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Biomedical subjects

William R Phillips

Publications and source records attributed to William R Phillips.

11 recordsLinked to original sources
PubMed2006

A conceptual framework for developing teaching cases: a review and synthesis of the literature across disciplines.

Case-based teaching is regarded as a superior instructional method compared with lectures in promoting a learner's critical thinking skills. While much is known about the role a discussion facilitator plays in case-based teaching, the debate on the influence of the format and structure of cases on learning is controversial. We sought to identify strategies for constructing cases based on studies from multiple disciplines, which report the development and use of cases in teaching and learning. The purpose was to offer the medical and other educational communities a conceptual framework that can be examined in future research. Based on a review of 100 studies, we synthesised 17 strategies around 5 core attributes of cases: relevant (level of learner, goals and objectives, setting of case narrative); realistic (authenticity, distractors, gradual disclosure of content); engaging (rich content, multiple perspectives, branching of content); challenging (difficulty, unusual cases, case structure, multiple cases), and instructional (build upon prior knowledge, assessment, feedback, and teaching aids). Despite the wide use of cases in disparate disciplines, there has been no overarching study that synthesises strategies of case development or tests these strategies in research settings. The framework we developed can serve as a menu of case development options that educators and researchers can pilot and evaluate in their local settings.

Clinical Competence↗
PubMed2006

Prepared but not practicing: declining pregnancy care among recent family medicine residency graduates.

BACKGROUND AND OBJECTIVES: Pregnancy care has been an important component of family medicine in the Pacific Northwest. This paper describes a sudden decline in the provision of pregnancy care by recent family medicine residency graduates in the region. METHODS: Two cohorts of graduates from the University of Washington Family Medicine Residency Network were surveyed about their current pregnancy care practice patterns. A total of 205 graduates from 1997-1999 (surveyed in 2000) and 223 graduates from 2000-2002 (surveyed in 2003) completed the surveys (69% and 65% response rates). RESULTS: From 2000 to 2003, there was a 20% decline in the proportion of recent family medicine residency graduates performing deliveries in their practice (78% versus 58%). The proportion performing prenatal care declined from 81% to 64%. Graduates from all the programs across the region rated their preparation for the practice of pregnancy care highly, regardless of whether or not they currently provided such care. In addition to graduation cohort, the provision of pregnancy care was also related to practicing in the Washington, Alaska, Montana, and Idaho (WAMI) region, providing hospital care, and feeling well prepared to provide pregnancy care. (Wyoming residency programs became affiliated with the WAMI network in 2003 and are not included in this analysis.) CONCLUSIONS: Fewer new family physicians are providing pregnancy care in the Pacific Northwest. This decline does not appear to be related to training but threatens access to service for patients.

Cross-Sectional Studies↗
PubMed2004

STD care: variations in clinical care associated with provider sex, patient sex, patients' self-reported symptoms or high-risk behaviors, partner STD history.

Sexually transmitted diseases in the United States are frequently diagnosed by private, as well as public, physicians. However, we know little about the decision processes that physicians employ when faced with people who may or may not be infected. To address this gap, we compared physicians' responses to different patient vignettes to assess how variations in patients' presentations affect physicians' clinical behavior. We systematically varied reported symptoms, behavioral risk, partner STD, and sex of patients in 16 different vignettes, with one vignette randomly presented to each physician in a national survey. Physicians rated the likelihood of 12 clinical management actions they might take with the patient vignette presented. Responses varied with self-reported symptoms, high-risk behavior, and report of an STD infected partner such that female physicians were more attentive to sexual health, and all physicians were more likely to treat female patients aggressively, relative to their male patients. Overall behavior was broadly congruent with sound medical practice, although we discuss several caveats to this general statement.

Decision Making↗
PubMed2004

Questioning the Future of Family Medicine.

The Future of Family Medicine Report is a milestone in the development of the discipline devoted to generalist physicians and the patients and communities they serve. From this vantage point, we must take stock of our past as well as our future. In this personal essay, I question the process of the Project and the conclusions of the Report. Important questions remain, and I list 10 that seem too important to leave unasked. Hope for the future springs from the capacity of the family physician to learn from experience, adapt to change, and care for people.

Delivery of Health Care↗
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↗
PubMed2002

STD screening, testing, case reporting, and clinical and partner notification practices: a national survey of US physicians.

OBJECTIVES: This study presents results from a national survey of US physicians that assessed screening, case reporting, partner management, and clinical practices for syphilis, gonorrhea, chlamydia, and HIV infection. METHODS: Surveys were mailed to a random sample of 7300 physicians to assess screening, testing, reporting, and partner notification for syphilis, gonorrhea, chlamydia, and HIV. RESULTS: Fewer than one third of physicians routinely screened men or women (pregnant or nonpregnant) for STDs. Case reporting was lowest for chlamydia (37 percent), intermediate for gonorrhea (44 percent), and higher for syphilis, HIV, and AIDS (53 percent-57 percent). Physicians instructed patients to notify their partners (82 percent-89 percent) or the health department (25 percent-34 percent) rather than doing so themselves. CONCLUSIONS: STD screening levels are well below practice guidelines for women and virtually nonexistent for men. Case reporting levels are below those legally mandated; physicians rely instead on patients for partner notification. Health departments must increase collaboration with private physicians to improve the quality of STD care.

Adult↗
PubMedDate not supplied

New knowledge for and about primary care: a view through the looking glass of the Annals of Family Medicine.

PURPOSE: At this second anniversary of the Annals of Family Medicine, we sought to characterize primary care research and to identify opportunities for new directions by analyzing the content of the first and second volumes of the Annals. METHODS: Using an a priori classification scheme, 2 editors independently categorized each research article and essay published in 2003 and 2004, excluding supplements. We categorized the domain of knowledge, methods, topical content, whether articles represented core values of primary care, and looked for articles that studied health/illness/symptoms from a uniquely primary care experience. We reconciled differences by discussion. RESULTS: Among 110 articles, knowledge domains reflected the 4 quadrants of the clinician (n = 6), patient, family, or community (10), health care system (32), disease (22), or the interface (39) between these quadrants. The most frequent methods were cross-sectional studies (23), cohorts (15), randomized clinical trials (13), qualitative interviews (11), analyses of secondary data (11), systematic reviews (11), methods/theory development (10), self-reflections (8), and mixed methods (5). The most common topical areas were chronic disease and prevention. Core primary care values were represented in 75% of articles. Only 2 articles represented an integrative illness/healing perspective. CONCLUSIONS: Despite contemporary forces driving a reductionistic approach, primary care research, as reflected by articles published in the Annals of Family Medicine, addresses the domains of knowledge that contribute to comprehensive, relationship-centered health care. More work is needed to understand the nature of health and illness in whole people and ways to integrate diverse knowledge, methods and fragmented health care.

Health Knowledge, Attitudes, Practice↗
PubMedDate not supplied

Zebras on the commons: rare conditions in family practice.

BACKGROUND: Family physicians (FPs) specialize in the management of common problems, but we know little about their role in the care of patients with rare conditions. OBJECTIVE: To describe the roles FPs play in the identification and management of patients with rare conditions in a typical practice. METHODS: Office record review of 100 patients with rare conditions in the everyday, community-based, private practice of 4 FPs. Analysis of patient demographic characteristics, diagnoses, and the roles played by the FP in the patient's care, including diagnosis, treatment, referral, and long-term patient management. RESULTS: These FPs cared for patients with a wide variety of rare disorders across the spectrum of patient age and sex, organ system involved, and medical specialty area. FPs identified the problem in 89%, diagnosed the disorder in 54%, provided acute care in 56%, and provided continuing care for 76% of patients. FPs consulted other physicians in 85% of cases. The condition was life threatening in 58% of patients. CONCLUSIONS: Family physicians provide a broad range of services to a wide variety of patients with rare medical problems.

Adolescent↗