PubMed Health⌕ Search

Biomedical subjects

J Zweifler

Publications and source records attributed to J Zweifler.

11 recordsLinked to original sources
PubMed2001

Development of a residency/MPH program.

BACKGROUND AND OBJECTIVES: Public health complements the care physicians provide to patients. Few residencies, with the exception of preventive medicine residencies, offer trainees the opportunity to obtain a public health degree. The University of California, San Francisco-Fresno (UCSF-Fresno) Family Practice Program and California State University-Fresno (CSU-Fresno) spearheaded the creation of a combined residency/MPH program at the UCSF-Fresno Medical Education Program. METHODS: We developed a combined residency/MPH program that allows family practice residents to obtain an MPH degree during their residency training years. We describe the development process, which included initiation of the program, setting goals and objectives, identifying MPH course content and funding, and selecting applicants for entry into the program. RESULTS: The program was successfully funded, and the course content was developed. Participant selection, registration, and enrollment procedures have now been developed. Performance standards have been established, and scheduling conflicts have been addressed. The program has thus far enrolled 29 residents and faculty. Nearly one third have dropped out of the MPH component of the program, mostly because of the workload involved in simultaneous residency and MPH training. CONCLUSIONS: Other training programs can replicate a combined residency/MPH program if a strong relationship with a nearby university offering a MPH degree can be forged. The experience at UCSF-Fresno can help guide others contemplating a combined residency/MPH program.

California↗
PubMed1998

Teaching residents to care for culturally diverse populations.

The authors discuss the growing need for primary care residents to learn how to care for patients of many cultural backgrounds. To effectively learn the needed skills, residents must incorporate insights from areas outside medicine. The authors focus on three such areas: cultural competency, public health, and community-oriented primary care. Regarding cultural competency, the authors make clear that on the one hand, physicians must be trained to be sensitive to cultural differences and patterns, but on the other, they cannot be expected to know the many cultures of their patients in depth. They discuss the Core Curriculum Guidelines on Culturally Sensitive and Competent Health Care created by the Society of Teachers of Family Medicine. Regarding community-oriented primary care (COPC), a process introduced from Europe in 1982, the authors state that one of its key elements is to provide accessible care to diverse and often underserved populations. However, various factors have kept COPC, and the federally funded community health centers that address the concerns of COPC, from having the widespread effects they could have. Regarding public health, the authors review the various services and orientations of public health and show how these help foster care for diverse populations. The authors then briefly describe their own residency program and its work with diverse populations. They conclude by emphasizing the importance for residents of learning the principles and practices embodied in cultural competency, public health, and COPC in order to effectively communicate with their patients.

Attitude to Health↗
PubMed1998

Preparing for managed care: family practice residents and capitated care in community health centers.

This article examines the financial impact on patients of family practice residents when a community health center (CHC) serving as a residency training site is converted to a capitated payment system. The costs in this analysis included using and educating family practice residents at CHCs, the cost of patient encounters at CHCs, and the cost of contracted capitated services. These costs were measured against capitated per member per month (pmpm) payments received by the CHC. If capitated patients were cared for by residents, the CHC would lose $8.42 pmpm. The CHC faced a $5.98 pmpm loss if it used staff physicians rather than residents. This analysis suggests there are educational costs associated with training physicians in capitated health care delivery systems. Family practice residencies and CHCs must prepare for the conversion to capitated systems; academic centers with managed care contracts must control patient encounter costs and utilization to remain competitive.

California↗
PubMed1998

Medical education in a changing world: thoughts from California.

BACKGROUND AND OBJECTIVES: Medical education has been buffeted by the frenetic changes in our health care delivery system. This commentary focuses on six major issues facing family practice training programs caring for underserved populations in California: 1) The patient base for training programs is eroding. 2) There is no or limited funding for graduate medical education (GME) in Medicaid managed care programs. 3) There are barriers to using residents in managed care systems. 4) Disproportionate share funding from Medicaid for hospitals caring for poor and underserved patients does not support medical education. 5) Capitated Medicare and Medicaid programs are siphoning off dollars meant for GME. 6) Consolidation in the health care market is threatening medical education training sites. To address these issues, primary care GME programs should work with community-based sites so both can increase patient care, educational activities, and revenue in this managed care era. At the same time, community-based training sites in primary care GME programs must redesign their delivery systems to provide efficient, cost-effective care. The result will be better access for primary care patients and more appropriate training for our residents. Family medicine educators should become increasingly involved at the local, state, and national levels to ensure that GME funding directly supports training and is not relegated to being a by-product of patient care.

California↗
PubMed1996

Extended educational sessions at three family medicine residency programs.

There are few descriptions of graduate medical education curricula in the literature, and the descriptions that have been written have focused more on content than on format. Traditionally, educational presentations in residency programs are offered in one-hour time slots, a format that may be too limited for interactive sessions or hands-on activities. Further, whether these one-hour sessions are offered in the morning, at noon, or in the afternoon, they all present hindrances to residents' attendance. The authors propose that reserving extended blocks of time for educational sessions for residents is one way for programs to ensure both that residents attend the sessions and that they are able to learn what they need to learn during their training to meet the special requirements of the appropriate residency review committee. The authors present the experiences of three family medicine residency programs in developing and implementing extended educational sessions. Each program has multiple training sites, including rural sites. The three programs release residents from their clinical responsibilities to enable them to participate in the half-day to day-long sessions, which cover behavioral issues, procedures training, and other topics. The success of these three programs suggests that extended educational sessions are a viable alternative to the traditional one-hour format.

Curriculum↗
PubMed1993

Balancing service and education: linking community health centers and family practice residency programs.

Many medical educators are calling for an increased emphasis on ambulatory care training, but financial constraints are often cited as impediments to developing ambulatory care training sites. A growing number of family practice residency programs (FPRPs) are affiliating with community and migrant health centers (C/MHCs). This movement has the potential to strengthen community-based ambulatory care training, while addressing some of the financial concerns noted above. This article illustrates how FPRPs can establish mutually beneficial linkages with C/MHCs, while operating within the policy parameters established by the Residency Review Committee (RRC) and the Bureau of Health Care Delivery and Assistance (BHCDA). For this to occur, BHCDA and C/MHCs need to calculate the time required for attending physicians to supervise family practice residents and to contribute to the legitimate educational and teaching needs of the FPRP. Conversely, FPRPs must work closely with C/MHCs to ensure that family practice residents maintain acceptable levels of productivity. The RRC can make it more feasible to have pathways at smaller C/MHCs by allowing those attending physicians supervising family practice residents to see a reduced patient load, determined by the number of residents working at the C/MHC.

California↗
PubMedDate not supplied

Barriers to recognition of erectile dysfunction among diabetic Mexican-American men.

BACKGROUND: Diabetes is widespread among Mexican-Americans, and erectile dysfunction is a well-recognized complication for which effective treatments are available. Men who desire treatment, however, might not volunteer erectile complaints to their physician, especially across cultural lines. METHODS: We surveyed diabetic Mexican-American men cared for in two community health centers to estimate the prevalence of self-reported erectile dysfunction, to learn how frequently they discuss sexual function with their physician, and to evaluate factors that facilitate or inhibit discussion. RESULTS: Of the participants surveyed, 59 percent (95 percent confidence interval [CI] 48-70) reported always lacking erection in one or more proposed circumstances, whereas 82 percent (95 percent CI 73-91) reported frequent erectile insufficiency in the same circumstances. Patients reporting erectile problems were no more likely to have discussed sexual function with their physician than those who denied frequent erectile dysfunction. Of those with frequent erectile dysfunction, only 47 percent had had a discussion about sexual function with their physician. We found that these men did not initiate discussion because they were embarrassed or expect the physician to initiate the dialogue. CONCLUSIONS: Erectile dysfunction is common in diabetic Mexican-American men and is underrecognized by clinicians and underreported by patients. Because effective treatments exist, primary care physicians should routinely ask their diabetic patients about erectile function.

Adult↗
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↗