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PubMedDate not supplied

Inpatient experience of family practice residents in a community hospital.

Decisions regarding residency training require repeated reevaluation of organization and curriculum. Developing an autonomous inpatient teaching service may become necessary in many community hospitals because of a new competitive environment. To predict the impact of this possible change in one community program, we performed a retrospective analysis of 2,735 admissions to a community hospital during a one-year period. Residents' cases were compared with those of practicing family physicians and general internists. If family practice residents in this hospital were limited to an autonomous service, their overall experience and management of patients would be comparable to practicing primary care physicians in the same community hospital. However, volume would be inadequate and exposure to certain types of problems and situations would be limited. In multivariable analysis age, payment status, total consultation rate, many diagnostic categories, and some specific diagnoses separate residents from practicing physicians. As a particular example, internists have a concentration of geriatric patients and patients with cardiovascular disease. In order to utilize this experience, family practice residents in this hospital cannot rely solely on an autonomous teaching service.

Adolescent↗
PubMed2003

Anxiety and anger among family practice residents: a South Carolina family practice research consortium study.

PURPOSE: To study the dimensions of anxiety and anger experienced by a statewide sample of South Carolina family practice residents. METHOD: A total of 350 family practice residents from seven programs participated. Each resident completed the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Profile of Mood States, the Hassles Scale, the Maslach Burnout Inventory, and the State-Trait Anger Expression Inventory (STAXI) on at least one occasion. We analyzed reported anxiety and anger by gender, year of training, race, marital status, type of program (community hospital versus university), location of program, and season of the year. RESULTS: Residents reported lower levels of anxiety and anger across most dimensions compared with the adult populations on which the tests were standardized and with other resident and practicing physician populations. The residents did not demonstrate excessive levels of anger as a trait or in response to situations, nor did they significantly suppress anger. Although the residents reported a higher frequency of hassles than did normal populations, they did not consider these hassles severe. A higher than normal level of depersonalization was found among male, Caucasian, and third-year residents. CONCLUSIONS: These family medicine residents did not experience excessive levels of anxiety or anger during residency training either as a trait, state or somatic response. Extensive social and emotional "in-house" support, attention to stress-management skills, and the moderate personality characteristics of family practice residents help explain these findings. Initial assessment of psychological functioning and early remediation and program support during training may significantly reduce the potential for residents' impairment.

Adult↗
PubMed1997

The maternity care practice of Navy family practice residency graduates while on active duty.

BACKGROUND AND OBJECTIVES: Military family practice residency programs produce a high percentage of graduates who provide maternity care. This study will define the scope of maternity care practice for one military family practice residency program's graduates while they were serving on active duty in the U.S. Navy. METHODS: Two hundred eight surviving graduates of the family practice residency at Naval Hospital, Jacksonville, Florida, from 1971 to 1995 were surveyed by mail regarding their maternity care practice while on active duty. One hundred eighty-one (87%) responded to the survey, and the data were analyzed with descriptive statistics. FINDINGS: The vast majority of these Navy family practice residency graduates provided prenatal care (88.4%) and routine vaginal delivery services (85.1%) while on active duty. The majority repaired third- and fourth-degree perineal lacerations and performed vacuum- or forceps-assisted vaginal delivery. Additionally, a significant minority provided more advanced maternity care services such as dilation and curettage, tubal ligation, and cesarean section. The overwhelming majority (97%) of these graduates felt that their residency education had adequately prepared them to provide these maternity care services while on active duty. CONCLUSIONS: During the past 25 years, Navy residency-trained family physicians provided a wide range of maternity care services while on active duty and felt that their Navy residency training program had prepared them well to meet this responsibility.

Family Practice↗
PubMed1995

The effectiveness of a nutrition education program for family practice residents conducted by a family practice resident-dietitian.

BACKGROUND AND OBJECTIVES: Despite current interest in the role of diet in disease prevention, physicians frequently lack adequate nutrition knowledge. This project sought to test family practice residents' nutrition knowledge, heighten their understanding of nutrition concepts, and implement a method of teaching nutrition in a residency program. METHODS: Following a pretest, family practice residents participated in four teaching sessions during a 5-month period conducted by a fellow resident who was also a dietitian. The residents were asked to keep a 3-day diet diary, which was analyzed with nutrition analysis software. A posttest measure changes in nutrition knowledge and interest. Pretests and posttests were also given to a control group of residents at another campus of the same university-administered program. RESULTS: The intervention group's mean scores increased from 54.7% to 70% (P<.001). Residents who kept a diet diary increased their scores by 23.5%, compared with a 7.4% increase for those who did not. Scores for control-group residents who took both pretests and posttests fell from 43.4% to 42.1%. CONCLUSIONS: Residents who attended lectures conducted by a family practice resident- dietitian and examined their diets showed remarkable improvement in posttest scores of nutrition knowledge. Factors most influential in increasing residents' nutrition knowledge include increasing residents' interest in nutrition, involving them in a longitudinal series of lectures, and providing support for their knowledge and its application.

Adult↗
PubMed2003

Priorities in behavioral science education: views of practicing family physicians.

BACKGROUND AND OBJECTIVES: The behavioral science curriculum in family practice residency programs consists of a wide range of diverse topics. Because of time limitations, not all topics receive equal emphasis. The goal of the present study was to replicate a previous study with family physicians practicing in a different geographical area. METHODS: Questionnaires were mailed to a sample of 543 family physicians in Mississippi. Respondents were asked to rate each of 28 behavioral science topics according to the priority to be given in residency education. RESULTS: One hundred eighty-five surveys were returned for a 34% response rate. The rank order of topics in the present study was highly similar to the rank order in the original study. Female physicians had higher overall mean ratings. CONCLUSIONS: This sample of family physicians in Mississippi provided similar ratings to those in a previous study of family physicians trained and/or practicing in Colorado. The results support that, regardless of geographic location and practice characteristics, family physicians hold similar opinions about which behavioral science topics should receive highest priority in residency training. The behavioral science curriculum in family practice residency programs consists of a wide range of diverse topics. Because of time limitations, not all topics receive equal emphasis. Published resources provide helpful lists of topics and teaching strategies but do not specify which areas should be given priority. Consequently, behavioral science teachers may have difficulty prioritizing the topics because there is no agreement on the core competencies to be given highest priority in residency education. In a previous study, investigators sent a survey to practicing family physicians to determine the topics of behavioral science considered to be most important in residency education. The physicians were able to identify specific topics to be given higher priority. While these previous results were useful, the study was limited by the homogeneity of the sample. All the family physicians had trained or were currently practicing in the state of Colorado. The goal of the present study was to replicate the original study with family physicians practicing in a different geographical area.

Attitude of Health Personnel↗
PubMed1981

Practice locations of family practice residency graduates.

The purpose of this study was to examine the practice location patterns of 1970-1978 graduates of family practice residency programs. Comparisons were made between the number of graduates practicing in a region in 1979 with the number of all graduates during 1970-1978 from family practice residency programs in that region and with the number of all graduates from medical schools in that region who eventually completed family practice residencies elsewhere. The Middle Atlantic and West North Central regions showed marked decreases, while the Mountain, Pacific, and New England regions showed increases. The majority practiced more than 100 miles from their residency program. Most respondents practicing in a nonmetropolitan area moved outside of a 100-mile radius from their residencies. Most respondents practicing in a metropolitan area practiced within the 100-mile radius. Physicians were likely to be practicing in a community similar to their backgrounds.

Family Practice↗
PubMed2001

Bringing a family practice model of health to the People's Republic of China.

The health care system in the People's Republic of China (PRC) is undergoing a major transition that has made the government revise its approach to how medicine is taught and practiced. Family medicine, which provides a generalist approach to medical care, is at the forefront of this transition. This article reviews the recent history of medical education in the PRC, including the establishment of the discipline of family medicine in the mid 1980s, and factors promoting development of family medicine. These include the movement away from government-subsidized health care in hospital settings, the aging population, increased urbanization, increasing incidence of infectious diseases, and rising health care costs. We conclude from observations made in the PRC and from a review of secondary sources that family medicine in China is in its infancy. The value of understanding the role that family medicine plays within China's changing health care system is that we gain a broader perspective of the variety and growing international importance of family practice as a profession.

Delivery of Health Care↗
PubMed1995

Results from the use of a 3-year computer competency curriculum in a family practice residency.

BACKGROUND: Computer competency is becoming essential to practicing family physicians. However, no published computer curricula exist for family practice residents. METHODS: A computer competency curriculum was designed, implemented, and evaluated. Computer software was divided into four categories: patient care, education, practice management, and hospital resources. Competency was measured and recorded by faculty. The residents evaluated the adequacy and relevance of the curriculum to their current and future needs using a questionnaire. RESULTS: Competency testing revealed that residents uniformly achieved competency but at different rates. Residents rated the quality and quantity of instruction in patient care programs highest and in practice management lowest. The usefulness of patient care programs was perceived as high during residency but was expected to be less useful after residency. In contrast, the usefulness of practice management programs was rated as low during residency but expected to be high after graduation. Education and hospital programs were intermediate. Self-assessment indicated that computer use increased during residency; 90% of residents characterized themselves as frequent users. CONCLUSIONS: Despite logistical problems, teaching computer literacy is a responsibility of physician educators. A curriculum must be continually evaluated to ensure that it remains current and relevant to the needs of the residents.

Computer User Training↗
PubMedDate not supplied

The relationship between medical student career choice and a required third-year family practice clerkship.

Family practice as a career choice has been related to a number of educational variables, including the presence of a required clinical clerkship. In order to determine whether or not the timing of the required clinical clerkship was also related to family practice residency selection, a study was undertaken to investigate the relationship between the required third-year family practice clerkship and family practice career choice. The results showed that students who attended medical schools with a required third-year clerkship in family practice were significantly more likely to enter family practice residency training (16.8%), than students who attended schools with a required fourth-year clerkship (14.5% P less than 0.05), or who attended a school with no required family practice clerkship (12.1%, P less than 0.001). These results support the recommendations of the STFM Task Force on Predoctoral Education that a required third-year clerkship in family practice is important in medical student career choice.

Career Choice↗
PubMed1991

Demonstrating the characteristics of family practice through the family medicine clinic located at a college hospital.

During its development, family practice in Taiwan has been housed at the university/college hospitals, and different settings have served as the main bases for service and teaching. To demonstrate the progress made in the family medicine clinic at the Chung Shan Medical College Hospital and to evaluate the appropriateness of this kind of family practice setting, our patient population of 616 was investigated. There were 5177 patient encounters during the period from September 1987 to August 1989. Of 616 patients, 52.3% were male, the average age was 38.5 years, 85.1% lived in Taichung, where the hospital is located, and 60.1% were insured. A total of 117 families, containing 310 members, made up 50.3% of the patient population. Most patients (64.0%) visited us after introductions by their relatives or friends. There was an average of 4.2 visits per patient per year, and only 6.3% of patients were lost to follow-up after their first visits. The three leading causes for visits to the Family Medicine Clinic were general medical examination (14.5%), acute upper respiratory tract infection (13.6%), and peptic ulcer diseases (8.0%): these comprised 36.1% of all patients' problems. The average referral rate among the 5177 patient encounters was 2.9%. Patient education about treatment of disease, immunization against hepatitis B, and screening for liver cirrhosis/hepatoma in hepatitis B antigen carriers were the most common preventative encounters in our clinic. In conclusion, university/college hospitals are certainly not the best site for service and teaching of family practice, since they are not based on ambulatory care.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

An approach to educating family practice residents and family physicians about complementary and alternative medicine.

Complementary and alternative medicine (CAM) in the context of medical education is a controversial topic among the medical community. With the increased popularity of complementary and alternative medicine, medical educators are faced with the need of educating physicians so they would become competent to communicate with patients about CAM. As academic medicine shows more interest in CAM, it is critical to develop initiatives to overcome physicians' attitudinal barriers toward CAM and develop an instruction strategy that can address these needs. An approach to educate family practice residents and family physicians about CAM is described in this article. This patient-centered teaching approach hinges on the belief that CAM and family medicine are closely related. It espouses utilizing critical thinking and basing decisions on evidence-based material. The course covered four main topics in CAM: herbal medicine, traditional Chinese medicine (TCM), homeopathy and complementary nutrition. The course had limited objectives of exposing physicians to the common methods in CAM and providing sufficient information, so physicians could provide their patients with an informed, safe and balanced advice. The instructions emphasized the importance of improving physician-patient relationship and enriching the participant both professionally and personally. Results of our study revealed that after the course physicians' referral to CAM became more selective, at the same time, their personal use of CAM also increased. This reflects the increased value of CAM in the physicians' own healthcare, as well as their improved knowledge of appropriate referral patterns. Most importantly, the course increased the physicians' awareness of the psychosocial aspect of clinical problems encountered in family practice and, through the close observation of CAM in practice, gave them an additional viewpoint to better understand the patient-doctor relationship.

Attitude of Health Personnel↗
PubMed1978

Quantitative assessment of the quality of medical care provided in five family practices before and after attachment of a family practice nurse.

The standards of patient care were maintained in five urban medical practices after the introduction of family practice nurses. Evaluations were achieved before and after their appointment by the indicator condition method. Minimal explicit criteria for the management of patients with 12 indicator conditions and by the use of 14 drugs were approved by an ad hoc peer group of community physicians. These cirteria were applied to the five practices by the use of a single-blind design and the abstraction of unaltered medical records. A standardized score for each practic e permitted comparison of scores for the management of indicator conditions and for the clinical use of drugs before and after attachment of the family practice nurses. For each of the indicator conditions and the drugs assessed in the five practices similar levels of adequacy were observed in the two study periods. These explicit (objective) audit resutls agreed with the implicit (subjective) assessments of the family practice nurses by their physician colleagues.

Drug Therapy↗