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PubMed1998

Changing face of family practice.

OBJECTIVE: To identify trends in family practice in London, Ont, between 1974 and 1994. DESIGN: Interview survey of all London family physicians in 1974. Questionnaire surveys in 1984 and 1994. SETTING: City of London, Ont. PARTICIPANTS: One hundred twenty-eight family physicians and general practitioners practising in London in 1974, 180 in 1984, and 237 in 1994. RESULTS: The percentage of female practitioners, practitioners with no in-hospital patients, and practitioners making no home visits in an average week increased significantly. The percentage of solo practitioners and family physicians practising obstetrics decreased significantly. Changes were found in the numbers of patients seen, in weekend coverage, in evening, and Wednesday afternoon office hours, and in level of satisfaction with practice. CONCLUSION: Fewer physicians cared for in-hospital patients, made home visits, practised solo, and delivered babies in 1994 than in 1974. Substantially more women were practising family medicine in 1994 than in 1974. The trend away from in-hospital care, with no corresponding increase in home care, raises questions about how urban family physicians can maintain certain clinical skills.

Family Practice↗
PubMed1978

Streptococal throat infections in family practice.

Beta hemolytic streptococcal throat infections occur often enough and cause sufficient morbidity that careful diagnosis and appropriate treatment are matters of concern to the family physician and others involved in primary patient care. Throat cultures aid the precision of diagnosis; a simple, inexpensive, and accurate method of performing cultures in the office is described. The risk of rheumatic fever secondary to untreated streptococcal infections appears to be less than it once was, and further work defining this risk in various population groups is needed. Penicillin remains the drug of choice for treatment, with blood levels maintained for at least ten days either by oral administration or by a single intramuscular dose of benzathine penicillin G. The results of a recent survey of US family practice programs and an equivalent number of practicing family physicians show that most physicians use a selective approach to diagnosis and treatment of throat infections based on symptoms, signs, and age of the patient.

Adult↗
PubMed1999

Entry of US medical school graduates into family practice residencies: 1998-1999 and 3-year summary.

This is the 18th report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family practice residency programs. Approximately 15.4% of the 16,114 graduates of US medical schools between July 1997 and June 1998 were first-year family practice-residents in October 1998, compared with 16.6% in 1997 and 15.9% in 1996. Medical school graduates from publicly funded medical schools were almost twice as likely to be first-year family practice residents in October 1998 than were residents from privately funded schools, 18.8% compared with 10.7%. The Mountain region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in October 1998 at 22.0%; the Middle Atlantic and New England regions reported the lowest percentages at 9.9% and 8.7%, respectively. Half of the medical school graduates (50.0%) entering a family practice residency program as first-year residents in October 1998 entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. This article reports the average percentage for each medical school for the last 3 years. Also reported are the number and percentage of graduates from colleges of osteopathic medicine who entered Accreditation Council for Graduate Medical Education-accredited family practice residency programs, based on estimates provided by the American Association of Colleges of Osteopathic Medicine.

Family Practice↗
PubMed2001

Use of vitamins, minerals and herbs: a survey of patients attending family practice clinics.

OBJECTIVE: To examine the use of vitamin, mineral and herbal supplements in patients attending family practice clinics. DESIGN: A prospective 1-year cohort study. SETTING: Sixteen family practices in Calgary. PARTICIPANTS: One hundred and eighteen patients (more than 18 years of age) were initially interviewed; 12 patients were lost to follow-up. MAIN OUTCOME MEASURES: Number and type of supplements used, duration of use, sources of patient information, beliefs about supplement efficacy and safety, reporting use to physicians, costs and changes in pattern of use over 1 year. RESULTS: Supplement use was unrelated to age, but more women (73%) used supplements than men (44%). Relative to age, more patients younger than 50 years believed supplements were safer than prescription medications (82% v. 43%, p = 0.0005). Younger patients were less likely than those over 50 years old to have received supplement information from physicians (10% v. 37%, p = 0.0008) and were less compliant than older patients with manufacturers' recommended dosages (p = 0.02). Whereas 74% of those over the age of 50 years informed their physician that they used supplements, only 30% of younger patients did so (p = 0.0006). At 1-year follow-up, the number of supplements taken per patient increased (p < 0.05), and there was a tendency for more patients to take supplements (61% v. 70%, p = NS). CONCLUSIONS: The majority of patients attending family practices in Calgary use vitamin, mineral or herbal supplements, and monitoring of supplement use by health care professionals is minimal. Young patients, in particular, tend not to report their use of supplements. They also believe the supplements are safer and more effective than prescription medications and obtain information from nonmedical sources. Physicians should enhance patient understanding of these products and include supplement use in all medical histories. In particular, younger patients require more reliable information on supplements.

Alberta↗
PubMed1996

Abortion training in family practice residency programs.

BACKGROUND: Despite a relatively fixed demand for services, access to abortion services has become increasingly limited, in part due to fewer training opportunities for OB-GYN residents. The recommended core educational guidelines for family practice residents include voluntary interruption of pregnancy up to 10 weeks gestation, but the availability of and interest in such training have not been reported. METHODS: A survey questionnaire assessing availability of abortion training, percentage of residents participating, program demographics, and resident interest in training was sent to all US family practice residency program directors and randomly selected third-year residents during the 1993-1994 academic year: A total of 301 of 399 (75%) program directors and 253 of 399 (63%) third-year residents completed the questionnaire. RESULTS: Twelve percent of programs nationwide offered abortion training during 1993-1994. Western programs were more likely to offer training (18 of 50 or 36%) than Northeastern (7 of 55 or 12%), Midwestern (6 of 98 or 6%), or Southern programs (4 of 98 or 4%). When available, 45% of trainees chose to participate. Training was primarily in suction curettage up to 12 weeks gestational age. The median duration of training was 4 weeks. Training was provided in both freestanding clinics and hospitals. Religious hospitals were less likely to offer training. CONCLUSIONS: About one of eight family practice residency programs nationwide offer training in abortion. When offered, nearly half of family practice residents choose to participate in this training. Interested family practice residents could be trained to fill an increasing need for physicians willing and able to perform first-trimester abortions.

Abortion, Induced↗
PubMed1980

Impact of family practice residents on obstetrics and gynecology basic clerkship: medical students' perceptions.

Increasing numbers of family practice residents and medical students require training in obstetrics and gynecology. The effect of these residents on medical student learning in a basic obstetrics and gynecology clerkship at the University of Washington was examined. Results of a questionnaire completed by 314 medical students revealed that family practice residents had a positive although highly variable impact on student learning. Individual differences in residents and students seem to account for much of the variability. Suggestions are made for enhancing the learning experience in obstetrics and gynecology for both medical students and family practice residents.

Education, Medical, Undergraduate↗
PubMed1985

A contractual model for accountability and financial stability in a community-based family practice residency.

A contractual model is described that defines the relationship between the hospital and the Department of Family Practice. The model provides institutions supporting graduate training in family practice with a method that is accountable and cost effective. Application of this model at a community hospital over a five-year period is presented. The model resulted in expansion of the family practice residency, increased faculty numbers, increased income for the faculty, and control of the institution's cost of graduate medical education.

California↗
PubMed1981

Profile of a unique community-based clinical pharmacy family practice program.

The provision of clinical pharmaceutical services in family practice offices has aroused considerable national interest among both pharmacists and physicians. Many of these clinical pharmaceutical services and educational programs have been university-funded and/or rely on colleges of pharmacy for fiscal support. Few examples of community-funded, ambulatory care clinical pharmaceutical programs have been reported. Community Health Care, Inc., and Davenport Medical Education Foundation, Inc., are two health care programs which sponsor an innovative ambulatory care clinical pharmacy program. Community Health Care is a nonprofit corporation which utilizes a multidisciplinary team concept to provide comprehensive ambulatory care services to patients. Davenport Medical Education Foundation is a nonprofit corporation that provides a community-based family practice residency program. Because the two separate parent organizations have distinct goals requiring individualized clinical pharmaceutical services, the responsibilities of the clinical pharmacist have evolved to be comprehensive in scope.

Family Practice↗
PubMed1991

Violence education in family practice residency programs--United States, 1989.

In the United States, violence is a well-documented public health problem (1-3), and physicians have been urged to help reduce the impact of this problem (4). To assess efforts to educate family practice physicians about violence, in 1989, an investigator in a family practice residency program conducted a national survey of all family practice residency directors. The survey assessed the beliefs of residency directors regarding specific types of violence and the role of family practice residency programs in educating physicians about this problem. This report summarizes results of the survey (5).

Curriculum↗
PubMed1993

1993 West Virginia family practice residents: demographics and future plans.

To call attention to the concerns of the 92 family practice residents in the five programs in West Virginia and assist with their retention, a questionnaire was mailed to these physicians. The questions asked concerned their home states, future plans, educational debts, salary expectations, recruiting preferences, and their suggestions on how to interest more medical students into this specialty. The responses to the survey provided valuable information regarding how to improve retention of family practice residents in the state, as well as increase the number of medical students entering family medicine. In addition, the survey showed the Bureau of Public Health, the Kellogg Program and the Rural Health Initiative Program are not as effective as they could be in recruiting family practice residents to practice in underserved areas of the state.

Career Choice↗
PubMed2003

Geriatric medicine training for family practice residents in the 21st century: a report from the Residency Assistance Program/Harfford Geriatrics Initiative.

Increasing the quality and quantity of geriatric medicine training for family practice residents is a particular challenge for community-based programs. With support from the John A. Hartford Foundation of New York City, the American Academy of Family Physicians (AAFP) implemented in 1995 a multi-part project to improve the amount and quality of geriatric medicine education received by family practice residents. This report summarizes the initial results of the regional geriatric medicine curriculum retreats for residency directors. The goals of the retreats were to build recognition among the residency directors of the skills that future family physicians will require to be successful providers of primary care to older adults and to allow the residency directors to identify and develop solutions to barriers to improving geriatric medicine training for residents. Forty-six program directors participated in the three retreats between February 2000 and February 2001. The participants represented 52 programs and rural tracks in all geographic regions, small and large programs, and urban and rural settings. The program directors developed a consensus on the geriatric medicine knowledge, skills, and attitudes that should be expected of all family practice residency graduates; developed a list of basic, required educational resources for each family practice residency program; and proposed solutions to common obstacles to successful curriculum development.

Attitude of Health Personnel↗
PubMed2001

A national survey of procedural skill requirements in family practice residency programs.

BACKGROUND AND OBJECTIVES: Procedural skill training is a controversial but important component of family practice residency programs. This study examines the use and composition of required procedure lists in US family practice residency programs. METHODS: The study used a cross-sectional nine-item questionnaire. This survey was sent to 467 residency program directors listed in the 1999 American Academy of Family Physicians Directory of Family Practice Residency Programs. RESULTS: A total of 326 programs (70%) responded to the survey. Of these, 242 programs (74% of respondents) reported use of a required procedure list. Sixty-six programs provided a list. Of these, 63 lists were interpretable. The number of required procedures on the lists ranged from a minimum of 3 procedures to a maximum of 117, with an average of 42. A total of 265 distinct procedures were identified, with 25 procedures named on more than half of the lists. Thirteen programs (21%) mandated competency in required procedures, but only five programs (8%) gave clear definitions of what constituted competency. There were no significant differences in lists among training program type, university affiliation, number of hospitals used for rotation, size of affiliated hospital, or number of residents. CONCLUSIONS: The expectations of individual programs vary greatly in terms of required procedures. Few programs define how to evaluate the technical competency of their residents.

Clinical Competence↗
PubMed1982

Patient care telephone calls received in family practice offices.

The majority of patients care calls referred to practitioners at each of two family practice office study sites were related to medications. However, there were significant differences in the proportion of patient care calls managed by staff physicians, family practice residents, and clinical pharmacists which involved discussion of medication. There were also significant differences in the callers and types of medication related calls managed by each practitioner group. Calls initiated by patients and those classified as refill requests accounted for the largest proportion of calls managed by staff physicians, residents, and clinical pharmacists. The majority of calls received by each practitioner group were managed without consultation. A follow-up office visit was recommended in approximately one half of all medication related calls. The findings of this study may be useful in determining the personnel required to manage medication related telephone calls and in identifying potential areas for education and training of personnel in family practice.

Delivery of Health Care↗
PubMed1995

Family practice management in an overseas theater.

The mandate to convert outpatient primary care programs to family practice programs reached the overseas military theater a number of years ago. Everyone seemed positive about initiating a system that facilitated the relationship between the patient and the health care professional of his/her choice. As a consequence, many new programs were started. A number of concerns have been raised by local medical treatment facility commanders. These concerns demonstrate uncertainty regarding the goals, principles, and expectations of family practice programs. This article endeavors to bring helpful information regarding the philosophy and strengths of family practice. Two very different patterns of organizational structure are discussed and practical advice is given that will, it is hoped, be helpful to senior clinical managers.

Delivery of Health Care↗
PubMedDate not supplied

Teaching psychiatry to family practice residents.

OBJECTIVE: This article outlines a psychiatry curriculum developed for family practice residents by family practice-psychiatry residents. METHODS: A literature review, needs assessment, planning, implementation, and initial assessment were conducted. CONCLUSION: Early results demonstrated improved general psychiatric knowledge and a high level of satisfaction.

Educational Measurement↗
PubMed1993

A combined family practice and occupational medicine residency program.

Family physicians deliver a significant proportion of occupational medicine services in this country. A shortage of physicians specifically trained in occupational and environmental medicine (OEM) has been well documented. A 1991 report from the Institute of Medicine recommends an alternative approach to certification of OEM physicians by creating a streamlined graduate training program that would result in dual certification in a primary care specialty and OEM. For the past three years, the University of Oklahoma has offered such a combined track program, comprising four years of training in family practice and occupational medicine. This article describes the development and structure of the combined program.

Curriculum↗