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PubMed1994

Factors associated with research interest and activity during family practice residency.

BACKGROUND: Family medicine lacks a tradition of research training during residency. Previous studies of research during residency have surveyed faculty to assess residents' research interests. In contrast, we directly assessed research interest and activity during residency by surveying all 203 Wisconsin family practice residents. METHODS: The survey instrument was a questionnaire that included questions about the appropriateness of research experience, interest in pursuing research during residency, involvement in research, and perceptions regarding program research support. The importance of factors that encourage research were evaluated. We then used stepwise discriminant analysis to assess whether residents with different levels of interest in research had different perceptions about program support and environmental factors that promote research. RESULTS: Of 143 respondents, most (85%) felt research experience was desirable, and 48% were interested in pursuing research during residency. Only 8% were active in research. Although faculty were perceived as having sufficient research skills and encouraging resident research, few residents responded that dedicated time, seminars on goals and methods of family practice research, or funding were available. Residents with research interests were more likely to respond that their faculty had sufficient research skills and knowledge. Active researchers rated time availability and access to resource personnel as highly important. Those interested, but not active, rated basic information, assistance in identifying topics, and a forum for presentation as highly important. CONCLUSION: Exposure to skilled and knowledgeable faculty researchers may stimulate interest in research. Teaching research goals and methods, assisting in identifying topics, and providing research forums, especially early in residency, may promote research activity. Dedicated time for research and availability of resource personnel will enhance this activity.

Attitude of Health Personnel↗
PubMed1989

Practice locations of Texas family practice residency graduates, 1979-1987.

The location of a physician's residency training is known to be a factor in selection of a practice location. In this paper, the authors analyze the practice locations of 689 family physicians who graduated from residency programs in Texas between 1979 and 1987 and who were practicing in Texas in 1988. One-third of these graduates were practicing in cities the same size as their residency program city. More than half were in counties located within 60 miles of the residency city. Both of these trends can be explained to a large degree by the fact that a high percentage of graduates remained in their residency city to practice. When these nonmobile graduates are removed from the sample, the findings show no correlation between the size of the residency city and the size of the practice city. More than two-thirds of those graduates who left their residency city were in counties beyond a 60-mile radius. Almost two-thirds were practicing in communities of less than 25,000 population. The authors conclude that state support for family practice residency training has been effective in distributing family physicians in a manner that addresses the needs of the state of Texas as a whole.

Family Practice↗
PubMed1983

Using private practice settings for academically intensive family practice clerkships.

The Department of Family Medicine and Practice at the University of Wisconsin has designed and conducted an academically intensive third-year three-month family practice clerkship based in private practice settings. This experience differs from more traditional preceptorships in the amount of academic structure and quality control applied to the student's learning experience. This clerkship has demonstrated that extramural experiences can be as academically intensive and carefully monitored as traditional, referral-hospital-based clerkships in family practice or other basic medical disciplines. Increases in the level of continuity of care occur over the entire 12 weeks.

Clinical Clerkship↗
PubMedDate not supplied

Length and content of family practice residency training.

BACKGROUND: Family practice residency programs are based largely on a model implemented more than 30 years ago. Substantial changes in medical practice, technology, and knowledge necessitate reassessment of how family physicians are prepared for practice. METHODS: We simultaneously surveyed samples of family practice residency directors, first-year residents, and family physicians due for their first board recertification examination to determine, using both quantitative and qualitative methods, their opinions about the length and content of family practice residencies in the United States. RESULTS: Twenty-seven percent of residency directors, 32% of residents, and 28% of family physicians favored extending family practice residency to 4 years; very few favored 2- or 5-year programs. There was dispersion of opinions about possible changes within each group and among the three groups. Most in all three groups would be willing to extend residency for more training in office-based procedures and sports medicine, but many were unwilling to extend residency for more training in surgery or hospital-based care. Residents expressed more willingness than program directors or family physicians to change training. Barriers to change included disagreement about the need to change; program financing and opportunity costs, such as loss of income and delay in debt repayment; and potential negative impact on student recruitment. CONCLUSION: Most respondents support the current 3-year model of training. There is considerable interest in changing both the length and content of family practice training. Lack of consensus suggests that a period of elective experimentation might be needed to assure family physicians are prepared to meet the needs and expectations of their patients.

Adult↗
PubMed1990

The role of computers in preventive medicine in a rural family practice.

Five family physicians in a group practice in rural Quebec have introduced a computer system to improve the delivery of preventive medicine. In addition to billing, the computer is used mainly to recall specific groups of patients for preventive measures, to prompt the physicians to carry out certain procedures at the patient's next visit, to indicate which procedures are required for the family members and to generate reminder letters. The physicians are conducting a randomized controlled trial to evaluate the impact of computer-generated reminder letters on patient compliance and disease prevention among families in their practice.

Adult↗
PubMed1999

Practice patterns of rural Texas physicians trained in a full-service family practice residency program.

The family practice residency program of John Peter Smith Hospital (JPSH) emphasizes "full-service" training to enable its graduates to provide a wide range of services to underserved areas, particularly rural communities. The purpose of this study was to investigate the practice patterns of rural JPSH family practice graduates. Of 180 identified JPSH family practice residency graduates who currently practice in rural Texas, 102 (57%) responded to a postcard survey. Data were analyzed by decade of graduation. Recent graduates were more likely to provide obstetrical care than were older graduates. The proportion of graduates providing obstetrical care at some time during their careers was similar. Recent graduates were more likely to perform office-based procedures such as colonoscopy and esophagogastroduodenoscopy. Rural JPSH family practice graduates provided more obstetrical care, critical care, and office-based procedures than did other rural members of the American Academy of Family Physicians. Practice patterns of JPSH family practice graduates have changed little over the past 30 years, except that recent graduates do more obstetrics and perform more endoscopies. These data show that the skills and knowledge of full-service family physicians are still needed in rural Texas.

Clinical Competence↗
PubMed1999

Implications for practice and education. Clinical activities of Iowa family practice PAs.

A survey of family practice physician assistants (PAs) in Iowa was undertaken to determine the frequency with which they utilized specific clinical skills. A response was received from 55 of 77 (74%) PAs surveyed. Average age of respondents was 42 years (range, 35 to 50). Respondents had, on average, been practicing for 13 years, mostly in family medicine; on average, they saw 25 patients a day. All reported providing patient education, prescribing and dispensing medication, interpreting radiographs, referring patients, and providing a wide range of services similar to their physician counterparts in Iowa. In regard to 62 activities identified, few differences emerged among respondents when population setting was considered--except that PAs who work in communities of fewer than 10,000 residents often perform a wider range of services than those who work in larger communities. Activities that have been ranked as important by Iowa family practice physicians in other surveys were also the clinical skills that PAs in this survey reported performing most often. This study supports mounting evidence that PAs are an important aspect of primary care delivery across society. Their activities in the delivery of care are similar to those that the physicians with whom they are most closely associated consider important.

Adult↗
PubMed2000

Treating allergies: a perspective in family practice.

The family practitioner is the first and most important contact person for a patient suffering from any allergic disorder. The reason is simple. Even in this fast-changing world of the twentyfirst century, the family practitioner will continue to be not only a doctor but also a friend, guide and philosopher to many a sufferer in our country. It is therefore important for the primary care physician to take time out for periodic reviews of the therapeutic scenario, which in fact is the objective of this article.

Anti-Allergic Agents↗
PubMed1991

The family culture: a useful concept for family practice.

Each family can be regarded as a unique small-scale society, with its own internal organization and view of the world or family culture. A crucial aspect of each family culture are those beliefs, behaviors, habits, and life-styles that are either protective of health or pathogenic, depending on the context. For family physicians, the insights of medical anthropology are useful in understanding the role of family culture in health, illness, and medical care.

Anthropology, Cultural↗
PubMed1987

Legal and ethical pitfalls in family practice psychiatry.

Family physicians provide a significant amount of mental health care in the form of psychotropic medication and supportive psychotherapy. Providers of primary psychiatric care face a number of legal dangers and ethical pitfalls. Most often, these derive from negligent diagnosis or treatment, failure to prevent suicide and exploitation of the patient. By adhering to sound clinical guidelines and ethical principles, physicians can both protect themselves and provide better care for their patients.

Adult↗
PubMed1996

Clinical practice arrangements of physician faculty in family practice residency programs.

BACKGROUND AND OBJECTIVES: This descriptive study sought information on the types of clinical practice arrangements and the nature of clinical responsibilities of full-time physician faculty in family practice residency programs. METHODS: A four-page, 37-item, self-administered questionnaire was sent to a 20% proportionate, systematic randomly sampled group of family practice faculty. Simple descriptive statistics were used for demographic and clinical practice data. Clinical practice characteristics were compared by the three most frequent clinical practice arrangements (private practice, on-site practice, and off-site practice) to determine differences. RESULTS: The majority of respondents were white, board-certified males. Most faculty saw patients two (26.9%) or three (27.7%) half days per week and between 6-10 (47.5%) and 11-15 (41.1%) patients per session. The most frequent clinical practice arrangements were having faculty see patients in their own private practice (5.3%), as part of the faculty practice in the residency program's health center (72.9%), and as part of the faculty practice remote from the residency program's health center (11.7%). There were no differences among the three arrangements with respect to clinical sessions per week, taking call at night to back up the resident on call, seeing patients outside of regularly scheduled office hours, making house calls, following patients in the nursing home, or offering pregnancy care. CONCLUSIONS: Further research is needed to determine the advantages and disadvantages of different clinical practice arrangements for the clinical skills and role-modeling ability of family physician faculty.

Adult↗
PubMed1990

Evaluating family counselling skills training for family practice.

Educational programmes for family practice should develop family counselling skills of students to moderate levels of competence. Few specific training programmes are part of the regular curriculum and of these few are evaluated. Twenty-three residents enrolled in a 2-year family practice programme in Toronto, Canada participated in a non-randomized control intervention study to assess a specific training programme. Pre-training counselling skills, and ability were assessed using two types of generally recognized measurement instruments, the Carkhuff Stems of Communication Skills and the Carkhuff Discrimination Index. The treatment group entered the training programme which involved supervised family counselling 8 half-days each week for one month as part of their usual rotations. They completed a second set of instruments following this course to assess immediate within-group change and then both they and the control group completed a set about one year later to measure differences. Initial scores for all residents showed a less than 'minimally facilitative' level of counselling response on both empathy and warmth dimensions. Following the course, the treatment group scored above this level and significantly better than the control group. Furthermore, the former showed a 20% improvement in ability to discriminate between effective and ineffective helping responses which was sustained over one year, while the control group's scores became worse. Teaching of counselling skills can be effective.

Adult↗
PubMed1975

Practice objectives and goals; a survey of family practice residents.

This study shows that the majority of family practice residents initially become aware of individual community needs for family physicians in either medical school or early in residency training, but the final decision in regard to the selection of a specific community for private practice is not generally made until late in the third year of residency training. When the final decision as to practice location is established, the family practice resident and his family have regarded at least six different factors as significant. Most family practice residents will enter private practice as members of a group practice, rather than as solo practitioners. There is a direct relationship between the population of the family practice resident's home community and the size of the communities being considered for private practice. The most influential recruiting technique is personal contact by the physicians and citizens of the community, whereas the least effective method of recruiting is through printed material distributed through mail service.

Evaluation Studies as Topic↗
PubMed1979

Morbidity in the first year of a family practice and its comparison to the Virginia study.

In the first year of practice two family physicians recorded 8,795 new problems. The problems were ranked in order of decreasing frequency and compared to the results of the Virginia study. The results support the concept that a curriculum for family practice residency training based on results of the Virginia study is a valuable concept. The study also sheds light on the patterns of disease in a new practive as well as suggesting applications for the use of the disease index in practice management.

Family Practice↗
PubMed1999

Physician practice style patterns with established patients: determinants and differences between family practice and general internal medicine residents.

BACKGROUND AND OBJECTIVES: This paper examines the practice style patterns of family practice and internal medicine residents for established patient visits. METHODS: New adult patients (n = 509) were prospectively and randomly assigned to family practice or internal medicine clinics at a university medical center and followed for 1 year of care by resident physicians. Initial and return visits were videotaped, and physician practice styles were analyzed using the Davis Observation Code (DOC). RESULTS: Resident physicians' practice styles with established patients during return visits were associated with various factors, depending on the DOC cluster of behaviors studied. These factors include patient gender, age, income, physical and mental health status, level of pain, number of return visits, and physician practice style displayed during the initial encounter. Family practice return visits had a greater emphasis on preventive services and counseling, compared with internal medicine return visits. Internists spent more visit time using technically oriented behaviors. CONCLUSIONS: Patient variables, as well as baseline physician behavior, have an important influence on physician practice styles during return patient visits. There are measurable differences in the established practice styles between family practice and internal medicine resident physicians, which may reflect differences in professional training programs.

Adult↗
PubMed1998

The effect of a secondary patient on the family practice visit.

BACKGROUND: This study describes how the provision of care to a family member other than the identified patient affects the outpatient family practice visit. METHODS: Research nurses directly observed consecutive patient visits on 2 separate days in the offices of 138 practicing family physicians. Patient visits during which another family member's problem was addressed were identified. Differences in patient and visit characteristics, patient satisfaction, delivery of preventive services, and time use, measured with the Davis Observation Code, were compared for visits with and without the provision of care to a family member. RESULTS: Care was provided to a secondary patient during 18% of observed outpatient visits. The secondary patient was present during only half of these visits. When another family member's problem was discussed, patients were more likely to report that their expectations for the visit were met. There was no difference in patient report of satisfaction with the visit, the delivery of preventive services, or the level of billing for visits at which another family member's problem was addressed. Visits during which another family member's problem was discussed were an average of 1.3 minutes longer; with less time spent chatting, providing feedback, and conducting physical examinations, and more time spent counseling, taking history, gathering family information, and delivering preventive services. CONCLUSIONS: The provision of care to a second family member is relatively common in family practice, and affects the care of the index patient in identifiable ways. This care of another family member represents an important added value of family practice.

Adolescent↗