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PubMedDate not supplied

From crisis to success. Turning around a family practice residency program.

On Match Day in 1991, Broadlawns Medical Center in Des Moines, Iowa, learned that no residents had matched for the family practice residency program. In the 1992 match, the medical center filled all its residency positions, and repeated the success in the 1993 and 1994 matches. Broadlawns affected this impressively rapid turnaround through a strong commitment to bring its program to a level competitive with leading family practice residency programs, substantive changes to the structure and curriculum of the program, and significant expenditures of time, resources and personal energy. The Broadlawns' case illustrates the need for family practice residency programs to position themselves as strong competitors in the residency market.

Curriculum↗

PubMed1979

Comparative content of three family practice residency programs.

A method of collecting physician-patient encounter data is described and applied to the comparison of the clinical content of residents' experiences in the family practice office. Comparisons were made of over 1,000 consecutive unselected encounters in each of the three family practice residency programs. Considerable differences between the patients encountered by the three programs were observed and between program patients and patients attending family physicians in Iowa. It is important to monitor the demography and diagnostic status of patients attending family practice residency programs to ensure the authenticity of the residents' experience.

Arizona↗

PubMed1984

The Journal of Family Practice--1974-1983: analysis of an evolving literature base.

This paper examines the spontaneous evolution of original work in the field of family practice as published in this journal over the past ten years. An analysis was carried out by principal content, by type, and by source of the more than 1,700 papers published during that period. More than one half (currently 60 percent) of published papers have dealt with biomedical subjects; a majority of the remaining papers have dealt with health services and educational subjects. The most common type of paper has been observational research, with case studies, reviews, methods, opinion, and experimental research following in that order. The last five years have seen a continuing increase in the proportion of observational research papers, a slight decrease in reviews and opinion, and a marked decrease in methods papers. Sixty percent of published papers have been contributed by family physicians or others working in family practice settings. About three fourths of papers have been contributed from university or medical school settings, with one fourth from various community settings. All parts of the country have contributed to the publication of original work in the field. The trends that have been identified over the first ten years in terms of focus and content of the literature of record seem quite appropriate for the current and next stages of development of family practice as a clinical specialty.

Family Practice↗

PubMed2001

Family practice and social and political change.

Reform in US medicine has been a longstanding process, and it has always been intertwined with politics and social issues. So-called organized medicine has often resisted reform, but despite this resistance, many changes took place in the US medical system in the 1960s. The establishment of the specialty of family practice coincided with these changes. Although family practice was established with many goals in mind, many of the goals did not match the public's perceived needs, and there is still much unfinished business. One of family practice 's current tasks is to examine its accountability to the public and decide what it can provide for the public good.

Family Practice↗

PubMed1988

Stressors and psychological symptoms of family practice residents and spouses.

Fifty-nine family practice residents and their spouses from one university-based and three community-based residency programs were studied to assess the frequency of stressful events in their lives and to quantify adverse psychosocial effects associated with that stress. A modified version of a questionnaire produced and tested by the University of Minnesota and the widely used, standardized Symptom Checklist-90 (SCL-90) were used to assess stress and psychological symptoms. There was a high correlation between high numbers of stressful events in the residents' and spouses' lives and high ratings of psychological symptoms. This finding was particularly true for the female residents. Overall, the residents' responses were near the mean for a nonpatient group used as a normative comparison on each of the nine subscales of the SCL-90 and on the overall mean for the entire scale. This finding indicated that the residents, although their lives were quite stressful, were handling the stress without major problems. The residents and their spouses also answered questions about 10 therapeutic interventions concerning stress and indicated which interventions they preferred.

Family Practice↗

PubMed1978

A medical information system for ambulatory care, research, and curriculum in an army family practice residency: 51,113 patient problems.

Over a 16-month period, the Family Practice Residency at Madigan Army Medical Center coded 51,113 ambulatory problems using the International Classification of Health Problems in Primary Care (ICHPPC) coding scheme. The demography of this defined active duty, retired, and dependent population is described as well as the rank order of the major diagnostic categories and top 25 individual diagnoses. A plot of the major diagnostic categories seen by month over a 16-month period is presented. Comparisons between similar curves are made. Physician compliance to coding approached 75 percent and an average of 1.42 problems were dealt with (coded) per visit. Fifty percent of all patient problems recorded fell into 25 descriptive diagnoses. Ninety percent of all patient problems recorded fell into 163 descriptive diagnoses. These data compare favorably to the Virginia study. Comparison of the top 25 patient problems also revealed similarities between this and the Virginia study. Difficulties arise in comparing data because of the differences in coding schemes (RCGP vs ICHPPC). A universally adopted code for all family practice and ambulatory care research would help in overcoming this problem.

Adolescent↗

PubMed1983

Newborn care in family practice.

Official guidelines regarding the training of family practice residents in newborn medicine have been meager and general. Guidelines have traditionally focused on defining the requisite duration rather than the content of nursery rotations. A competency-based curriculum in newborn medicine is needed that defines requisite knowledge, skills, and attitudes; defines the appropriate role for the family physician in managing newborn problems; reflects the actual newborn experience of family physicians; is incorporated into residency training on a daily basis; and can be utilized in documenting resident competency in newborn health care. This paper describes the development, content, and daily implementation of a newborn curriculum that addresses these issues.

Family Practice↗

PubMed1977

Hypertension in a family practice.

The performance of an urban Canadian family practice in the detection, evaluation, treatment, control and follow-up of hypertension for a 10-year period 1965-74 was reviewed. Vigorous case-finding and treatment were followed by good control of hypertension in 67% of cases and a significant decrease in mortality from stroke and congestive heart failure. It is strongly suggested that the proper location for dealing with hypertension is the primary-care practice and that the general practitioner deserves greater assistance from clinical specialists, health foundations and ministries of health in attacking this problem.

Adolescent↗

PubMed1995

Family practice educators' perceptions of computer-based patient records.

BACKGROUND: Despite the National Institute of Medicine's endorsement of computer-based patient records (CPRs), the majority of family practice residency programs continue to use paper records. This study examined the perceptions of family medicine educators about CPRs to understand their limited use of computerized patient record systems. METHODS: A survey was mailed to the directors of 247 family practice residency programs; 199 were completed and returned (response rate 81%). Respondents were asked to identify their concerns about CPRs, what they perceived as the advantages and disadvantages of CPRs compared with paper records, and the likelihood that their program will implement a CPR within the next year and within the next 5 years. RESULTS: The perceived benefits of CPR were greater efficiency, accuracy, and quality in patient care. However, many respondents were concerned about cost, mechanical breakdowns, conversion hardships, training needs, and physicians' attitudes. Despite these objections, the majority of respondents reported it is ¿somewhat¿ or ¿very¿ likely that their program will implement a CPR system within the next 5 years. CONCLUSIONS: Although the surveyed family medicine educators believed that CPRs offer significant benefits, they also perceived several disadvantages of converting from paper to computer-based patient records. Widespread use of CPRs among family practice programs in the near future depends on the extent to which vendors and others heighten awareness and knowledge about the benefits of CPRs and address concerns about cost, mechanical breakdowns, and transition difficulties.

Attitude of Health Personnel↗

PubMedDate not supplied

A survey of Balint group activities in U.S. family practice residency programs.

The investigators conducted a survey of Balint group activities among family practice residencies in the United States. The survey was designed to discover how many programs have Balint groups as well as the groups' characteristics, leadership, and structure. Of the 381 family practice residencies surveyed, 93% responded. Of those, 66 offered Balint seminars to 115 different groups. Most groups met at weekly intervals for two to three years. Most groups were led by family physicians (32%), psychologists (25%), or social workers (19%). Most leaders followed the format of a spontaneous case presentation from memory. Support for residents and resolution of professional role conflict were rated as the two major objectives of training. The leaders rated an understanding of feelings generated when with patients and an enhanced sense of professional self-worth as the most attainable attitudinal changes.

Curriculum↗

PubMed1983

Determination of worries and expectations of family practice patients.

One of the cornerstones of family practice is the development of the physician-patient relationship within the context of the consultation. Each consultation is modified both by the prior expectations of the participants and by illness-related worries held by the patient. This paper describes the development of an instrument to record the worries and expectations of patients visiting their family physicians and changes occurring as a result of the consultation. The instrument comprises a card sort composed of 26 cards, on each of which is typed a statement relating to a worry or expectation that a patient might hold. One hundred patients were asked to sort these cards before and after the consultation. The major worries of the group were about discomfort, the effects of illness on the family, the prospect of a physical examination, and about explaining the problem to the physician. Prominent expectations were for an explanation of diagnosis and treatment and a friendly and understanding manner from the physician.

Adolescent↗

PubMed1996

To stay or not to stay: factors influencing family practice residents' choice of initial practice location.

BACKGROUND AND OBJECTIVES: This study examined what factors influence US third-year family practice residents' choice of location of their first practice. METHODS: A survey was developed by the members of Northeastern Ohio Network to assess the influence of factors related to family, education, geography, finances, the medical community, and others on the selection of practice location. Surveys were sent to all program directors listed in the American Academy of Family Physicians 1994 Directory of Family Practice Residency Programs to be distributed to all third-year family practice residents. The program directors indicated the type of residency program, the number of surveys distributed, and the number returned, then forwarded completed surveys to the investigators. RESULTS: Two hundred fifty-nine of the 380 programs (68%) with PGY-3 residents responded. Of the programs that responded, 1,012 residents (64%) of a possible 1,578 completed surveys. Estimated from the directory, 812 residents from non-responding programs did not complete the survey for an overall response rate among residents of 42% (1,012/[1,578+812]). Family-related items seem to have the most influence on choice of practice location and are more important to married people. More than 50% of residents want to practice in the same size community in which they grew up. Money-related factors were not rated as highly as expected. CONCLUSIONS: Several factors appear to be important to family practice residents when selecting their first practice location. Hospitals interested in retaining their graduates can maximize their success by concentrating on these areas.

Adult↗

PubMed1989

The effect of government policy on family practice programs.

Government, both federal and state, has long recognized that the American public does not have ready access to primary care physicians. Federal and state legislation has been passed to establish and fund family practice programs to alleviate the shortage of primary care physicians. In addition to federal and state funds, family practice programs receive financial support from hospitals and generate patient fee income. In the current era of cost containment, family practice programs are more dependent on patient fee income and hospital support.

Comprehensive Health Care↗

PubMed1981

The social worker as educator of family practice residents: principles for practice.

Social workers have been involved in medical education for several decades. The field of family practice offers new opportunities and challenges for social work educators to help family physicians address not only the biological needs of their patients, but their psychosocial needs as well. To be successful, the educator will need to be familiar with resident learning styles and preferences, with their attitudes toward the behavioral sciences, and with differential teaching strategies. Research about the impact of training programs on the family practice resident will make for more effective curriculum planning efforts by social workers.

Family Practice↗

PubMed1979

Family practice residents' perceptions of behavioral science training, relevance, and needs.

Fifty-six family practice residents representing programs in 23 different states were surveyed concerning their training experience in behavioral science. Questions covered three basic areas of concern: experiential content, subsequent relevance to family practice, and suggestions for curriculum improvement at the residency level. The results point out definite knowledge of medical psychology, psychiatric consultation to medical patients, and practical intervention skills. Suggestions are made concerning curriculum development in behavioral science which (1) emphasize some new areas of concern raised by the residents, (2) recommend a more practical, integrated approach beginning in the medical school training, and (3) emphasize a dual approach requiring skills in medical psychology and skills more traditionally subsumed under the "mental health" field.

Behavioral Sciences↗

PubMed1991

The use of a self-report questionnaire to assess the frequency of sexual dysfunction in family practice clinics.

The epidemiology of sexual dysfunction has been investigated recently in various clinical and nonclinical conditions but, to date, little research has been conducted in the family practice setting. The authors have developed a brief self-report questionnaire addressing most of the common sexual problems, and assessed its usefulness as a screening device in two distinctly different family practice clinics. The proposed questionnaire has gained over 90% response rate in each practice, indicating an appropriate level of acceptability. The sex- and practice-specific prevalence ranged from 31% to 63%, and was found to be significantly higher among male patients than among female patients. Overall dissatisfaction with the present sexual life of either the respondent or his partner (as indicated by the former) was expressed by nearly 20% of the respondents, the majority of whom reported on both self and partner's dissatisfaction. Relatively few patients of those who reported on a sexual problem had ever sought any professional help, but approximately 50% of men and 25% of women indicated that the family physician was their preferred expert for this purpose. It is concluded that sexual dysfunction is highly prevalent in the family practice setting but is nevertheless under-reported. Anonymous screening in one's practice, as presented in this study, will provide the family physician with valuable information, and may contribute to further direct discussions of these delicate concerns.

Adolescent↗

PubMed1986

Psychiatric decision making in family practice. Future research directions.

Psychiatric illnesses in family practice are significantly underdiagnosed because of factors associated with both the physician and patient. Clinicians too often fail to utilize a biopsychosocial approach in the assessment process, tending to assess symptoms as organic regardless of their etiology. Patients similarly tend to emphasize the physical nature of their complaints when presenting in medical settings. Efforts have been made to improve the physician's diagnostic accuracy through the use of screening scores. The results, however, are inconclusive. It remains unclear whether the physician disregards this information or considers it irrelevant. We suggest that future research investigate not only the accuracy of the clinician's diagnostic formulation but also the processes whereby the family practitioner elicits, analyzes, and synthesizes or discards cues pertinent to mental illness. By combining statistical analyses with the analytic techniques developed in studies of medical decision making and general problem solving, detailed leads should emerge for the design of improved didactic and experiential training programs.

Attitude of Health Personnel↗

PubMed2005

How bipolar disorders are managed in family practice: self-assessment survey.

OBJECTIVE: To investigate family physicians' experience in diagnosing and managing bipolar disorder, how they rate their undergraduate and postgraduate training in this area, and what they think they need to learn in the future. DESIGN: Survey questionnaire. SETTING: Family practices in London, Ont. PARTICIPANTS: Random sample of 297 family physicians. MAIN OUTCOME MEASURES: Physicians' experience in diagnosing and managing patients with bipolar disorder, rating of their undergraduate and postgraduate training in this area, and thoughts about what they need to learn in the future. RESULTS: Of 297 surveys sent out, 147 (49.5%) were returned. Male respondents accounted for 62%, and female respondents 37%, of completed surveys. Average year of graduation from medical school was 1979. The most common response for level of experience in diagnosing and treating bipolar disorders was "somewhat comfortable." Physicians frequently reported screening for symptoms of mood disorders (42%), and most of them were sharing care with other professionals (88%). Undergraduate training was rated as poor (42%) or satisfactory (46%), and postgraduate training was rated as poor (42%) or satisfactory (44%). Physicians thought they needed more education in issues of diagnosis and pharmacotherapy. CONCLUSION: Family physicians were only somewhat comfortable with diagnosing and managing bipolar disorders, and most thought their undergraduate and graduate training in this area had been, at best, satisfactory. They expressed a need for more education in the areas of diagnosis and pharmacotherapy.

Adult↗