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PubMed1996

Family practice residency training capacity in Wisconsin: current status and future projections.

BACKGROUND: High quality health care depends on superior training and outstanding residency opportunities for new physicians of all types, especially those entering family practice. But concern over the availability of adequate opportunity has caused the medical community concern across the country. Wisconsin is no different. To estimate future residency needs in the Badger State, we examined recent trends in specialty selection and information gathered from 1995 medical school graduates entering family practice residency training here and in other states. We surveyed all Wisconsin medical school graduates entering family practice training positions in July 1995, asking them to rank in-state and out-of-state programs, as well as graduates' motivations for selecting those programs. RESULTS: Response rates to our surveys were exceptional. A full 86% (n = 30) those entering residency in Wisconsin and 95% (n = 18) for those in out-of-state programs responded. One graduate who entered a Wisconsin program ranked an out-of-state program higher and one graduate who entered an out-of-state program ranked a Wisconsin program higher than their ultimate residency sites. Not surprisingly, the variable most predictive of whether students pursued training in Wisconsin rather than out-of-state was the student's state of residency before entering medical school. CONCLUSIONS: The resulting trends show positive trends toward state-based family practice training, but may not be as optimistic as experts first predicted. If interest in family practice rises to goals set by the state's medical schools, more training positions will be needed, but not as many as proposed in medical school plans to the state Legislature.

Career Choice↗

PubMed1979

Group process in teaching family dynamics to family practice residents.

Behavioral science training in family practice at Madigan Army Medical Center, Tacoma, Washington, has used small group seminars to teach family dynamics on an experiential level. The group process is similar enough to dynamics within families to facilitate understanding by introspection. Small groups are an efficient method for teaching, and allow experiential learning to occur spontaneously as well as on a planned basis.

Family↗

PubMed1989

The Journal of Family Practice 1974-1988. Window to an evolving academic discipline.

This paper examines the spontaneous evolution of original work in family practice as published in The Journal of Family Practice over the 15-year period since it began publication in 1974. An analysis was carried out by principal content and type of paper for the last five years in a manner comparable to an earlier analysis of the journal's first ten years of publication. Trends that emerge from this reanalysis provide a window to observe the further development of family medicine as a scientific and academic discipline. The last five years have seen a marked increase in clinical content of papers (from approximately 60 to 80 percent of published papers) together with continued emphasis on health services subjects. There has been a concurrent sharp increase in research papers, continued strong representation of case studies, and some decrease in both reviews and methods papers. Descriptive research continues to predominate among research papers. Although experimental research still represents only 5 percent of published papers, this percentage has more than doubled over the last five years. The reanalysis also revealed a substantial decline in the proportion of educational papers, as other journals in the field have assumed the primary role for this content area. It appears that the manuscript supply represented by original work in the field is still limited and that there is at present adequate or even surplus journal capacity for publication of work carried out in family practice settings. The quality and type of work continue to mature consistent with the needs of family medicine as a scientific and academic discipline.

Family Practice↗

PubMed1991

Attitudes of family practice residents about speech-language-hearing referrals.

The "family doctor" has been identified as the professional most likely to be contacted by the general public with concerns about communication disorders; yet the family practice physician is unlikely to refer patients with communicative disorders to speech-language pathologists or audiologists for nonmedical evaluation and treatment. The purpose of this study was to determine attitudes of family practice residents about referral patterns for communication disorders using a survey format. Thirty-nine residents estimated that they had referred an average of 1.5 patients to a speech-language pathologist and 2.2 patients to an audiologist during a six-month interval. The findings indicated that these residents did not routinely refer patients to speech-language pathologists. When they did refer, a limited view of communication problems was used.

Attitude to Health↗

PubMedDate not supplied

Entry of U.S. medical school graduates into family practice residencies: a national study, December 1983.

This study is the second in a series of reports from the American Academy of Family Physicians on the percentage of each medical school's graduates who enter family practice residency programs. Approximately 12.9% of the 15,985 graduates of United States medical schools between July 1981 and June 1982 were first-year residents in family practice in December 1982. The West North Central region reports the highest percentage of medical school graduates who were first-year residents in family practice programs in December 1982; the New England and Middle Atlantic regions had the lowest percentage. Medical school graduates from publicly funded medical schools were twice as likely to be first-year residents in family practice in December 1982 as were graduates from privately funded medical schools.

Family Practice↗

PubMed2002

The clinical pharmacist as a preceptor in a family practice residency training program.

BACKGROUND: According to a recent survey, 27% of 579 family practice residency programs in the United States employ a full-time clinical pharmacist. The majority of pharmacists' time is spent teaching, usually at the point of care either on inpatient rounds or precepting in the outpatient clinic. This paper describes the precepting activity of a full-time clinical pharmacist in a community-based family practice residency training program. METHODS: A computer program written in Microsoft Access captured the following data on each pharmacist-physician encounter: date, time, requestor, topic, therapeutic category, type of question, summary of question and answer, resources used to answer the question, and time spent answering the question. The database was updated daily to include all encounters. RESULTS: Between February 1, 1999, and January 31, 2001, we documented 2,260 precepting encounters. Almost half of the questions related to general pharmacotherapeutic management of chronic or acute diseases. The most common therapeutic categories encompassed cardiovascular, psychiatric, infectious disease, and neurologic disorders. Seventy-six percent of questions were answered using clinical knowledge and experience, while 24% were based on published resources. CONCLUSIONS: Based on more than 2,000 precepting encounters between a faculty pharmacist and family practice residents, most encounters represented requests by residents for information on general drug management of diseases. The pharmacist answered most questions based on clinical knowledge and experience. Evaluations of the pharmacist by the residents indicated that she is an effective teacher and useful in helping take care of patients.

Data Collection↗

PubMed2003

The current state of esophagogastroduodenoscopy training in family practice residency programs.

BACKGROUND AND OBJECTIVES: Esophagogastroduodenoscopy (EGD) is a useful diagnostic procedure to evaluate patients with upper gastrointestinal complaints. Although family physicians have demonstrated that they can competently perform EGD, only a minority of family physicians perform EGD. This study determined the current state of EGD training in US family practice residency programs and how often graduating residents seek EGD privileges. METHODS: We conducted a cross-sectional descriptive study surveying program directors from all Accreditation Council for Graduate Medical Education-approved family practice residency programs regarding EGD training in their program. RESULTS: Of the 471 surveys mailed, 441 (94%) were returned. A total of 143 (32%) program directors reported that their program offered EGD training, but only 58 (13%) actually trained at least one resident. Residents performed a mean of 20 +/- 2.4 EGDs per resident, and residents trained by family physicians performed more EGDs than residents trained by other specialties. In July 2000, .04% of graduating family practice residents sought credentials for EGD, and their training occurred in 32 (7%) residency programs. CONCLUSIONS: Only a minority of family practice residents seek credentialing after residency to perform EGD.

Clinical Competence↗

PubMed1996

Lafayette's family practice residency program: practice patterns of graduates.

The Lafayette Family Practice Residency Program graduated 25 physicians prior to 1995. This project was undertaken to support our assumption that graduates establish their practices in communities near their residency programs. Further we surveyed the graduates to determine graduate satisfaction and practice characteristics. The vast majority (88%) of these physicians were practicing in Louisiana at the time of this survey. Over half the graduates were practicing in Acadiana. The results suggest that these physicians are indeed satisfied in their careers as family physicians.

Data Collection↗

PubMed1977

Behavioral science in family practice: an ethical imperative.

Behavioral science confronts at least three major problems within American medicine that must be overcome if the family physician of the future is to receive an adequate graduate education and maintain his professional integrity. Through increasing specialization, the once unified biological perspective of man was severely fragmented, and with increasing emphasis on the science of medicine, the disease process was objectified and reified. Twentieth century man joined his myth of technological mastery with medicine's desire to eliminate pain and suffering. This gave rise to the idea that life could be medically managed and existential dilemmas anesthetized. To overcome these problems behavioral science has two ethical issues to address in family medicine. First, behavioral science must restore the physician's sense of personhood by recognizing the person of the physician as the primary diagnostic and therapeutic "tool" of family practice. Second, behavioral science must help family practice refocus its professional responsibility on the social problems of the day. This will happen through a critical review of the custodial aspects of the physician's role and an emphasis on role innovation. Approaches to these two ethical issues at the Medical University of South Carolina family practice residency are described.

Behavioral Sciences↗

PubMedDate not supplied

Physical and psychological health of family practice residents.

OBJECTIVE: Substantial evidence supports the concept that residency training is physically and emotionally stressful. However, few studies have examined resident health. This study measured the physical and psychological health of family practice residents and compared these results with population norms. METHODS: This cross-sectional, descriptive study used physical health measures of weight, blood pressure, skin-fold thickness, serum cholesterol, and aerobic exercise capacity. Psychological measures included the Beck Depression Inventory, the State-Trait Anger Expression Inventory, the State-Trait Anxiety Inventory, and the Ways of Coping Questionnaire. A demographic and lifestyle questionnaire was also administered. Data were collected on 178 residents in seven family practice residency programs in South Carolina. RESULTS: Physical health measures show that residents are indistinguishable from age-specific population norms. Psychological testing revealed excellent coping skills with clinically significant psychological symptoms noted in only one of the 178 residents. CONCLUSION: This study provides evidence that despite the rigors of residency training, family practice residents in South Carolina have average physical health and better-than-average psychological health, according to age-adjusted population norms. These results suggest that the coping skills of family practice residents are well suited to the stresses of family practice residency training.

Adult↗

PubMedDate not supplied

A family practice model of health care for homeless people: collaboration with family nurse practitioners.

The growth of a large population of people without permanent housing in the United States has brought with it the necessity to address the unmet health needs of this group. As homelessness spreads, its demographic pattern has become more heterogeneous, with young vulnerable families now the major subgroup. This paper explores issues of homelessness in Westchester County, N.Y., which, despite being the 10th richest county in the United States, has the highest per capita homeless rate in the state. Children younger than age 18 represent the majority of this group. Barriers to the delivery of health care services are described, including fragmented life-styles, lack of insurance, insensitivity of care givers, distance from services, and inflexibility of traditional sources of health care. A model that has been developed for delivery of services is discussed. This model, the Outreach Health Care Unit, is run by nurse practitioners in collaboration with family physicians and is centered at the site of social service activities for homeless families and single men in Yonkers, N.Y. It is a collaborative endeavor of a nursing school, community hospital family practice residency program, and a network of social service agencies. The use of this model for education and research is also discussed since the goal is to provide both health services and training for health care providers.

Adolescent↗

PubMed2006

Family practices registration networks contributed to primary care research.

BACKGROUND AND OBJECTIVE: Family physicians (FP) play a key role in the diagnosis and treatment of health problems in the community and for evidence-based guidance clinical research must be based on primary care data. This paper analyses the state-of-the-art approaches to collection of data and the building of databases in family practice. METHODS: Experience in the Netherlands in family practice-based research networks (PBRNs) is explored in registering and analyzing primary care data, illustrated with four examples of PBRN studies. RESULTS: PBRNs bring together practices and FPs with a research interest to collect data and pursue research under routine patient care conditions. This directs research at relevant questions of family practice. Important features of success are practitioners' ownership of data and the use of data in improving care of patients in the participating practices. International standardization of terminology and definitions in the international classification of primary care improves the scientific quality of data recorded in registration networks and PBRNs. CONCLUSIONS: Through primary care registration networks and PBRNs it is possible to tap-in unselected care of patients and at the same time produce scientifically rigorous data. This enables research that represents the realities of primary care with valid data.

Evidence-Based Medicine↗

PubMed1992

Family practice residents' identification and management of obesity.

This study, involving 25 family practice residents and 2746 patients in a family practice residency programme, addressed four hypotheses regarding the identification and management of obesity in the primary care setting: (i) the physician-identified prevalence of obesity is significantly lower than the actual prevalence in the population, (ii) obesity is more likely to be addressed with management actions when it is recorded on the medical record problem list than when it is not recorded, (iii) physician actions dealing with obesity are influenced by the patient's age, sex, level of motivation, and body mass index (BMI) value, and (iv) the type of physician management actions taken are affected by the patient's age, sex, level of motivation, and level of BMI value. Obesity was identified as a risk factor by physicians for 51.6% of all patients with a BMI greater than or equal to 30. Obesity was recorded on the medical record problem list for 70.6% of the physician-identified obese patients. When obesity was recorded on the problem list, management actions were taken for 92.9% of patients. However, when obesity was recorded on a risk factor evaluation form but not on the problem list, management actions were taken for only 56.6% of patients. Self-care strategies were selected as the management strategy more frequently than return visits. Demographic characteristics, BMI value and level of patient motivation did not influence the selection of follow-up management strategies. Given the potential for significant improvement in a patient's health status through early recognition and aggressive management of obesity, the barriers to physician identification and involvement in clinical management of obesity deserve further investigation.

Adult↗

PubMed1996

The community health center and family practice residency training.

Community health centers (CHCs), sponsored by US Public Health Service (USPHS) Section 330, represent successful models of the application of community-oriented primary care principles. Recently, increased interest has been shown in conducting medical education programs in CHCs. The USPHS has tried to facilitate this interest, particularly through its support of establishing linkages between CHCs and family practice residency programs. In this paper, we describe an integrated CHC-family practice residency continuity training clinic program. We discuss the challenges inherent to conducting family practice residency training in the CHC, including the educational content of clinical experiences, the impact of provider productivity expectations, the academic and operational governance of the program, and the financial considerations pertinent to the integrated function of the program. We conclude that while the clinical experiences available in the CHC differ somewhat from mainstream family practice, successful adaptations can be made, and a CHC offers a rich educational environment. We also conclude that the challenges inherent to integrated CHC-family practice residency programs can be successfully addressed. Of great concern, however, are financial considerations relevant to the operation of such integrated programs. These considerations underscore the urgent need for a reassessment of the funding of ambulatory clinical medical education.

Ambulatory Care↗

PubMed1981

Influence of stereotypes in the diagnosis of depression by family practice residents.

The focus of this study was on the diagnosis of depression by family practice residents. The sensitivity and specificity of the residents for depression were determined by comparing their diagnoses with the results of an objective assessment of depression for a group of 222 ambulatory patients from a family practice center. The objective assessment involved the administration of the Beck Depression Index to the patients, whereas charts were audited for resident diagnoses. The results indicated that the sensitivity and specificity of the residents' diagnostic acumen for depression were .18 and .90, respectively. In addition, the operation of a sex stereotype was suggested by an analysis which revealed that a disproportionate number of females were diagnosed as depressed by the residents. These results suggest that an increased emphasis be placed on the diagnosis of common psychiatric problems such as depression in family practice residency programs.

Adult↗

PubMed1986

A research clearinghouse for family practice.

A database containing descriptive information on ongoing research projects in family practice has been developed by the Huffington Library of the Family Health Foundation of America. Between May 1983 and April 1985, 460 research projects and 661 researchers were added to the database. The data were gathered by a questionnaire sent to departments of family medicine, family practice residencies, and state chapter offices of the American Academy of Family Physicians. The projects in the database are described in several dimensions: funding sources; study categories; research design; data sources; study setting; gender and ages studied; and project topics, analyzed broadly by Medical Subject Heading terms.

Family Practice↗

PubMed1980

Family practice as a part of undergraduate medical training in South Africa.

Undergraduate tiution in family practice was fully instituted for the first time in South Africa at the University of Pretoria in 1977. Students in the 2nd-5th years of study are taught the various aspects of family medicine and practice management by means of formal lectures and practical clinical work. The treachers are all general practitioners, most of whom hold a higher degree in family practice. In addition, each student spends at least 1 week with a practitioner in general practice. In Pretoria the outpatient and casualty departments of the two teaching hospitals are run by the Department of Family Practice. Large numbers of patients who would not be seen in the wards are thus made available for teaching purposes, and the standard of service to patients is improved. Until recently, medical teaching was confined to the various specialities and only patients admitted to teaching hospitals were available for teaching purposes. As less than 1% of persons reporting sick are admitted to hospital inpatients are not representative of the disease profile seen in general practice. Undergraduate medical training in family practice could be further improved by more participation in the teaching programme by experienced general practitioners in active practice.

Curriculum↗

PubMed1982

Utilization of pneumococcal vaccine in a family practice residency.

Pneumococcal diseases continue to account for a significant amount of morbidity and mortality in family practice. Daily charts audits revealed significant underutilization of pneumococcal vaccine in a family practice residency. Identified primary factors for pneumococcal vaccine underutilization were inadequate physician knowledge regarding the vaccine and failure to consider vaccine need during physician-patient encounters. A physician education update regarding vaccine indications and use was completed. A questionnaire was developed and given to each patient, allowing the physician to quickly evaluate each patient's need for pneumococcal vaccine. Evaluation of the first 1,000 questionnaires revealed the approximately 20 percent of the patients had indications for pneumococcal vaccine. Evaluation of immunization records revealed significant increased utilization of the pneumococcal vaccine following initiation of the questionnaire. Patient questionnaires such as this can prove to be a useful tool in the evaluation and provision of preventive medicine services in the family practice setting.

Bacterial Vaccines↗