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PubMedDate not supplied

When family practice residents are parents: effect on in-training examination scores.

This study examines the effect of parenthood on family practice residents' knowledge of pediatrics by evaluating their performance on the pediatric portion of the American Board of Family Practice in-training examination. The 1986 examination results for five Army family practice residencies were obtained. A faculty member at each program noted on the test report whether or not each of 109 residents had children at the time of the exam. Overall, residents with children had slightly higher scores than those without children on the pediatric portion of the in-training examination. The exception was the PGY1 group where residents with children scored markedly lower than those residents without children. However, none of these differences were statistically significant. Although these results do not refute the possibility of special insight possessed by physicians who are also parents, these physicians do not appear to have any particular advantage on written tests over residents without children.

Achievement↗
PubMed1996

Cancer occurrence and screening in family practice. A 20-year experience.

BACKGROUND: This article is a sequel to a previously published article describing the occurrence of cancer in a rural family practice and the contribution of screening to the diagnosis of breast, colorectal, and cervical cancer. Together, the two articles describe a 20-year family practice experience in diagnosing and screening for cancer. METHODS: The study is a retrospective chart review of all cancers diagnosed in a family practice from January 1985 through December 1994. Records of a regional tumor registry were reviewed to validate and ensure completeness of the cancer diagnoses. RESULTS: One hundred twenty-one cancers were identified during the 10-year study period in a population of approximately 4000 patients. Screening by fecal occult blood testing identified 11 of 20 colorectal cancers, mammography and physician examination identified 9 of 12 breast cancers, and a program of biannual Papanicolaou smears resulted in the diagnosis of 3 of 3 cervical cancers. Only 3 melanomas, 3 ovarian cancers, and 1 testicular cancer were diagnosed in this practice during the entire 20 years of the combined studies. CONCLUSIONS: The five most common cancers--skin, colorectal, lung, breast, and prostate--accounted for 71% of the cancers diagnosed. A high rate of provider and patient compliance with screening was achieved. Screening detected a majority of breast and colorectal cancers. Annual Papanicolaou smear screening would have provided no incremental benefit over the biannual screening used in this practice.

Adult↗
PubMed1979

Medical student clinics: the basis for a clerkship in family practice.

In this paper, the authors describe a popular elective clerkship in family practice a Community Hospital, Santa Rosa, California. The key element in the clerkship for the past six years has been the student's General Medical Clinic. Here, under the supervision of a family physician teacher, senior medical students care for patients with a wide variety of problems. The students work as a team with family nurse practitioners. The clinic has succeeded in offering patients an alternative to the emergency room and an entrance to the hospital's Model Family Practice Center. The students give the clerkship a very high rating as an educational experience. It has also been viable economically.

California↗
PubMed1999

Interactive computer technology, behavioral science, and family practice.

In this paper we discuss conceptual and practical uses for interactive computer applications (ICAs) for family practice, with an emphasis on implications for patient self-management, physician-patient relationships, primary care research, and health care systems quality improvement. We discuss recent behavioral science advances in patient self-management and the advantages and potential limitations of ICAs for medicine. We describe the benefits and risks of using ICAs for providing information, coping-skills training, and social support for patients and for improving the consistency and quality of care given by physicians. There are currently many effective ICAs, and they will play a central role in future health care. There is also the risk of inappropriate use of ICAs. We provide a summary of the empirical literature examining the use of ICAs to aid patients and providers in behavioral change and guidelines adherence efforts. We advise those people researching and applying ICAs in health care to be bold in what they attempt, but cautious in what they claim. Rigorous scientific evaluation and standardized reporting criteria can help quicken this advance, and there are important policy and ethical issues to consider. We conclude with a list of issues for family practices to consider when selecting and using ICAs.

Ambulatory Care Information Systems↗
PubMed1989

Vasectomy complications at a family practice center.

Vasectomy is a safe, effective, economical, and convenient form of permanent sterilization since it can be performed in an outpatient setting. Seventy-three vasectomies were performed during a nine-year period at the Kanawha Valley Family Practice Center. The procedures were performed by family practice residents under the active instruction and supervision of the attending staff. The complication type and frequency are as follows: epididymitis, 5.5 per cent; sperm granuloma, 2.7 per cent; wound infection, 1.4 per cent, and hematoma, 12 per cent. No failures occurred in this study group. All of the complications were minor and responded to conservative medical management. The results of this study reveal that vasectomy complications at this teaching family practice center are comparable to those reported in the medical literature. This study therefore supports the opinion that vasectomies can be performed safely and taught by trained family practitioners in the outpatient setting.

Adult↗
PubMed1995

A homeless shelter medical clinic organized and staffed by family practice residents.

A medical clinic was organized in a homeless shelter to help address the health care needs of the homeless population in a small California city. A second-year family practice resident, together with two community nurses and a local family practitioner, organized and staffed the clinic. After the first winter of operation, family practice residents on their own initiative took over the management of the clinic. The clinic serves the needs of the clients in the homeless shelter, provides family practice residents an opportunity to work independently of the residency program, and offers a sought-after experience in caring for the underserved.

California↗
PubMedDate not supplied

Evidence of discrimination against international medical graduates applying to family practice residency programs.

BACKGROUND AND OBJECTIVES: The purpose of the study was to test the hypothesis that discrimination exists against international medical graduates (IMGs) applying to US family practice residency programs. METHODS: Two sets of letters were sent to 146 family practice residency programs randomly selected from the Directory of Graduate Medical Education Programs. The letters requested information and an application. All letters were identical except that the author of the first set was described as "a foreign medical graduate." The author of the second set was described as "a fourth-year medical student at the University of Nebraska Medical Center." Replies were monitored for 6 weeks after the second mailing. Response rates to each "candidate" were measured. In addition, responses were evaluated for the presence of a brochure describing the residency program, an application, cover letter, invitation for interview, eligibility criteria, and other material. RESULTS: A total of 113 programs (79%) responded. Of these, 102 responded to the fourth-year medical student and 57 responded to the IMG. Of the 46 programs replying to both candidates, only 20 provided identical mailings. Nine of the 46 programs required IMGs to meet standards that exceeded requirements set by the Educational Commission for Foreign Medical Graduates for residency training in the United States. CONCLUSIONS: A pattern of dissimilarity exists in the way family practice residency programs respond to requests for application materials, and the differences appear to depend on whether the candidate is a US medical graduate or an IMG. These results raise questions about the fairness of current methods of resident selection.

Family Practice↗
PubMed1979

Continuity of care in a family practice residency program.

Continuity of care, one of the basic characteristics of family medicine, was studied over a 12-month period in a family practice residency program. Continuity was measured in three contact areas; office hours, after hours, and on the inpatient service. The intensity of continuity was defined at three levels, from encounters with the personal physician to those with physicians on other medical teams. Continuity was further assessed in relation to family encounters. Third year residents averaged 83 percent continuity with their individual patients and 70 percent with their assigned families. Residents from other years were noted to have lower levels of continuity. Similar figures were noted for family practice inpatients. Continuity of care in private practice occurs in about 80 percent of patient encounters and it seems reasonable and feasible to expect residency training programs to come close to this figure.

Continuity of Patient Care↗
PubMed2001

Head injury and alexithymia: implications for family practice care.

BACKGROUND: Alexithymia, a deficit in emotional information processing, and a history of head injury have both been found to be related to high rates of psychosomatic illness, substance abuse, depression, and utilization of primary care services. To date, no study has examined the potential comorbidity of alexithymia and head injury in a family practice setting, a necessary step in evaluating the aetiologic role of head injury in the development of alexithymia. The goals of this study are to establish prevalence of head injury and alexithymia in a family practice setting and to evaluate the relation, if present, between the two. METHODS: Patients (n =135) of a family practice residency facility were screened using the Traumatic Brain Injury Questionnaire and the Toronto Alexithymia Scale-20. RESULTS: Forty-nine per cent of the participants reported a history of head injury and 18% were alexithymic. Those with a history of head injury had significantly higher scores of alexithymia. Chi-square analysis indicated a relation between head injury and alexithymia. CONCLUSIONS: The high rates of self-reported history of head injury in family practice settings, particularly in the context of alexithymia, may adversely affect a physician's ability to care for these patients. Increasing physicians' awareness of head injury and the potential mediating role of alexithymia in medical and psychological illness may facilitate effective diagnosis and patient-physician communication.

Adolescent↗
PubMed1981

Inpatient service of a Navy family practice residency program.

A retrospective chart audit was conducted among the 294 admissions to an autonomous family practice inpatient service of a large Navy family practice residency program over a seven-month period. Data obtained included level of training of primary care physician, duration of stay, hospital ward, age/sex profile, primary discharge diagnosis, and number and types of consultations requested. Routine obstetrical deliveries accounted for the largest amount of admissions, followed by infections, cardiovascular disease, and respiratory problems. Adult onset diabetes mellitus, gastroenteritis, and preeclampsia were the most frequent medical, pediatric, and obstetric disease entities, respectively. The wide variety of diseases admitted to the service and the low consultation rate (13.2 percent) demonstrate the flexibility and depth of the inpatient management skills of residency trained family physicians.

Adolescent↗
PubMed1996

Community-oriented primary care in a family practice residency program.

BACKGROUND: The practice of medicine needs to include disease prevention, health promotion, community health, and clinical epidemiology. Community-oriented primary care (COPC) can be used as an educational strategy to develop competencies in these areas. METHODOLOGY: An interdisciplinary team that included public health representatives was created to teach COPC principles to family practice residents and supervise their community projects. Allied health and nursing graduate students were also involved in the process. Projects were implemented in collaboration with community representatives. RESULTS: Family practice residents and community representatives were positive about working together. The family practice residents appreciated the interdisciplinary experience and reported that the COPC model will be useful to them in the future. However, the program's didactic phase was insufficient to provide adequate skills for use of the COPC process. The program could benefit from more involvement of medical students and students in other health professions. CONCLUSIONS: The program encountered several significant obstacles such as competing clinical priorities, limited health education skills, and inadequate project evaluations. Despite the challenges, the family practice residents, as well as the interdisciplinary faculty, health science graduate students, and community representatives, reported a positive experience.

Clinical Competence↗
PubMedDate not supplied

Hypochondriacal beliefs and attitudes in family practice and psychiatric patients.

Beliefs and attitudes which can be responsible for hypochondriacal behavior were explored by administering the Illness Attitude Scales and two distress scales to patients attending a family practice clinic, nonpsychotic psychiatric outpatients and a random group of employees. Family practice patients were more distressed, had more hypochondriacal concerns and had more bodily preoccupations than employees and took more precautions about their health. Psychiatric patients were more distressed and had more fears about illness and death than family practice patients, yet took fewer precautions about their health. The findings appear to have implications for treatment.

Adult↗
PubMed2002

Improved preventive care in family practices with outreach facilitation: understanding success and failure.

OBJECTIVES: To understand why some family practices with a facilitator improved preventive performance more than others. Sustainability of practice improvements one year after the intervention was also explored. METHODS: Interviews with physicians and nurses from seven practices and data gathered during the intervention were used to form case studies of three high performing and four low performing family practices. Case studies were developed using cross-case analysis with a combination of the constant-comparative method and memoing-diagramming. Two researchers independently conducted in-depth coding of transcripts and documents, individual case construction for each study site, and then cross-case analysis of the identified themes between study sites. RESULTS: Staff involvement and a positive attitude toward implementation of changes were central to high improvement in performance. A lack of computers, low staff involvement or high staff turnover were associated with low improvement in performance. Personal characteristics of the facilitator are important. Six of the seven practices still had the prevention tools in place one year after the intervention and all noted that participation had improved their understanding of preventive medicine. CONCLUSIONS: When using facilitators, one should avoid practices in turmoil, strive for continuity over time, and recognise the importance of the relationship between the facilitator and the practice.

Attitude of Health Personnel↗
PubMed1982

Outpatient termination of pregnancy: experience in a family practice residency.

At the University of Washington Family Medicine Clinic, termination of pregnancy procedures were performed on 260 patients. Their records were reviewed, and an analysis was completed on demographic data, technical procedure parameters, and complication rates during and following the procedure. The majority of patients were not primigravida. Fifteen percent were between six and eight weeks of gestation. Following the procedure, 3.8 percent had excessive bleeding, and 2.7 percent developed endometritis at rates comparable to those found in the obstetrics and gynecology literature. No known perforations occurred. Outpatient termination of pregnancy performed on selected patients in a family practice setting can be a procedure of low morbidity.

Abortion, Induced↗
PubMed1990

Ethics and family practice: some modern dilemmas.

Ethical dilemmas in family practice have increased in frequency and complexity as both the potential benefit and the potential harm of medical treatments have increased. All physicians must be aware of moral issues relating to medicine. Family physicians commonly face ethical problems concerning the patient with diminished autonomy; the right to refuse treatment; allocation of resources; informed consent; surrogate consent (for children, for the incompetent, and for those with diminished autonomy); and the appropriate level of aggressiveness in treatment.

Altruism↗
PubMed2006

Internet gambling: an emerging concern in family practice medicine?

BACKGROUND: Gambling problems are rarely brought to the attention of family practice physicians, but pathological gambling can be associated with poor emotional and physical health. Recent availability and easy accessibility of Internet gambling may be associated with pathological gambling status, and Internet gambling may confer health risks. OBJECTIVE: This study evaluated the prevalence of Internet gambling, its association with pathological gambling, and the relationship between Internet gambling and health status among patients attending medical and dental clinics. METHODS: The South Oaks Gambling Screen and Short Form 12 were administered to 1414 adults in waiting areas of clinics. RESULTS: Only 6.9% of respondents reported ever gambling on the Internet, with 2.8% indicating frequent Internet wagering. Almost two-thirds (65.9%) of regular Internet gamblers were classified as probable pathological gamblers, compared with 29.8% of ever-Internet gamblers and 7.6% of non-Internet gamblers. Internet gambling was associated with poor mental and physical health, and this association remained significant even after controlling for age, gender, site and pathological gambling status. CONCLUSIONS: These data suggest that Internet gambling is linked to pathological gambling and is independently associated with poor health. Family practice physicians should consider referring patients who gamble on the Internet for further treatment.

Adult↗
PubMed1980

Resident development in family practice training: a personal counseling program.

A family physician's personal development and professional functioning are strongly meshed. Family practice residencies need to implement programs which promote personal development and support the integration of the resident's personal and professional development. This paper describes and evaluates the personal counseling program in the Department of Family Medicine, Medical University of South Carolina, from 1973 through 1978. The evolution of goals and their implementation are outlined. Providing resident counseling as part of a family medicine curriculum presents problems which are generic to primary care. These problems and their solutions, within the model of resident development, are defined and addressed.

Counseling↗