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PubMed1975

Continuity of care in family practice. Part 4: implementing continuity in a family practice residency program.

Although continuity of care is an important goal of family practice residency programs, there are many factors which inevitably prevent its full achievement by individual residents in any program. Each resident is frequently faced with conflicting responsibilities involving the Family Practice Center, inpatient clinical services, and other parts of the residency training program. This paper explores this dilemma and suggests a variety of positive approaches to resolve the issue. All family practice residents must necessarily be intimately involved in providing continuity of patient care and develop the requisite skills and attitudes. However, full continuity of care must ultimately be provided on a program and group level, not exclusively by the individual resident.

Comprehensive Health Care↗
PubMed1978

Organizational complexity in family practice: a sociological model of a family practice group.

The growth of a family practice goup is presented as a case study. Enlarging size and increasing functions require organizational change--from solo to collegial to bureaucratic to political systems. Organizational theory distinguishes between the characteristics and functions of individual, collegial, bureaucratic, and political organizations. Different styles and strategies are appropriate at different stages.

Decision Making↗
PubMedDate not supplied

Family practice curriculum: how well does it reflect family practice?

We developed a survey to send alumni from the family practice program at the University of Texas Medical Branch at Galveston. Program graduates were asked how well they had been trained in 29 curricular areas during their residency program. Family practice alumni from programs in Virginia, Wisconsin, Minnesota, and Washington responded to similar questions in previous studies. The Kendal coefficient of concordance was used to determine whether or not graduates of these programs saw the same pattern of curricular strengths and weaknesses; results showed a similar pattern of training needs across the country (W = .81, P less than .001). Alumni saw a need for more training in orthopedics, rehabilitation, and office management.

Curriculum↗
PubMed1980

A family practice education system based on patient care outcomes in family practice settings.

The philosophy, goals, objectives, methodology, and results of a family practice faculty development program are described. Developing family practice educators who will create an education system based on patient care outcomes in family practice settings is the central philosophical purpose of this faculty development program. On completion of the program all participants recognized the essential nature of this philosophical goal and were more comfortable and confident in their ability to: (1) determine resident learning needs; (2) organize curriculum units; (3) use different teaching techniques; and (4) understand their own personal teaching needs and interests. The implications of these changes for developing a family practice curriculum based on patient needs are described.

Faculty, Medical↗
PubMedDate not supplied

Colposcopy practice and training in family practice residency programs.

BACKGROUND: The potential growth of colposcopy as a family medicine procedural skill is directly related to the training currently offered to family practice residents. To define whether these skills are being adequately offered to physicians who want to perform this procedure for their patients, a study was designed to investigate the current status of colposcopy practice and training in family practice residency programs. METHODS: A 16-item survey sent to 356 family practice residency directors in the United States included items concerning colposcopy practice, training, educational programs and strategies, colposcopy coordinator educational background, and colposcopic resource materials and equipment. RESULTS: Surveys were returned from 204 (57 percent) family practice residencies. Colposcopy was performed at 45 percent of the residencies that responded. Ninety-six percent of the respondents who did not perform colposcopy believed colposcopy is a procedure that should be performed by family physicians. Clinical teaching and supervision was the most common method of resident training (74 percent). Colposcopy training coordinators were usually family physicians (72 percent), primarily trained by gynecologists. Assistance with implementing a colposcopy training program was requested by 85 percent of those programs presently not performing colposcopy. CONCLUSIONS: This study indicates that there are opportunities for further development of colposcopy practice and training in family practice residencies.

Attitude of Health Personnel↗
PubMed1998

A close look at family practice in Louisiana: manpower '97. Louisiana family practice residency program needs.

There is a shortage of family physicians in Louisiana. This manuscript reports on the current status of primary care in Louisiana. It compares these data with national averages and assesses current needs. Finally, it proposes necessary steps by which this shortage can be decreased. Medical schools, residency programs, and practicing physicians will need to be involved in the solution to this problem. Louisiana can have a bright future in family medicine if the recommendations in this paper are thoroughly addressed. With ever increasing costs of quality medical care, well-placed funding and emphasis on family practice appear to be the right direction.

Curriculum↗
PubMedDate not supplied

A method for projecting ambulatory visits to a family practice center.

Family practice model centers serve multiple teaching, research, and patient care roles. Accurate projection of patient care demand should promote a center's efficiency. Clinic visit forecasts were performed for a university based family practice center using an exponential time series analytic model. The model provided reliable clinic projections for a one-year time horizon. The projections proved useful for administrative, educational, and academic governance purposes. Time series analysis is a useful and relatively easily implemented tool which can facilitate family practice center administration and support.

Ambulatory Care Facilities↗
PubMed1992

Association between clinical experiences in family practice or in primary care and the percentage of graduates entering family practice residencies.

In 1990 the authors surveyed all U.S. medical schools in order to solicit information about students' clinical experiences in family practice and in primary care. Of 126 schools, 104 (82.5%) responded. Survey data were correlated with each school's quartile ranking based on the average percentage of graduates who entered family practice residencies. A significant association (p = .0013) was found between required family practice clerkships or preceptorships and institutions ranked in the highest quartile (i.e., having more than 17% of their graduates enter family practice). A similarly significant association (p = .0056) was found for those 12 institutions that had more than 30% of their students select family practice options in required primary care clerkships or preceptorships. The authors suggest that active recruiting of students to take such options may increase the number of graduates who enter family practice.

Career Choice↗
PubMed1976

The Adlerian approach: a practical psychology for family practice.

A systematic approach to understanding the patient's personality and helping him cope with common life problems is found in Adlerian Psychology. It is uniquely appropriate to family practice because it stresses the interpersonal purposes of behavior and symptoms and the influence of family constellation on the development of the individual life-style. By obtaining a small amount of data about the patient's present life situation and his family of origin, the physician can gain a basis for understanding how the patient developed his unique way of acting and reacting to the physical and social stresses of life. Interpretation of two or three early recollections reveals what the patient expects of himself, others, and life. The insight thus gained is used as the basis for a holistic assessment of the problem; a directive, supportive, action-oriented plan for treatment; and an ongoing doctor-patient relationship of mutual respect.

Adolescent↗
PubMed1983

Clinical practice plans in family practice residency programs.

This paper examines clinical practice plans (CPPs), systems for remunerating physician faculty based on their clinical productivity, in family practice residency programs. A stratified random sample of residency directors responded to a CPP survey. CPPs were found significantly more frequently in residencies (usually operated by universities) either with CPPs in their parent institutions or with high patient volume. Residencies operated by community hospitals were more likely to distribute CPP benefits to faculty based on individual clinical activity, whereas residencies operated by universities were more likely to distribute equal benefits to all faculty or to include academic as well as clinical activities in the benefit determination. While most residency directors felt that CPPs brought financial benefits to a residency and to individual faculty, many directors who did not have CPPs feared that such a plan would create conflicts between patient care and teaching. A case report tracing the evolution of a CPP in one university-administered residency is presented.

Faculty, Medical↗
PubMed1998

Maternity care practices of navy family practice residency graduates after leaving the military.

BACKGROUND: Nationwide, 32% of residency-trained family physicians deliver babies compared with 73% to 90% in the military. This study describes and defines issues that could ultimately help revive family practice maternity care. METHOD: We surveyed 112 family physicians who had left the navy. RESULTS: Ninety-one percent had delivered babies in the navy, 45% since leaving the military, and 25% currently. Principal maternity care incentives both in and out of the military were personal and professional satisfaction. Reasons for not providing civilian maternity care included malpractice risks, insurance costs, and lifestyle issues. The decision for providing maternity care was usually made before or during residency, whereas the decision against was most often made upon leaving the military. Among more recent graduates (1990-1995), 48% continued to deliver babies in civilian practice. (This is about 20% more than recent civilian graduates.) Malpractice concerns were less important to this group than to earlier graduates. CONCLUSIONS: Factors discouraging family physicians from providing maternity care arise from their practice environment and are not easily overcome with improved training and experience. Recent navy residency graduates are not as easily discouraged.

Adult↗
PubMed1983

Practice management training in family practice residencies.

Recent surveys have suggested that practice management instruction in family practice residency programs is inadequate. The majority of third-year family practice residents graduating in 1980 felt inadequately trained in nearly all aspects of practice management. Thirty-five percent of these residents noted that their residency programs offered no regularly scheduled time for practice management training. Results of four family practice residency graduate follow-up surveys showed that no fewer than 25 percent and, often, 60 to 80 percent of graduates felt underprepared in most areas of practice management.

Administrative Personnel↗
PubMed1980

Psychosocial support of residents in family practice programs.

Family practice residency programs (N = 347) were surveyed to examine the frequency of 11 kinds of psychosocial support available to residents through their programs. Family practice programs offer a considerable number of support elements to residents, with programs showing much homogeneity in the kinds of support offered. The size of a program does influence the kinds of support available, with small programs less likely than medium or large programs to offer the formal kinds of support examined in this study. Four patterns of support emerge from the data, each reflecting a specific orientation: (1) the psychological orientation, (2) the "bare bones" of support, (3) the support group orientation, and (4) the family orientation. In general, the kinds of support that address the residents' family needs are least likely to be available. Because time away from work helps to relieve the pressures of residency training, length of vacation and frequency of night call were also examined. On the average, first year residents cover night call every 3.64 nights and have 2.4 weeks of vacation.

Counseling↗
PubMed1978

Toward the evaluation of family practice: development of a family utilization index.

This paper describes a research project that establishes criteria for utilization patterns of a family practice that could be used to develop evaluation techniques for family practice as a method of delivering primary medical care. The criteria are summarized in a Family Utilization Index, which measures the utilization patterns of a family unit. Changes in the Utilization Index are compared over a five-year period. Changes in attitudes and opinions about family practice in general and the specific Family Medicine Clinic are also compared over time and related to changes in the Family Utilization Index. Utilization patterns have significantly shifted over a five-year period, with more total visits to the clinic due to an increase in the number of family members per family unit using the clinic. Both the utilization patterns and attitudes toward the role of the family physician have shifted, indicating an increased acceptance of family practice.

Adolescent↗
PubMed1979

Differences in morbidity patterns among rural, urban, and teaching family practices: a one-year study of twelve Colorado family practices.

An analysis of one year's data from family practices in Colorado tested the hypothesis that there are no significant differences in the proportion of patients with problems in each of the 18 major International Classification of Health Problems in Primary Care (ICHPPC) categories among visiting patients in rural, urban, and teaching family practices. Four rural, three urban, and five residency practices participated in the study from January 1, 1978, through December 31, 1978. Transient patients were excluded. There were 25,525 patients included in the study. Each setting was compared with the other two settings in each of the 18 ICHPPC categories. More than half of the comparisons differed at the .001 significance level, and the setting with a significantly greater proportion of visiting patients with diseases in a given category was identified. These differences may have implications for disease surveillance, the planning for delivery of primary health care in different settings, and the preparation of health care providers for practice.

Adolescent↗