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PubMed1990

Asthenic symptoms in a rural family practice. Epidemiologic characteristics and a proposed classification.

Asthenic symptoms (eg, fatigue, lassitude, weakness) are of major concern in family practice setting, yet relatively little research has addressed this issue. A retrospective chart review over a 10-year period was conducted to better characterize these symptoms in a rural family practice providing health care to 508 adult patients. Asthenic complaints were recorded at least once in the medical charts of 164 patients (32%) with a preponderance of female patients. Peak prevalence occurred in the third decade of age and during the summer months. Associated symptoms, mainly pain and dizziness, were reported in 75% of the cases. A cause or diagnosis was not identified by the practicing physician in nearly 50% of the encounters; nevertheless, most episodes resolved spontaneously. Patients could be subclassified into three categories according to the recurrence pattern of their asthenic symptoms during the study period. The largest category (64%) included patients who had a single or two episodes and was thus termed "episodic asthenia." Forty-five patients (27%) with recurrent episodes (mean 4.4, range 3 to 10) were classified as having "recurrent episodic asthenia." A third small group (14 patients, 9%) with persistent complaints over the years but no evidence of the chronic fatigue syndrome were classified as having "chronic persistent asthenia." The proposed classification may help future research of asthenic symptoms in the family practice setting.

Adult↗

PubMedDate not supplied

Gay and lesbian physicians in training: family practice program directors' attitudes and students' perceptions of bias.

BACKGROUND: Disclosure of homosexual orientation by medical students or physicians has generally been regarded as having dire professional consequences. We surveyed family practice residency directors to determine how knowledge of homosexual orientation might affect a residency applicant's ranking. We then surveyed gay and lesbian medical students to better understand their attitudes and beliefs about disclosure of orientation during residency application. METHODS: A survey was mailed to all family practice residency directors and a convenience sample of third- and fourth-year gay and lesbian medical students. RESULTS: The program director response rate was 73%. Of these respondents, 67% showed accepting attitudes toward homosexuality, 25% were neutral, and 8% had negative views. One of four directors admitted they "might rank" or "most certainly" would rank an applicant known to be gay lower than a heterosexual one. The medical student response rate was 81%. When choosing a specialty, 42 students (71%) considered how other physicians might accept them as a lesbian or gay provider. Psychiatry and family practice were perceived as the most accepting specialties. Thirty-one student respondents (52%) agreed that at most residency programs, an applicant known to be gay or lesbian would be ranked lower than an applicant assumed to be heterosexual. CONCLUSIONS: Most family practice residency directors have accepting attitudes toward gays and lesbians in general, but 25% of directors express hesitation in matching openly gay residents. Gay and lesbian medical students want to match in residency programs where they will be welcomed and respected but fear discrimination if they disclose their orientation.

Administrative Personnel↗

PubMed2001

Results of the 2001 National Resident Matching Program: family practice.

The results of the 2001 National Resident Matching Program (NRMP) reflect a persistent decline of student interest in family practice residency training in the United States. Compared with the 2000 Match, 240 fewer positions (317 fewer US seniors) were filled in family practice residency programs through the NRMP in 2001, as well as 76 fewer (47 fewer US seniors) in primary care internal medicine, 5 fewer in pediatrics-primary care (7 fewer US seniors), and 7 fewer (1 fewer US senior) in internal medicine-pediatric programs. In contrast, 40 more positions (64 more US seniors) were filled in anesthesiology and 11 more (10 more US seniors) in diagnostic radiology, two "marker" disciplines that have shown increases over the past 3 years. Ninety-one fewer positions (2 fewer US seniors) were also filled in categorical internal medicine, while 49 more positions (67 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 a market for family physicians, family practice experienced a fourth year of decline though the 2001 NRMP. Current forces, including student perspectives of specialty prestige, the turbulence of the health care environment, media hype, market factors, lifestyle choices, and student debt, all appear to be influencing many students to choose subspecialty rather than primary care careers.

Career Choice↗

PubMedDate not supplied

Health promotion/disease prevention in family practice residency training: results of a national survey.

BACKGROUND: Patient screening criteria for health promotion/disease prevention have become widely available in recent years, but their effect on day-to-day practice has been somewhat limited, highlighting the importance of emphasizing health promotion in family practice residency training. METHODS: To determine the extent and content of health promotion education in residency curricula and perceived shortcomings in this area, we conducted a survey of all 386 accredited family practice residency programs in the United States and Puerto Rico in February and April 1991, with a response rate of 80%. Program directors completed a two-page questionnaire on curriculum coverage of health promotion, subject areas included, and resources used. RESULTS: The survey found that 88% of residencies had a formal health promotion curriculum, with the most common topics being immunization protocols and hyperlipidemia and the least common topics being behavior change and compliance. American Academy of Family Physicians materials are the most common resources available in residencies, but the most frequently used is the US Preventive Services Task Force Report. Use of the latter resource varies by geographic location. CONCLUSION: Our study demonstrates that health promotion education is part of virtually all family practice residency training programs but also shows that use of available resources varies and that program directors find it difficult to help residents incorporate health promotion into day-to-day medical practice.

Curriculum↗

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↗

PubMed1982

Impact of participation in a family practice track program on student career decisions.

Two classes of entering freshman medical students at the University of Utah indicated career preferences prior to the start of preclinical classwork. A group of interested students applied to a special family practice curriculum track. From this group, 20 were randomly selected each year to participate in the track program. The number was limited because of the need for a small student/faculty ratio. Students participating in the program were found to select residencies in family practice at a significantly higher rate than their classmates who expressed an interest but were not selected to participate. Students who stated a preference for family practice as freshmen were also found to select residencies in family practice at a significantly higher rate than freshman not preferring it. Nevertheless, most senior students matched with residencies different from their freshman preferences.

Career Choice↗

PubMed2005

Medical errors in primary care: results of an international study of family practice.

OBJECTIVE: To describe errors Canadian family physicians found in their practices and reported to study investigators. To compare errors reported by Canadian family physicians with those reported by physicians in five other countries. DESIGN: Analytical study of reports of errors. The Linnaeus Collaboration was formed to study medical errors in primary care. General practitioners in six countries, including a new Canadian family practice research network (Nortren), anonymously reported errors in their practices between June and December 2001. An evolving taxonomy was used to describe the types of errors reported. SETTING: Practices in Canada, Australia, England, the Netherlands, New Zealand, and the United States. PARTICIPANTS: Family physicians in the six countries. MAIN OUTCOME MEASURES: Types of errors reported. Differences in errors reported in different countries. RESULTS: In Canada, 15 family doctors reported 95 errors. In the other five countries, 64 doctors reported 413 errors. Although the absence of a denominator made it impossible to calculate rates of errors, Canadian doctors and doctors from the other countries reported similar proportions of errors arising from health system dysfunction and gaps in knowledge or skills. All countries reported similar proportions of laboratory and prescribing errors. Canadian doctors reported harm to patients from 39.3% of errors; other countries reported harm from 29.3% of errors. Canadian physicians considered errors "very serious" in 5.8% of instances; other countries thought them very serious in 7.1% of instances. Hospital admissions and death were among the consequences of errors reported in other countries, but these consequences were not reported in Canada. CONCLUSION: Serious errors occur in family practice and affect patients in similar ways in Canada and other countries. Validated studies that analyze errors and record error rates are needed to better understand ways of improving patient safety in family practice.

Adolescent↗

PubMedDate not supplied

A taxonomy of clinical research methods: comparisons of family practice and general medical journals.

Although an understanding of research methodology has been identified as an important skill for family practice researchers, the available literature contains confusing terminology and lacks agreement about research design classifications. A multidimensional taxonomy is presented to clarify and simplify the understanding of research designs, data collection methods, and research populations for family practice researchers. The taxonomy was used to classify 103 articles from five medical journals. Compared with general medical journals, reports in family practice journals used similar research designs but were more likely to rely on self-report data and to draw subjects from outpatient populations.

Data Collection↗

PubMed1997

Creating a spirituality curriculum for family practice residents.

The purpose of this pilot study was to investigate issues related to the creation of a curriculum to teach spirituality to family practice residents; specifically, (1) to determine whether there was support among family practice residents and faculty to include such teaching in the residency curriculum, and (2) to determine specifically what should be taught and how it should be taught. The hypothesis was that residents and faculty would support such a curriculum and that specific educational methodologies could be identified to implement it. This was accomplished by conducting one-on-one interviews and focus groups and by administering a written curriculum needs assessment to family practice residents and faculty, compiling and interpreting the results, and subsequently writing an integrated curriculum.

Curriculum↗

PubMed1998

Environmental health concerns in urban and rural family practice.

OBJECTIVE: To describe environmental health problems encountered in some Ontario family practices and to describe differences between the environmental concerns of urban (small and large) and rural physicians. DESIGN: A self-completed questionnaire was mailed to 536 family physicians with hospital affiliations in three areas of Ontario. SETTING: Family practices (rural, small urban, and large urban) in Ontario. PARTICIPANTS: Of 521 eligible community family physicians with hospital affiliations, 214 returned usable questionnaires for a 41% response rate. MAIN OUTCOME MEASURES: Environmental health problems encountered in practice were measured using questions about physician concerns, reported patient questions, physician-identified high-risk groups, problems related to environmental exposure, self-rated knowledge, and current and preferred sources of information on environmental health effects. RESULTS: Physicians were highly concerned and reported many patient questions about the health effects of environmental exposures. Pregnant women, agricultural workers, and children were considered important at-risk groups. Self-ratings of knowledge were generally very low. Rural physicians were concerned about agricultural pesticide exposure and their patients about moldy hay. Urban physicians had different concerns about lead and reported patient concerns about exposure to Great Lakes fish. All groups used similar sources of current environmental health information. CONCLUSIONS: Family physicians who participated in this study identified important patient and professional concerns about environmental health issues and reported a lack of resources to meet those concerns. This study provides information to family medicine residency programs and continuing medical education providers to help them enhance their focus on environmental health.

Adult↗

PubMed1999

Pulmonary auscultatory skills during training in internal medicine and family practice.

We conducted a multicenter, cross-sectional assessment of pulmonary auscultatory skills among medical students and housestaff. Our study included 194 medical students, 18 pulmonary fellows, and 656 generalists-in-training from 17 internal medicine and 23 family practice programs in the Mid- Atlantic area of the United States. All participants listened to 10 pulmonary events recorded directly from patients, and answered by completing a multiple choice questionnaire. Proficiency scores were expressed as the percentage of respondents per year and type of training who correctly identified each event. In addition, we calculated a series of cumulative scores for sound recognition, disease identification, and basic knowledge of lung auscultation. Trainees' cumulative scores ranged from 0 to 85 for both internal medicine and family practice residents (median = 40). On average, internal medicine and family practice trainees recognized less than half of all respiratory events, with little improvement per year of training, and were not significantly better than medical students in their scores. Pulmonary fellows had the highest diagnostic and knowledge scores of all groups. These data indicate that there is very little difference in auscultatory proficiency between internal medicine and family practice trainees, and suggest the need for revisiting these time-honored skills during residency training.

Attitude of Health Personnel↗

PubMed1997

Training in firearm safety counseling in family practice residency programs.

The purpose of this study was to establish a national baseline regarding the prevalence of training of family practice residents regarding firearm safety counseling. A national survey of the residency directors at the 420 accredited family practice residency programs in the coterminous United States was used to assess the prevalence of training in firearm safety counseling, perceived effectiveness of such training, and perceived barriers to such counseling in residency programs. Program directors were sent a two-page questionnaire on firearm safety counseling activity in their programs and 71% responded. Few residencies (16%) had formal training in firearm safety counseling. The most common perceived barriers were no trained personnel (31%), too many other important issues (31%), not enough time (30%), and lack of educational resources (28%). Patient education materials (57%), video training programs (49%), and a curriculum guide (46%) were identified as resources that would be most helpful in implementing a firearm safety counseling program. The results showed that formal training in firearm safety counseling is virtually absent from family practice residency training programs. This finding is not surprising given that less than 14% of the directors perceived firearm safety counseling would be effective in reducing firearm-related injuries or deaths and that research on effectiveness of such counseling is very limited.

Analysis of Variance↗

PubMedDate not supplied

Correction of deficiencies in flexible fiberoptic sigmoidoscope cleaning and disinfection technique in family practice and internal medicine offices.

To assess whether deficiencies exist in the processing of contaminated flexible fiberoptic sigmoidoscopes in family practice and internal medicine offices and whether training of office personnel results in a correction of identified deficiencies, we conducted a prospective review of sigmoidoscope processing in family practice and internal medicine offices before and after a training course. Participants were questioned on their current endoscope processing for 17 standards before and 2 months after receiving training. The 19 offices had between 4 and 11 deficiencies per office before training, with an average of 6.8 deficiencies per office. After training, deficiencies ranged from 0 to 8, with an average of 0.9 deficiencies per office (P < or = .001; Student t test). Personnel responsible for processing flexible sigmoidoscopes in family practice and internal medicine offices are insufficiently trained for this function. Endoscopes are not being processed according to current standards. After a 2-hour training period, these persons maintain their equipment close to or according to standards.

Disinfection↗

PubMed1992

A survey of formal training in the care of children in family practice residency programs.

BACKGROUND: Declining hospitalization rates for children and an increased emphasis on ambulatory care may be affecting the way family practice residency programs train their residents in the care of children. METHODS: We surveyed all US family practice residency program directors to determine the nature of the child care training that programs currently provide to residents. RESULTS: Responses were received from 78% of the programs. Residencies required a mean of 5.2 months of formal pediatric training (range: 1 to 11 months). Thirty percent of programs noted a declining inpatient census on inpatient pediatric teaching services, but since 1978, the mean duration of inpatient pediatric training increased by 0.4 months to a required mean of 2.7 months of general pediatric inpatient training (range: 0 to 6 months). The mean time devoted to structured outpatient pediatric training was only 1.6 months (range: 0 to 6 months). Nine percent of responding programs required no formal pediatric outpatient training other than family health center experience. CONCLUSIONS: Despite declining inpatient census and increased emphasis on comprehensive ambulatory care, family practice residencies require more formal inpatient pediatric training than formal outpatient training.

Ambulatory Care↗

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

The clinical librarian: new team member for a Family Practice Inpatient Service.

A clinical librarian program was developed for the Family Practice Inpatient Service at the San Francisco General Hospital Medical Center. Objectives of this special service were: (1) to provide relevant articles and other printed resources relating to patient care problems; (2) to alert the team to library resources; (3) to assist the attending physicians in building a reading file for the inpatient service; and (4) to determine library service needs of the team. Two patient cases are included which illustrate how the clinical librarian service functioned. The program was successful and is recommended for inclusion in other family practice programs or inpatient units.

Family Practice↗

PubMedDate not supplied

The Montana Family Practice Residency Satellite Program: a unique solution to multiple problems.

States that do not have a family practice residency program face problems in attracting residency trained family physicians. This article describes the development of a unique program in Montana utilizing a series of satellite programs under the direction of family physicians and a statewide coordinating office. These offer the resident a one- or two-month rotation during off-campus elective time in the second or third year of a family practice residency. The program offers the practicing physician a chance to participate in the training of residents and offers the resident an educational opportunity in rural medicine. It also exposes the resident to a Montana community and to practice in Montana. Survey evidence indicates that this type of program has a definite influence on a resident's choice of a practice location.

Family Practice↗

PubMed1990

The Texas Family Practice Residency Program: a profile.

In 1977, the 65th Texas Legislature created the Texas Family Practice Residency Program to encourage the training of family physicians and to improve access to health care in medically underserved areas. During the past 12 years, the number of family practice residency programs has grown from 12 to 25, with 1,174 graduates as of September 1988. This article discusses the program's origins, administration, effectiveness, and future.

Family Practice↗