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PubMed1978

Internal review--a fruitful family practice evaluation tool.

In 1975 the Department of Family and Community Medicine, University of Toronto, initiated a system of internal review of its undergraduate and postgraduate programs. During the next six months each of the major teaching resources for the family practice component of the programs was visited by an inspection team. A detailed report with recommendations was prepared and received wide distribution. After this initial review, the internal medicine and pediatric components of the curriculum were evaluated. Again reports and recommendations were made. At the present time the surgical and psychiatric components of the program are being evaluated. This ongoing internal review has had several benefits including specific changes in programs, better organization, and a better understanding of the department and its goals. Some of the difficulties are the time and organization necessary for a valid and appropriate review.

Curriculum↗
PubMed1990

A nursing home rotation in a family practice residency.

A nursing home rotation can be a complementary component of geriatrics education in a family practice residency curriculum. Using nursing homes in teaching geriatrics has been done for some time but has of late received more emphasis. This increasing emphasis has been brought about by the growing health care needs of an aging population and a concomitant focus on education in geriatrics. If implementation of a nursing home rotation is contemplated, both the positive and negative aspects of such action as it relates to the residents, the nursing home, and the nursing home patients should be explored. The rotation as incorporated into the geriatrics curriculum of the Family Practice Residency, Knoxville Unit, University of Tennessee College of Medicine, involves all second-year and third-year residents in the medical care for patients of a 222-bed long-term care facility. From an educational standpoint, overall evaluation of the rotation reflects satisfaction. The experience exemplifies personal and comprehensive continuity of patient care. Other educational benefits include desensitization to the nursing home environment, understanding the kinds of medical care that can be delivered in this setting, and appreciation for the cost not only to the patient and the family but also to the medical care system as well.

Family Practice↗
PubMed1999

Domestic violence education in family practice residencies.

BACKGROUND AND OBJECTIVES: This study evaluated the extent of domestic violence (DV) education in US family practice residency programs and compared the results to those of a prior study of the same topic. METHODS: We mailed a four-page survey to the directors of all US family practice residency programs. The survey asked the extent to which the topic of DV in particular and other areas of violence in general are included in the curriculum. RESULTS: Surveys were returned from 298 (65.9%) programs, of which 69.4% of respondents indicated that the extent to which violence education is a formal part of their curriculum is either somewhat or a great deal, and 79.9% responded similarly about DV education specifically. On average, programs provide 4-5 hours of training each year, mostly through didactic lectures. Compared to a previous study, our findings demonstrate an increase in violence education in these programs. CONCLUSION: Our findings demonstrate that family medicine educators have increased the amount of residency curricular time devoted to training on DV.

Curriculum↗
PubMed1994

Cancer prevalence in Israeli family practice. The Cancer Research Group.

OBJECTIVES: To study the prevalence of different cancers in several communities in Israel, using data supplied by family physicians, and compare these with the data from the National Cancer Registry. The attendance pattern of cancer patients at the family practice and consultation clinics was also studied. DESIGN: 17 family physicians reported on all living cancer patients under their care. SETTING: 15 family practices in northern Israel, urban and rural, Jewish and Arab. SUBJECTS: The study population included nearly 26,000 patients. OUTCOME MEASURES: Standardised prevalence rates of cancer for different types of cancer and for different communities (per 1000 people at risk); duration of survival since the diagnosis. RESULTS: 249 cancer patients were identified, excluding 130 with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) of the skin, giving a prevalence of 9.6/1000 (excluding BCC and SCC). This is lower than that of the few reports found in the literature. Half of the cancer patients in the study had survived over five years since the diagnosis. Marked differences were found between the Jewish and Arab populations, with standardized prevalence of less than half among the Arabs. Significant differences were also found between the different types of Jewish community, kibbutzim having a rate three times higher than any of the others. A comparison of the data from the study with those of the Israel National Cancer Registry showed 50% more cases known to the ambulatory system. Half of this discrepancy is inexplicable. CONCLUSIONS: Data collection in cancer care should be supplemented from primary care sources. Larger studies, with emphasis on registration quality control, are required, to explain some of the differences found in cancer prevalence between different communities.

Ethnicity↗
PubMed1993

Consumer assessment of interview skills in a family practice certification examination.

BACKGROUND: In New Zealand, the family practice certification examination includes an assessment that uses simulated patients. In 1990, for the first time, consumers participated in evaluating the performance of examinees in the simulated-patient section of the examination. METHODS: The consumer examiners and medically trained examiners observed the candidates during interactions with simulated patients. The consumers, medical examiners, and simulated patients independently scored the candidates' performances. One hundred and nine examination candidates participated in two simulations each, and the scoring behavior of each rater was compared. RESULTS: Consumer and medical examiners showed significant differences in their scoring behaviors, disagreeing on whether the candidate should pass or fail in 7.8% of interviews. In comparing the scores given by consumers, medical examiners, and the simulated patients, low inter-observer correlations were noted. CONCLUSION: Medical personnel, consumer observers, and simulated patients all provide a different perspective on the communication skills of physicians.

Certification↗
PubMed1984

Telephone management of febrile young children in a family practice setting.

To examine which factors are related to the telephone disposition of febrile children in a university family practice setting, telephone encounter records of a cohort of febrile young children were analyzed. No relationship was found between telephone disposition and a child's sex, age, or temperature, the latter two being well-known risk factors for occult and serious illness in febrile young children. There was a significant relationship between telephone disposition and telephone diagnosis. The lack of association between telephone disposition and either age or temperature of a child should be impetus for staff education concerning the telephone management of febrile children in this family practice.

Age Factors↗
PubMed2002

A longitudinal community-based underserved care elective for family practice residents.

The Longitudinal Community-based Underserved Care Elective at the Virginia Commonwealth University-Hanover Family Practice Residency Program is, to our knowledge, the first report of a longitudinal 2-year elective in community-based clinics for underserved patients that supplements continuity patient care at a residency family practice center. Providing longitudinal patient care in both settings offers benefits for participating residents and the community. Over the program's first 3 years, 13 residents have provided approximately 2,700 office visits to the area's uninsured poor. Residency programs lacking a significant underserved patient population but located near community-based clinics for the underserved may benefit from offering a similar experience.

Adult↗
PubMed1981

Academic development in family practice.

To date most faculty development programs in family practice have concentrated on aspects of the educational process as well as on the acquisition of research and administrative skills. While effective, such programs have characteristically been directed at a limited range of elements of a typical faculty member's professional role. A model of academic development is proposed that combines an epigenetic pattern of adult development and a sequential pattern of an individual's development in the academic role. The model permits a reasonable approximation to be made of the developmental status of an individual faculty member which, when viewed in the context of personal and institutional needs, can be used as the basis for defining and implementing appropriate assistance strategies. Adoption of the model offers two general approaches to planning, organizing, and delivering faculty development activities: promotion and intervention. Promotion activities are aimed at helping faculty assume the academic role in the most effective manner possible, while intervention activities occur when the process of development has gone awry.

Adult↗
PubMed1991

Patient preferences regarding educational pamphlets in the family practice center.

Educational pamphlets are widely used in family practice offices despite few studies on patient attitudes toward this educational technique. The purpose of this study was to: 1) determine how frequently patients perceive that pamphlets are used and how often they are desired; 2) determine what is usually done with pamphlets; and 3) determine patient preferences regarding requesting pamphlets, location of unsolicited pamphlets, techniques of getting pamphlets, and style of pamphlets. In this survey of 360 patients, 90% reported wanting a pamphlet at some or all of their office visits. Overall, 67% reported reading or looking through and saving pamphlets received, 30% read or looked through them and then threw them away, and only 2% threw them away without review. Only 11% of males and 26% of females reported ever asking a doctor for pamphlets. Some conclusions are that: 1) more patients desire pamphlets than are receiving them; 2) most patients do save pamphlets; and 3) patients need encouragement and permission to ask for pamphlets.

Adolescent↗
PubMed1988

Correlates of burnout among family practice residents.

Burnout among 67 residents in four family practice training programs was explored. The residents' scores on the emotional exhaustion, depersonalization, and lack of accomplishment subscales of the Maslach Burnout Inventory were used to assess burnout. These scores were examined in relation to situational and background measures, two personality instruments (the Millon Clinical Multiaxial Inventory and the Myers-Briggs Type Indicator), and to regrets about career decisions. Few significant relationships were found between the background and situational factors and the burnout scores, but numerous relationships were found among personality measures, burnout scores, and measures of regret. The pattern of these relationships indicates the importance of interpersonal comfort and skills in mitigating burnout. Although personality factors were more predictive than demographic and situational variables of the variability in burnout among residents in the sample, the variables shared across the sample--long hours, little time for leisure activities and social contact, and compulsive personality characteristics--may contribute to the moderate level of burnout shared by these residents.

Adult↗
PubMedDate not supplied

Development and content validation of family practice residency recruitment questionnaires.

BACKGROUND AND OBJECTIVES: The residency recruitment process involves a substantial time and financial commitment on the part of medical students and residency programs. This paper describes the development and content validation process of two written questionnaires designed to assess the application and interview process at our family practice residency program. METHODS: Two written questionnaires were developed after completion of a literature review and from areas deemed important by our academic faculty. Drafts of each questionnaire were sent to nine jurors to assess content validity. Content reviewers provided both a qualitative and a quantitative assessment of each questionnaire. RESULTS: The inclusion of both open- and closed-ended questions/items was deemed necessary and appropriate by the panel of content jurors. Assessing faculty, residents, curriculum, program's reputation, geographic location, and spouse/family influence were considered the most important factors to include on the questionnaires when assessing a family practice residency program. CONCLUSIONS: With increasing pressure to fill positions across many family practice residency programs, it is important for faculty involved in the recruitment process to recognize that both factors within and out of their control contribute to the selection process.

Family Practice↗
PubMed1977

The analysis of family practice workloads by seriousness.

There is a need for a measure of the overall seriousness of a given family practice workload. In the past, such measurements have been attempted in various ways. In this work, the rubrics of the Canuck Book Classification (a classification of health problems in family practice) were rated for seriousness. There was sufficient agreement on 96 rubrics for them to be used as indicators of the seriousness of workloads in general. Some examples of the uses of the system are shown. Several difficulties were encountered; these are not insuperable, and the method deserves to be developed further.

Adolescent↗
PubMed1976

Reform in the United States: its impact on medicine and education for family practice.

The historical concept of reform is useful as an aid to understand the modern rise of family practice education. Beginning about 1890, historians have identified several themes of reform in the United States which have been expressed culturally, politically, and socially. Each of these themes, agrarianism, bureaucratization of the professions, and utopianism, has influenced medicine and medical education--first at the turn of the century in the activities of the AMA in promoting public health and in establishing the natural sciences as a basis for medical education and practice. Since the end of World War II, additional reform themes have become visible which are also influencing medicine. Among these are humanism, consumerism, and the women's movement. It is the author's thesis that the present vitality and future development of family practice as a discipline is more dependent on its capacity and willingness to be identified with these expressions of reform than on its negotiations and compromises within the medical education establishment.

American Medical Association↗
PubMed1998

Maternity and family leave policies in rural family practices.

To help recruit and retain physicians, especially women, rural family practice groups need to establish policies regarding maternity and other family leaves. Also important are policies regarding paternity leave, adoptive leave, and leave to care for elderly parents. We surveyed members of the American Academy of Family Physicians in rural practice in 1995 to assess the prevalence of leave policies, the degree to which physicians are taking family leave, and the characteristics of ideal policies. Currently, both men and women physicians are taking family leaves of absence, which indicates a need for leave policies. Furthermore, a lack of family leave policies may deter women from entering rural practice.

Adult↗
PubMed1995

Where there is no family doctor: the development of family practice around the world.

Family physicians are generalists trained at the postgraduate level to address the majority of primary care needs of patients of all ages in communities they serve. Throughout the world there is a need for family physicians to serve as cornerstones of comprehensive health care systems that provide high-quality, cost-effective medical and public health services to the entire population. To meet this need, each country must value and adequately finance essential medical and public health services and must provide family physicians with a thorough education focused on the relevant health care problems of the population being served. The authors present an overview of the status of this training throughout the world, outline challenges to the development of such training, and suggest strategies for successful development accompanied by illustrative case studies from South Korea, Venezuela, and Pakistan.

Education, Medical↗
PubMed1987

Patient compliance with screening for fecal occult blood in family practice.

Thirty-two family physicians in British Columbia collaborated in a study to evaluate their patients' compliance when offered testing for fecal occult blood (FOB) with Hemoccult II as a screening test for asymptomatic colorectal cancer. Of the 5003 eligible patients 71% complied. Thirteen variables were investigated. Compliance was found to be directly related to age in a linear manner (chi-squared value for trend = 180.4, p less than 0.0001), age alone correctly classifying 58.5% of the patients as complying or not complying. The association with other variables was less strong. Restricting the consumption of red meat during the test period had no effect on compliance.

Age Factors↗