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PubMed1983

Graduate follow-up in the US Air Force family practice residency programs.

Between June 30, 1973, and June 30, 1982, 216 family physicians completed residency training in family practice residencies sponsored by the US Air Force. The primary purpose of this study was to measure the adequacy of the graduates' residency training program. One hundred seventy-nine (83 percent) of the graduates responded to an extensive eight-page survey. The study assessed all Air Force program graduates as a whole as well as each program separately. Seventy-four percent of the respondents are still in the Air Force. All but one are board certified, and 19 have been recertified. Of the 179 respondents, 37.0 percent are involved in teaching medical students of family practice residents, only 5.0 percent are dissatisfied with their present hospital privileges, 43.5 percent felt that their residency training was superior to that provided by civilian family practice residency, 53.7 percent felt the training was equal, and 2.8 percent felt the training was inferior. Practice satisfaction and continuing medical education needs were also addressed in the study.

Family Practice↗

PubMed1977

The role of geriatrics in a family practice residency program.

In an attempt to clarify the role of geriatrics in family practice, the program at St. Joseph's Hospital and Nursing Home of Yonkers is outlined. The objective of this Family Practice Program are: 1) to assist in identifying needs in a target population and in developing and providing services to meet these needs; 2) to train and educate the Family Practice resident in the multiple medical, social and psychiatric problems of late life; 3) to indoctrinate this resident in the unique and numerous needs of the institutional elderly and of the institution in which they reside; and 4) to develop new and comprehensive systems of health care that will permit the marginally ill elderly to remain in the community as long as possible.

Family Practice↗

PubMed1997

Recent implementations of electronic medical records in four family practice residency programs.

Electronic medical records (EMRs) are increasingly replacing paper records, and many residency program directors are interested in incorporating EMR systems into their clinics. The authors describe their experiences implementing EMRs in their family practice residency programs; the four programs are the Eau Claire Family Practice Residency Program, the Galveston Family Practice Residency Program, the Mayo-Scottsdale Residency Program, and the Wyoming Valley Family Practice Residency. The authors provide background information about each program and an overview of the EMR systems; they then describe the implementation processes, addressing training, integration with other software- and paper-based systems, security, costs, and effects on patient volume and staffing levels. Finally, they discuss the general benefits of and barriers to EMR-system implementations, and make recommendations for other programs considering implementing EMRs.

Attitude to Computers↗

PubMed1979

The after-hours call: a survey of United States family practice residency programs.

This article reports the results of a 1977 survey of 245 family practice residency programs providing after-hours care. The objectives of the study were: (1) to clarify the involvement of family practice residents in this aspect of medical care; (2) to investigate the organization of after-hours care in the family practice centers as a possible training model for future family physicians; and (3) to establish whether or not specific educational activity was based on after-hours calls. All the responding operational programs provided after-hours care to patients, using all levels of residents as providers. Most of the programs used an answering service. Only 67 percent documented all patient encounters in writing. Regular educational feedback to residents was undertaken by 71 percent of the residency programs.

Appointments and Schedules↗

PubMed1994

Family practice residents' attitudes toward their academic projects.

BACKGROUND AND OBJECTIVES: As research has become an increasingly important activity in family medicine, so the teaching of research skills has become an important part of family practice residents' training. The purpose of the study was to determine the attitudes toward research and related topics of a family practice program's graduates who had participated in a required academic project during their residency training. METHODS: A questionnaire using Dillman methodology was mailed to graduates of the University of Toronto family practice program. Graduating years surveyed were 1987-1992. RESULTS: There were 321 (78%) responses from the 427 graduates. Most projects completed during residency had been literature reviews. Ninety percent of respondents felt that critical appraisal skills were important to them as practicing physicians, but only 39% felt they had been sufficiently educated about these skills. Other research-related skills (writing, presenting, data analysis) were learned more thoroughly. The majority (58%) felt neutral or negative about their projects, and 79% would not have done a project if it had been optional. CONCLUSIONS: This cohort of family practice graduates felt negatively about the teaching of research skills during residency. Providing more support and developing a curriculum may improve resident satisfaction.

Adult↗

PubMed1983

Entry of US medical school graduates into family practice residencies: a national study.

No authoritative source has reported the percentage of each medical school's graduates who enter family practice residency programs. This study is the first of a series of reports from the American Academy of Family Physicians to report such data. Approximately 12.8 percent of the 15,667 graduates of United States medical schools between July 1980 and June 1981 were first-year residents in family practice in December 1981. The West North Central Region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in December 1981; the New England and Middle Atlantic regions had the lowest percentages. Medical school graduates from publicly funded medical schools were twice as likely to be first-year residents in family practice in December 1981 as were graduates from privately funded medical schools.

Career Choice↗

PubMed2003

Results of the 2003 National Resident Matching Program: family practice.

The results of the 2003 National Resident Matching Program (NRMP) reflect a persistent decline of student interest in family practice residency training in the United States. Compared with the 2002 Match, 118 fewer positions (179 fewer US seniors) were filled in family practice residency programs through the NRMP in 2003, as well as 23 fewer (12 fewer US seniors) in primary care internal medicine, 20 fewer in pediatrics-primary care (11 fewer US seniors), and 23 fewer (34 fewer US seniors) in internal medicine-pediatric programs. In comparison, 40 more positions (14 more US seniors) were filled in anesthesiology and 8 more (8 more US seniors) in diagnostic radiology, two "marker" disciplines that have shown increases over the past 3 years. Sixty-seven more positions (but 148 fewer US seniors) were also filled in categorical internal medicine, while 107 more positions (33 more US seniors) were filled in categorical pediatrics programs, where trainees perceive options for either practicing as generalists or entering subspecialty fellowships, depending on the market. While the needs of the nation, especially rural and underserved populations, continue to offer opportunities for family physicians, family practice experienced continued decline though the 2003 NRMP. Many different forces, including student perspectives of the demands, rewards, and prestige of the specialty; the turbulence and uncertainty of the health care environment; liability protection issues; and the impact of faculty and resident role models, are impacting medical student career choices. The 2003 NRMP again confirms the trend away from family practice and primary care careers.

Education, Medical, Graduate↗

PubMed2002

Results of the 2002 National Resident Matching Program: family practice.

The results of the 2002 National Resident Matching Program (NRMP) reflect a persistent decline of student interest in family practice residency training in the United States. Compared with the 2001 Match, six fewer positions (103 fewer US seniors) were filled in family practice residency programs through the NRMP in 2002, as well as 48 fewer (30 fewer US seniors) in primary care internal medicine, 1 fewer in pediatrics-primary care (8 more US seniors), and 45 fewer (45 fewer US seniors) in internal medicine-pediatric programs. In comparison, 43 more positions (70 more US seniors) were filled in anesthesiology, but 11 fewer (16 fewer US seniors) in diagnostic radiology, two "marker" disciplines that have shown increases over the past 3 years. Eight fewer positions (60 fewer US seniors) were also filled in categorical internal medicine while 99 fewer positions (142 fewer US seniors) were filled in categorical pediatrics programs, where trainees perceive options for either practicing as generalists or entering subspecialty fellowships, depending on the market. While the needs of the nation, especially rural and underserved populations, continue to offer opportunities for family physicians, family practice experienced a fifth year of decline through the 2002 NRMP. Many different forces, however, are impacting medical student career choices, including student perspectives of the demands, rewards, and prestige of the specialty, the turbulence and uncertainty of the health care environment, liability protection issues, and the impact of faculty and resident role models. The 2002 NRMP results may herald the leveling of recent trends away from family practice careers.

Adult↗

PubMed1983

The telephone in family practice.

In a time-and-motion study in family practice it was found that 35,8% of all patient contact was per telephone. The study further revealed that 12,3% of total practice time was spent on the telephone, stressing its importance as a useful tool in family practice. The study supports others which suggest that 'telephone medicine' is worthy of careful examination in terms of cost-effectiveness. The implications for the doctor-patient relationship are also considered.

Family Practice↗

PubMed1997

Family practice house officer perceptions of faculty teaching behaviors.

In 1985, Wolverton and Bosworth published an often referenced study of family practice teaching behaviors. Their research identified 20 "most helpful" and 10 "least helpful" behaviors. In 1994 all United States Army family practice house officers were asked by survey to rate each of the original 38 Wolverton and Bosworth teaching behaviors as "not at all helpful," "somewhat helpful," "moderately helpful," "very helpful," or "most helpful" in aiding their learning. Mean values were calculated for each teaching behavior. Twenty most helpful and 10 least helpful faculty teaching behaviors were identified for U.S. Army family practice house officers; several differences were identified in comparison with Wolverton and Bosworth's original study. Additionally, three most helpful and four least helpful teaching behaviors were clearly illuminated. Incorporating the results of this new study into residency programs could improve the learning opportunities afforded family practice house officers during their internships and residencies.

Attitude of Health Personnel↗

PubMedDate not supplied

Medical students view family practice.

All students at the University of Minnesota, Duluth, School of Medicine responded to a 65-item questionnaire about their perceptions of changes facing medicine, the future of family practice, and career choices. Three different orientations toward family practice were identified--"stayers," "defectors," and "potential defectors." Students who had abandoned their original preference for family medicine (defectors) were compared with students who had maintained an interest in family medicine (stayers). Defectors anticipated a diminishing clinical role for future family practitioners, expressed doubt about the financial viability of smaller community based family practices, and explicitly linked concerns about their anticipated debt load to their changes in career preferences. This study also identified a subgroup of "potential defector" students (within the stayer cohort) who maintained an interest in family practice but evidenced concerns similar to the defector students. Implications of these findings for the future supply of primary care physicians for rural and traditionally underserved communities are discussed.

Attitude of Health Personnel↗

PubMed1977

A british view of American family practice.

I report my impressions, as a British doctor, of American family practice and describe training schemes for family practice and the American approach to assessment and continuing education.

Education, Medical, Graduate↗

PubMed2003

What to do when faced with the closure of a family practice residency.

The turbulent health care environment, combined with recent reductions in federal support for graduate medical education, has threatened the viability of many residency programs. Several family practice programs are in the process of struggling for survival, while others have been forced to close. A new Residency Assistance Program (RAP) consultation has been developed to help programs "justify their existence " to sponsoring institutions. This paper discusses the signs that a program's viability may be in jeopardy and offers recommendations to reduce the risks of closure. For those residencies forced to cease operations, 11 recommendations are provided to minimize the negative impact of closure on the program's residents, faculty, and staff. Those include steps to assure that current residents receive full credit for the training time completed and the importance of notifications to the Residency Review Committee for Family Practice, the American Board of Family Practice, and the Association of Family Practice Residency Directors. Decisions must be made about whether the option exists to permit current residents to complete their training in the same facility or whether assistance is available to facilitate resident transfers to other programs. Open and honest communication among affected parties is emphasized to minimize the emotional consequences of such an important event.

Academic Medical Centers↗

PubMed1998

[Preconception counseling in family practice; a survey of 100 family physicians].

OBJECTIVE: To assess the awareness, opinions on desirability and preconditions such as special knowledge with regard to the concept of preconceptional health counselling among general practitioners. DESIGN: Descriptive. SETTING: General practices in the Groot Gelre district of the Dutch General Practitioners Society. METHOD: A representative sample of 100 general practitioners were asked by phone for permission to send a questionnaire; 89 out of the 94 general practitioners who were sent a questionnaire replied (response: 89%). RESULTS: Almost all general practitioners (88%) knew about the concept of preconceptional health counselling and most of them already gave some kind of preconceptional advice. 93% considered preconceptional health counselling part of their job responsibility and 91% were prepared to give more preconceptional health care in the future. 53% of all general practitioners, however, indicated that they lacked sufficient knowledge to give adequate advice. The advantages of preconceptional health care were considered to outweigh possible disadvantages such as medicalization of pregnancy. CONCLUSION: The general practitioners knew about preconceptional health care and considered it part of their job. Many already provided preconceptional health care, although not in a structured way. General practitioners appeared to lack time and appropriate knowledge, which indicates a need for postgraduate training.

Data Collection↗

PubMed1987

Factors determining patients' satisfaction in a family practice residency teaching center.

A primary function of family medicine teaching centers is to provide residents with ongoing experiences with patients and their families. A critical issue in maintaining a stable patient population for such teaching is patient satisfaction. In the study reported here, the authors examined the factors determining patients' satisfaction. A questionnaire was mailed to a representative sample of 10 percent of the patients in a family practice in a family medical center. Seventy-eight percent of the sample responded; these respondents were representative of the sample population. Four variables were identified as significant in determining the patients' satisfaction: whether the patients felt that the time spent with their identified family physician was adequate and that the physician's explanations regarding their health care and the teaching program were clear; whether the patients felt comfortable in expressing their concerns about the teaching program to the permanent staff members; whether the patients had a positive attitude regarding the teaching program; and whether the patients felt that their identified family physician was available to them.

Consumer Behavior↗

PubMed1980

Psychiatric illness in family practice.

One hundred twenty patients from each of 6 family practices were surveyed to determine the prevalence of symptom-based psychiatric illness (emotional distress) in family practice. Assessments of presence or absence of emotional distress and the severity of this distress were made using ratings made by the treating physician and by the patient. Nineteen percent of the surveyed patients were designated by their physicians as having "high distress," and 21% by the patient-completed abbreviated Hopkins Symptom Checklist (HSCL-25). High concordance (86.7%) existed between the "case" assessment by the physician and the patient's own rating of distress. For the majority of "high distress" patients, pharmacotherapy was considered the treatment of choice by physicians.

Adult↗

PubMed1983

Responses to questions frequently asked by medical students about family practice.

During their medical school years medical students are frequently exposed to misinformation about family practice from faculty members in other specialties. Responses to 26 questions frequently asked by medical students about family practice are presented with a review of recent literature. These responses may assist medical students and their advisors when considering careers in family practice.

Attitude↗

PubMed2001

Interpretation of the American Board of Family Practice In-training Examination.

The American Board of Family Practice (ABFP) In-training Examination (ITE) is the most frequently used method of evaluation among accredited family practice programs. Despite its common use, there are still misunderstandings regarding the proper interpretation of the ABFP ITE results. The ABFP ITE is a norm-referenced test that allows for comparison of a resident's performance relative to other residents in the same year of training; it does not measure absolute performance. There is a paucity of evidence supporting the validity of the ABFP ITE. The eight specialty areas and clinical set problems lack sufficient reliability to be interpreted per individual resident. The composite score of the ABFP ITE has sufficient reliability to be used as part of a formal and comprehensive evaluation system. Group comparisons using the 10 ABFP ITE measures are appropriate.

Data Interpretation, Statistical↗