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PubMed1981

Symptoms encountered during a three-year family practice residency.

Family practice research so far has placed a heavy emphasis upon diagnoses (or problems). There are no published descriptive studies of symptoms collected in a family practice in the United States. This study is a collection of the symptoms encountered by a family medicine resident during his three years in a model unit. Three hundred four patients were seen, offering 1,377 complaints in 956 visits (1.44 symptom per visit). Morbidity related complaints consisted of 59 percent of the total, 9 percent of the total being low back or extremity complaints, while 41 percent were nonsymptomatic reasons for a visit. The majority of morbidity complaints dealt with pain. Three percent of the total consisted of delayed complaints, presented only after the resident previously had dealt with other minor complaints in that visit. The results corresponded closely to those found in the National Ambulatory Medical Care Survey.

Adolescent↗
PubMed1997

The extent of military medicine topics taught in military family practice residency programs: Part I. A survey of current military family practice residency directors.

The Military Unique Curricula (MUC) was published in 1988 as a guideline for instruction at military residencies in military-specific topics. To evaluate the degree of implementation and the perceived necessity of the MUC curricula and the attitudes and logistical factors relevant to military medicine instruction in military family practice residencies, questionnaires were sent to all 18 military family practice residency directors. The results reveal a wide range of opinions regarding the importance of military medicine and the amount of instruction of military medicine topics among the residency programs. The total number of topics taught was correlated (p < 0.05) with years as residency director, awareness of the MUC, and an opinion that the material would not be better taught at service-specific schools. There appears to have been little influence of the MUC on the curricula of military family practice residencies since its publication.

Attitude of Health Personnel↗
PubMed2006

Management of incontinence for family practice physicians.

Family practice physicians are likely to encounter urinary incontinence and overactive bladder (OAB) in their patients. An informed family practice physician can generally accurately diagnose the cause and type of incontinence in patients with a properly focused physical examination and, if necessary, auxiliary testing. Accurate diagnosis can lead to effective treatment when physicians are familiar with available treatment options, including pharmacologic, surgical, behavioral therapies, and catheterization.

Family Practice↗
PubMed1988

Alcoholics remaining anonymous: resident diagnosis of alcoholism in a family practice center.

Family practice residents rarely detect more than one half of the alcoholic patients they see. This study examines detection rates in terms of the patient's presenting complaint, the clinical encounter, and the resident's attitudes. Over four months 218 patients of the family practice center of a large community hospital completed a survey that included the Short Michigan Alcoholism Screening Test (SMAST). Chart audits of each patient's visit assessed each resident's behavior in recording questions about the patient's use of alcohol. After the first four months, each resident completed a survey of his or her experiences and attitudes concerning alcoholism. Using the SMAST scores and chart audits, 25 of the 218 patients were identified as alcoholic. The residents detected only 12 of the 25 alcoholics. Of 51 patients who presented for physical examinations, the residents recorded asking only 28 about their drinking; of 157 patients who presented for more limited visits, the residents recorded asking only six about their drinking. Residents rated the alcoholic patient as less motivated, more dangerous, less hopeful, and much sicker than the average person. First-year residents rated alcoholics much more negatively than did upper-level residents. The SMAST again proved to be much more effective than clinical interviews in detecting alcoholism in patients.

Adult↗
PubMed1994

Measuring self-reported comfort with general family practice skills during a required third-year family practice clerkship.

BACKGROUND: To judge the effectiveness of a new required third-year family practice (FP) clerkship, we designed a 20-item FP comfort assessment (FPCA) to measure students' self-reported comfort with a wide range of FP skills. This report examines the behavior and characteristics of the FPCA. METHODS: During the 1990-91 academic year, 179 students who completed the FP clerkship were asked to complete the FPCA on the first and last days of the clerkship. RESULTS: Factor analysis of responses yielded four factors that explained 66.4% of the total variance: relationships and values, history and physical, diagnosis and management, and preventive medicine. After adjustment, internal consistency for each factor ranged from .77 to .89. All postclerkship factor scores were significantly greater than preclerkship factor scores, indicating that the FPCA performed as expected. All postclerkship factor scores and two of the change scores correlated significantly with the students' overall clerkship grade, indicating concurrent validity. CONCLUSION: The FPCA is a reliable and valid measure of student comfort with patient-centered FP skills.

Clinical Clerkship↗
PubMed1997

Which procedures should be taught in family practice residency programs?

BACKGROUND: Family practice residencies lack clear guidelines defining which procedures should be included in their curricula. The American Academy of Family Physicians (AAFP) Task Force on Procedures developed a recommendation (approved by the AAFP Board of Directors) that can be used to create a set of procedures that should be taught in residencies. The task force recommendation is based on procedures taught in most family practice residencies and performed by most practicing family physicians. METHODS: The AAFP Task Force on Procedures surveyed all family practice residency programs and departments to determine which procedures they were teaching. The task force also surveyed a representative sample of practicing family physicians to find out which procedures they were performing. RESULTS: Residency programs and departments returned 397 surveys (74.1% response), and the sample of 4,400 practicing physicians returned 2,028 surveys (46.1% response). The survey data identified 69 procedures as being taught in most family practice residencies, and 30 of these procedures as being performed by most practicing family physicians. CONCLUSIONS: Many procedures can be identified as being taught in most family practice residencies or performed by most practicing family physicians. Fewer procedures are performed by practicing family physicians than are taught in residencies.

Clinical Competence↗
PubMed2001

Assessing guidelines for use in family practice.

With more than 1000 new guidelines produced annually over the past decade, it is impossible for the practicing family physician to determine which ones should be adapted into their clinical practice. The Ontario Ministry of Health and Long-Term Care and the Ontario Medical Association formed the Guideline Advisory Committee (GAC) in 1997 to assess and disseminate guidelines that would improve the quality and utilization of health care services in the province. Over the past 3 years the GAC has developed a strategy to identify important topics, to rank order guidelines published on these topics based on the quality of their development, and to reformat guidelines as necessary to make them user-friendly for implementation in clinical practice. The GAC is currently assessing a number of strategies to enhance the dissemination of selected guidelines to improve the quality of care delivered in the province.

Cost of Illness↗
PubMed1976

Importance of obstetrics in a comprehensive family practice.

Four family practices in the San Francisco Bay Area, two of which did not include obstetrics and two of which did, were examined with reference to their patient populations and to the number of families for which they provided comprehensive, continuous family care. The groups practicing without obstetrics were found to do acute care primarily and, to a lesser extent, long-term care internal medicine, with very little pediatrics or gynecology. The groups practicing with obstetrics did significantly more minor surgery, gynecology, pediatrics, and psychotherapy. During the six-week study, the group practicing with obstetrics saw five times as many patients who were members of families receiving continuous, comprehensive care from the practice under observation. Psychotherapy done by the group including obstetrics was primarily family therapy; for the other group, individual therapy. If larger studies support these findings, then important implications are suggested for training programs in family practice and for the resident deciding to enter practice.

Adult↗
PubMed1991

Obstetric practice patterns among family practice residency graduates.

Obstetric services are a critical health care need in the southeastern United States. Until recently, many family physicians included obstetrics as a part of their practice. In recent years there has been significant attrition from the practice of obstetrics among family physicians. This survey looks at attrition among graduates of the Tuscaloosa Family Practice Residency Program and their practice patterns, as well as the reasons family physicians give for discontinuing obstetric practice. We also discuss implications for residency curricula and remedial measures at the state and national levels.

Alabama↗
PubMed2000

Cluster randomized trials in general (family) practice research.

Cluster randomized trials are increasingly common in general practice (family medicine). This paper will consider the design and analysis of such trials and emphasize the similarities and differences with trials in education, heath promotion and public health. Issues discussed are the estimation and range of values of the intra-cluster correlation coefficient found in general practice, and the associated sample size problems. There are problems with widely varying numbers of subjects per cluster, which leads to planning and analysis difficulties. Ethical issues in these trials, and considerations such as the principle of intention to treat are also considered. An example of the type of analysis available for a continuous outcome variable is given, and the available software is summarized briefly.

Biometry↗
PubMed1999

A longitudinal, national study of the effect of implementing a required third-year family practice clerkship or a department of family medicine on the selection of family medicine by medical students.

PURPOSE: To conduct a longitudinal study of the effect of implementing a required third-year family practice clerkship or a department of family medicine on the proportion of graduating medical students choosing family practice as a specialty. METHOD: Using national data sets, the authors studied the proportion of students who chose family practice as a specialty at each medical school that implemented a required third-year family practice clerkship or a department of family medicine between 1984 and 1993. They compared the mean proportions of students choosing family practice for the three years before and three years after implementation of the required clerkship or the department. They controlled for national trends by comparing study schools with schools that did not have required family practice clerkships. RESULTS: The mean proportions of students who chose family practice increased 2.36% above control schools (95% CI = 1.06, 3.65) in public schools and 2.07% (95% CI = -2.58, 6.73) in private schools after a required third-year clerkship was implemented. The proportion of students choosing family practice declined by 0.84% (95% CI = -4.05, 2.47) after a department of family medicine was established. CONCLUSION: Implementing a required third-year family practice clerkship led to an immediate, significant increase in the proportion of students choosing family practice. Implementing a department of family medicine had no noticeable effect on the proportion of students choosing family practice in the first three years after implementation.

Career Choice↗
PubMed1983

Family conferences: an approach to teaching family systems care in a family practice residency.

Family conferences facilitate optimal planning for patients in a variety of medical situations. In one family practice residency the social worker plays a leading role in planning and arranging family conferences, while involving residents-in-training in the process. Such conferences provide family-oriented care for a spectrum of illness problems common to family medicine. Such conferences are most commonly held prior to discharging a patient from an in-hospital stay. These sessions may also be arranged when a chronic illness is diagnosed in one member of a family or when there is a medical crisis. Family conferences are convened by a resident physician in collaboration with the social worker and/or other appropriate faculty member.

Family Practice↗
PubMed2003

Family practice training over the first 26 years: a cross-sectional survey of graduates of the University of Washington Family Practice Residency Network.

PURPOSE: To describe the current practice setting, scope of practice, and adequacy of residency training of a large cohort of family practice (FP) residency graduates. METHOD: In February 2000, questionnaires containing 120 demographic, practice, and training items were mailed to 1,498 graduates (1973-1999) of the University of Washington Family Practice Residency Network. RESULTS: A total of 983 (71%) graduates completed the survey. Of the 870 who were currently practicing family physicians, 38% were women, 73% worked full-time, 45% practiced in FP groups, and 97% were board certified in FP. A total of 37% practiced in communities of fewer than 25,000 residents, and 29% practiced in federally designated health provider shortage sites. Most cared for their patients in the hospital: 79% for adult medical patients, 54% for adult ICU/CCU patients, and 71% for children. Most provided maternity care: 63% delivered babies and 58% assisted at cesarean sections (12% as primary surgeon). Even in cities of over 100,000, 58% delivered babies. Large numbers of responders performed colposcopy, flexible sigmoidoscopy, vasectomy, and minor surgery. A higher proportion of the most recent graduates provided maternity care and performed colposcopy. Most graduates reported that residency training prepared them well. CONCLUSIONS: FP residency training is modeled to prepare primary care physicians to meet the needs of all patients in all communities. These data document the success of this model in producing and sustaining family physicians to fulfill these roles in practice.

Cross-Sectional Studies↗
PubMedDate not supplied

A model for evaluating the stressed patient in the family practice setting.

Family physicians frequently encounter patients with stress-induced medical and psychological problems. When the symptoms are severe, or the mechanisms are vague, it is often useful to perform a detailed medical, behavioral, and psychological evaluation in order to initiate effective therapy. This paper illustrates a model for evaluating stress-related and other psychosomatic problems in a family practice.

Adult↗
PubMed1994

Management of upper respiratory tract infections in Dutch family practice.

BACKGROUND: Family physicians vary in their management of upper respiratory tract infections (URTIs), especially regarding prescription of antimicrobial drugs and patient referral. This study was designed to provide insight into this variation in the management of URTI. METHODS: A secondary data analysis of a nationwide study of morbidity and interventions regarding the management of cases of acute otitis media, otitis media with effusion, acute upper respiratory tract infections (acute URTIs), sinusitis, and acute tonsillitis was performed. One hundred sixty-one Dutch family physicians and 335,000 patients were included in the study. RESULTS: About 10% of all first contacts in this study were house calls, which are most often made to patients in the youngest and oldest age categories. In one third of all first contacts, an antimicrobial drug was prescribed, most frequently for sinusitis (72%) and acute tonsillitis (74%), much less frequently for otitis media and acute URTI. Doxycycline and amoxicillin were prescribed most frequently; two thirds of all antimicrobial prescriptions for the first contact were for one of these two drugs. In 1% of all first contacts and 6% of repeat contacts, patients with URTI were referred to a specialist. CONCLUSIONS: Compared with physicians in other countries, Dutch family physicians show a relatively restrictive and selective prescription behavior in dealing with URTI. This may be why the Netherlands has one of the lowest reported levels of antibiotic resistance. House calls are still important in Dutch family practice.

Adult↗