencies that are concerned with medical education, providing physicians to underserved communities, and increasing the supply of primary care physicians. Redirecting graduate medical education funding from hospitals to selected ambulatory care training centers of excellence would facilitate placing residents in community centers. This change would have the dual advantage of addressing the current imbalance between training in ambulatory care and hospital sites and increasing the capacity of community health centers to meet the health care needs of underserved populations.

California↗
PubMed1992

Computerized health information in The Netherlands: a registration network of family practices.

A registration network of family practices (Registratienet Huisartspraktijken) has recently been established in the Netherlands. Forty two general practitioners in 15 practices, with a patient population of 80,000 people, are using a general practice health information system to establish a central computerized anonymous database containing certain patient characteristics and all relevant health problems. By September 1990 patient characteristics and problem lists for 32,972 patients had been entered and a total of 94,476 health problems had been identified. The database has been set up primarily as a sampling frame, allowing researchers to identify patients with particular health problems. The database can also provide descriptive data on prevalence and incidence rates, fulfil a monitoring function and provide data for practice audit, medical education and health management.

Adolescent↗
PubMed1988

First-year results of routine alpha-fetoprotein testing on prenatal patients in a family practice.

For one year all pregnant women presenting to a family practice clinic for prenatal care were routinely tested for maternal serum alpha-fetoprotein levels (MSAFP). Unexpectedly, 14 (15.7 percent) of 89 tested patients had low MSAFP levels. All 14 pregnant women underwent appropriate diagnostic workups because of the low MSAFP level and were subsequently followed until delivery. Although the literature reports that low MSAFP levels are associated with chromosomal anomalies, none of the 14 women were delivered of infants with anomalies. Reasons for the unexpectedly high rate of abnormal MSAFP levels were investigated. Investigation revealed that normal values for MSAFP tests had been derived from testing performed on high-risk pregnant women who had an inherently higher rate of abnormal pregnancies and, apparently, a different range for normal MSAFP levels than a population of unselected family practice patients. The results of this study demonstrate that it may not be appropriate to apply diagnostic algorithms based on data derived in high-risk subspecialty clinics to unselected patients in a family practice.

Adult↗
PubMed2003

Patient satisfaction and quality of care in walk-in clinics, family practices and emergency departments: the Ontario Walk-In Clinic Study.

BACKGROUND: Although walk-in clinics are an increasingly common feature of Ontario's health care system, the quality of care they provide is the subject of continuing debate. In this study we examined differences in patient satisfaction and quality of care for common acute conditions in walk-in clinics, family practices and emergency departments. METHODS: For this prospective cohort study, we recruited 12 walk-in clinics, 16 family practices and 13 emergency departments from 11 geographic areas in greater Toronto, Hamilton-Burlington and London, Ont. An expert review panel selected and established quality-of-care criteria for 8 common acute conditions. Patients who sought initial care for 1 of the 8 conditions were recruited by an on-site data collector. We used a questionnaire to assess the satisfaction of 433 patients with patient-centred communication, the physician's attitude and any delay in the waiting room during the study visit. Abstractors reviewed 600 charts for the study patients to assess whether the quality-of-care criteria had been met. A quality score for each case was computed as the percentage of applicable criteria that were met. Mean quality scores for the 3 settings were computed, with adjustment for potentially confounding variables (sex, age, city and diagnosis). RESULTS: After adjustment for 12 patient characteristics, walk-in clinic patients were significantly more satisfied than emergency department patients on all 3 satisfaction scales. Family practice patients were more satisfied than walk-in clinic patients on all 3 satisfaction scales, but the difference was statistically significant only for satisfaction with waiting time. Adjusted mean quality-of-care scores were 73.1% for emergency departments, 69.9% for walk-in clinics and 64.1% for family practices. The scores for walk-in clinics and emergency departments were significantly higher than that for family practices. INTERPRETATION: Satisfaction with waiting time was highest among family practice patients. Both family practices and walk-in clinics were perceived more positively than emergency departments on all 3 dimensions of satisfaction. Overall quality-of-care scores were higher in walk-in clinics and emergency departments than in family practices.

Adolescent↗
PubMed1979

Changes in patient perceptions toward a family practice: a case study.

This paper presents the results of an evaluation of a family practice that focuses on changes in patient perceptions over five years. The evaluation includes an analysis of patient attitudes as well as behavior. Patient attitudes are measured by means of a personal interview and behavior is analyzed by creation of a Family Utilization Index. Significant changes are noted in the areas of both reported and actual utilization, with fewer changes in the areas relating to patients' perceptions of health and illness or in attitudes toward either the model of family practice of the specific site of obtaining care. This is not a definitive model for evaluation of family practice, but it is one of the few empirical studies available and suggests the need for more documentation of the effectiveness of family practice as a model for delivering primary care services.

Adolescent↗
PubMed1979

Family practice in the United States of America: the first 10 years.

Family medicine was officially recognized as an independent discipline and as the twentieth specialty in the USA in 1969, when the American Board of Family Practice was established.The main achievements of the first 10 years has been the establishment of departments of family practice in two thirds of the medical schools and the growth of graduate training has advanced rapidly from a total of 290 residents in 1970 to over 6,000 in 1978. Developments in group practice, team work, and medical records have been considerable and research is expanding.In 1976, the 50-year trend of falling numbers of family physicians in the USA was reversed for the first time and excellent progress is also being made in countering the geographical maldistribution of physicians.The challenges for the future of family practice are different from those in the past and are discussed.

Education, Medical↗
PubMed2002

Entry of US medical school graduates into family practice residencies: 2001-2002 and 3-year summary.

This is the 21st 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 10.9% of the 15,900 graduates of US medical schools between July 2000 and June 2001 were first-year family practice residents in 2001, compared with 12.8% in 2000 and 13.4% in 1999. Medical school graduates from publicly funded medical schools were more likely to be first-year family practice residents in October 2001 than were residents from privately funded schools, 12.7% compared with 8.4%. The West North Central region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in October 2001 at 15.2%; the Middle Atlantic and New England regions reported the lowest percentages at 8.0% and 7.2%, respectively. Nearly half of the medical school graduates (48.0%) entering a family practice residency program as first-year residents in October 2001 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 Councilfor Graduate Medical Education-accreditedfamily practice residency programs, based on estimates provided by the American Association of Colleges of Osteopathic Medicine.

Adult↗