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PubMed1987

Musculoskeletal problems in the family practice setting: guidelines for curriculum design.

Rheumatology training is essential for family practice residents, but major inadequacies have been described in current programs. In an effort to guide the design of our own rheumatology curriculum, all patient visits to a family health center over a 15-week period were surveyed. Musculoskeletal problems were reported overall in 23% of the 2285 patient visits and were commoner as patient age increased. Osteoarthritis and regional joint pain were the 2 most frequent problems noted, whereas systemic and inflammatory rheumatic diseases were unusual. Rheumatology curricula for family physicians should stress evaluation, management and prevention of problems in those defined areas.

Adolescent↗

PubMed1983

Health hazard appraisal in a family practice center: an exploratory study.

Health Hazard Appraisal (HHA), a tool of primary prevention, has been advocated for use in family practice. Yet little evidence exists regarding its effectiveness in clinical settings or its acceptability to practitioners or patients. In this study, 69 family practice patients completed a HHA questionnaire. Their responses were computer-analyzed and returned in two to three weeks. The patients were telephoned three to five months later to assess the effectiveness of HHA in terms of desired behavioral changes. Of the patients who were recommended to undertake specified behavioral changes, 41.3% reported that they had begun an exercise program, 27.8% had stopped smoking cigarettes, 20.0% had limited their alcohol intake, 23.5% had reduced their driving mileage to under 10,000 miles, and 75.0% of the women started breast self examinations. Although the patients' self-reports may have been exaggerated, they nonetheless represent encouraging results. Evaluations by patients revealed little objection to the personal questions, length of time to complete, or cost of the HHA form. Physician evaluations expressed the consensus that HHA was beneficial to the doctor-patient relationship, but a few indicated they did not feel comfortable discussing the HHA results with the patient.

Adolescent↗

PubMed2002

Can distance learning improve smoking cessation advice in family practice? A randomized trial.

INTRODUCTION: Family physicians (FPs) underuse opportunities to provide smoking cessation advice during routine consultations with patients who smoke. Distance learning is a promising approach to continuing medical education, particularly for FPs practicing in rural and remote areas. We developed a distance learning module, conducting a randomized trial to assess its educational impact on knowledge, attitudes and skills ("competence"), self-rated competence, confidence, and readiness to change. METHODS: Volunteer FPs were randomly allocated to receive either a distance learning module or a preventive care guideline. Self-administered questionnaires were completed at baseline and post-test. RESULTS: Fifty-three FPs enrolled in the study. There were no changes in knowledge or attitudes. Change in skills was limited to a reduction in use of one ineffective technique, namely "nicotine fading." Change in self-rated competence between baseline and post-test was significantly greater for the intervention than for the control group, however (p = .03). Although self-ratings of confidence increased significantly between baseline and post-test in both groups, the magnitude of change was no greater in the intervention than the control group (p = .3). Both groups demonstrated only nonsignificant shifts in readiness to change. DISCUSSION: These modest changes are of uncertain educational value, inviting caution before recommending distance learning approaches to promote smoking cessation advice in family practice.

Australia↗

PubMed1998

Results of the 1998 National Resident Matching Program: family practice.

The 1998 National Resident Matching Program (NRMP) results reflect a change in the perceptions and choices of physicians entering graduate medical education in the United States. Ninety-one fewer positions were filled in family practice residency programs in 1998, as well as 21 fewer in primary care internal medicine, 12 fewer in primary care pediatrics, and 13 fewer in internal medicine-pediatric programs. In contrast, 49 more positions were filled in anesthesiology, and 12 more US seniors chose diagnostic radiology, two "marker" disciplines that have recently been market sensitive. Thirty-four more positions were also filled in each of categorical internal medicine and pediatrics programs, where trainees are "pluripotential" with perceived options for practicing as generalists or entering subspecialty fellowships, depending on the market. While the demands of managed care and the needs of rural and underserved populations continue to offer a market for family physicians, family practice may have experienced a "primary care backlash" though the 1998 NRMP.

Career Choice↗

PubMed1996

Norplant prescribing in family practice.

BACKGROUND: This study describes the Norplant prescribing experience, training, and attitudes of South Carolina family practice and general practice (FP/GP) physicians. METHODS: A survey was mailed to all FP/GP physicians licensed in South Carolina, with two follow-up mailings to nonrespondents. RESULTS: Responses were received from 520 physicians, representing 43% of all licensed FP/GP physicians and 73% of all board-certified FP physicians. Norplant had been inserted by 39% of the respondents, and fewer than 10% reported encountering complications during the insertion process. Norplant removal was reported by 135 physicians, averaging 4.4 removals per year. Complications during removal were reported by 52% of physicians, with the most common problem being difficulty finding the capsules. Some degree of training in Norplant insertion was reported by 82% of physicians; 69% reported having had some training, formal or informal, in removal; but only 57% reported having received formal training either during residency or at a workshop. Training reduced insertion time but did not affect removal time or the number of complications encountered. Formal training was more likely to prepare physicians to successfully manage procedural complications. CONCLUSIONS: FP/GP physicians are important providers of Norplant. Improved training is needed to ensure that insertion is performed properly and to disseminate effective removal techniques.

Adult↗

PubMedDate not supplied

Resident physicians in family practice: who's burned out and who knows?

Sixty-seven family practice residents and 18 faculty members completed the Maslach Burnout Inventory and listed three factors they believed most responsible for resident burnout. In addition, faculty rated residents and residents rated themselves on overall burnout. Mean resident scores on the Maslach ranged from moderate to high, while global self-ratings indicated moderate burnout. Patterns did not vary across programs surveyed, postgraduate year, or gender. Faculty did not appear to be modeling burnout, since they scored in the low to moderate ranges on all Maslach subscales. Residents and faculty overwhelmingly cited time demands as the factor most responsible for resident burnout. Residency directors were more accurate than psychologist faculty in identifying which residents saw themselves as most burned out. Directors significantly underestimated the absolute level of burnout, but psychologists did not. Combined assessments of both faculty groups resulted in significantly better identification than either alone. The prevalence and patterns of burnout and difficulties in identifying affected residents are discussed in terms of the demands of residency training programs and the investment of residents and faculty in current models of medical education.

Adult↗

PubMed2000

The comfort of family practice residents with health care of patients of the opposite gender.

BACKGROUND AND OBJECTIVES: Studies have shown that female and male residents see disproportionately few patients of the opposite gender. Such an imbalance may be detrimental to the quality of residency training. This study examined residents' levels of comfort in caring for patients of the same and opposite genders and their assessments of the adequacy of the number of same- and opposite-gender patients they saw during residency training. METHODS: Data were collected from four family practice residency programs in the Midwest. All current family practice residents at the four sites surveyed were given a questionnaire asking them to rate their perceptions of the gender distributions of their patient panels and comfort with several areas of health care, some gender specific. The questionnaire used a five-point Likert scale. RESULTS: Ninety-four surveys (83% response rate) were collected. Ninety-three percent of female residents reported seeing enough female patients, but only 54% reported seeing enough male patients. Seventy-six percent of male residents reported seeing enough male patients, but only 31% reported seeing enough female patients. More females than males (88% versus 48%) felt comfortable with women's health, but more males than females (70% versus 31%) felt comfortable with men's health. Male residents were significantly more comfortable than female residents in performing or managing prostate exams, testicular exams, and prostatitis. Female residents were significantly more comfortable with clinical breast exams and breast disease. CONCLUSIONS: Male and female residents perceive disproportionate experiences in their exposure to patients of the opposite gender. Significant differences between male and female residents were also apparent regarding their relative comfort in managing some gender-specific health care topics. These results have implications for residency education.

Clinical Competence↗

PubMed1975

Continuity of care in family practice. Part 2: implications of continuity.

Continuity of care in family practice cannot be adequately described merely in terms of duration. It is not delineated by the nature of a patient's illness, but involves the family physician's ongoing commitment to the patient and his family as persons. An implicit contract exists between the family physician and the patient. This kind of continuity of care provides several important elements related to patient care, such as the feasibility of long-term observations allowing effective diagnosis with less need for extensive one-time workups, the potential for psychotherapy and counseling through a continuing personal relationship, and the opportunity to perceive illness in the context of the whole person and his environment. Continuity of responsibility by the family physician is achievable despite mobility of some patients and is more a matter of the physician's attitude and style of practice than duration of the doctor-patient relationship.

Comprehensive Health Care↗

PubMed1994

The quality of clinical trials published in The Journal of Family Practice, 1974-1991.

BACKGROUND: Previous analyses of published clinical trials have identified major deficiencies in reporting, design, analysis, and overall quality. The purpose of this study was to determine the strengths and weaknesses of published clinical trials in family practice, and to identify predictors of quality in these trials. METHODS: Randomized controlled clinical trials published in The Journal of Family Practice from 1974 to 1991 were eligible for the study. Two raters independently evaluated the adequacy and appropriateness of reporting, design, and analysis for each clinical trial, using the Chalmers index for assessing clinical trial quality. Multiple linear regression was used to determine the predictors of quality. RESULTS: The 53 trials included in the study showed deficiencies in reporting, design, and analysis, although fundamental design issues, such as blinding, were a relative strength. On average, the trials scored 35% of the possible points on the scale. Three factors were positively associated with overall quality: year of publication, number of pages of the published report, and the type of intervention. Trials with pharmacologic and non-medication therapy interventions, such as diet, had higher quality scores than did trials with psychosocial or educational interventions. CONCLUSIONS: The overall quality of these clinical trials was less than optimal but comparable to previously analyzed groups of trials. The improvement in quality over time may be related to improvement in the quality of the trials themselves, or more exacting editorial standards, or a combination of the two.

Bias↗

PubMedDate not supplied

A perinatal group in family practice.

Pregnancy is a time of natural stress that can have a marked effect on the relationship of the expectant parents and, subsequently, on the child. A group was formed to provide emotional support for the women and to involve the husbands in the process. By offering this service in a family practice residency program, it not only has a beneficial effect on the outcome of the pregnancy but also gives family practice residents a valuable learning experience.

Family Practice↗

PubMed1994

Computerized performance support systems: applications in a family practice clerkship.

This article describes a computerized performance support system, the Clerkship Learning Expert and Resource Consultant (CLERC), developed to improve the quality and consistency of learning available to medical students in a third-year family practice clerkship. CLERC is an integrated computer system with an interactive knowledge base, software applications, literature search capabilities, and clinical diagnostic software programs. Medical students enrolled in a third-year family practice clerkship use CLERC to access up-to-date clinical information and to complete clerkship assignments.

Clinical Clerkship↗

PubMed1998

[Incidental high blood pressure in family practice: due to hypertension and/or left ventricular hypertrophy in more than half of the patients].

OBJECTIVE: To determine if patients with incidentally high blood pressure actually have hypertension and if these patients have an increased left ventricular mass. DESIGN: Cross-sectional study. SETTING: Two family practices with 8 general practitioners in Leiden and Noordwijk, the Netherlands. METHODS: From the Family Practice Network in the Leiden area 133 (67%) out of 200 patients with incidental high blood pressure, who did not receive antihypertensive medication, participated in the study. Their blood pressure was measured 6 times with a mercury manometer, an automatic, non-invasive ambulatory blood pressure monitoring during 24 hours was performed once and their left ventricular mass was measured by means of echocardiography. RESULTS: Of the 133 selected patients 46% had a mean diastolic blood pressure > 95 mmHg measured with the mercury manometer and 64% had a mean 24-hr diastolic blood pressure > 90 mmHg measured with the ambulatory blood pressure monitor. The correlation between both blood pressure measurements was moderate (correlation coefficient 0.73). Left ventricular hypertrophy was found in 53% of the patients, irrespective of their blood pressures. CONCLUSION: In this investigation 45-65% of patients with an incidentally high blood pressure had a mean diastolic pressure > 95 mmHg as measured with a mercury manometer and (or) a mean 24-hr diastolic blood pressure > 90 mmHg as measured with the ambulatory blood pressure monitor; 53% had left ventricular hypertrophy.

Adolescent↗

PubMed1977

A university/community hospital family practice residency program.

A residency program associated with a major university has many obvious advantages. On the other hand, a residency program located in an area of health manpower shortage is a major advantage to that community. This paper describes the development of a university affiliated family practice residency in the Mojave Desert of Southern California. It reports that it is possible to form a successful alliance between a medical center and a rural community, bringing increased primary care to the community, upgrading the quality of medicine practiced in the community and augmenting the staff of the local hospital without sacrificing training for the family practice residents. Furthermore, the residency program can become financially self-sufficient.

California↗

PubMed1999

Responses to questions about the specialty of family practice as a career.

This article provides answers to many of the questions medical students ask about the specialty of family practice. It is the fourth update of a previous article and was developed in response to feedback from medical students at the 1997 National Congress of Student Members held by the American Academy of Family Physicians. Students at the 1998 Congress also identified areas of interest and concern. This article discusses the hours and income of the family physician, the scope of medical practice in the specialty, required continuing medical education and board certification, family practice residency training and combined-specialty training.

Career Choice↗

PubMed1992

Support services for family practice residents.

BACKGROUND: Internship and residency are stressful experiences for physicians in training. Residency programs vary in their provision of supportive services for residents. METHODS: A random sample of 50% of the nation's family practice residency programs was surveyed to determine the prevalence of 19 support services, 10 of which were assessed a decade previously. Programs were also asked about on-call frequency, vacation benefits, and program size. RESULTS: Approximately 91% of the programs responded. The surveys indicated that residents were on call an average of once every four nights, a 10% decrease from a decade ago. The prevalence of three support services had increased over the last decade: seminars and speakers on the stresses and conflicts of being a physician, support groups for residents, and child care services. "Night-float" rotations and part-time residencies are the least offered support services of those studied. CONCLUSIONS: Support for family practice residents is increasing, yet in many cases remains inadequate.

Family Practice↗

PubMed1983

A model for teaching ethics in a family practice residency.

The model used for teaching ethics at the Ghent Family Medicine Residency at Eastern Virginia Medical School consists of a monthly one-hour noon conference integrating ethical principles and clinical decision making. The underlying objective is to help produce effective physicians by developing their knowledge, skills, and attitudes. The model combines didactic material and clarification of personal values in a case study format. The most important kind of learning to be derived is the self-awareness of one's own value structure and its contribution to the clinical decision-making process. Such a conference will succeed in capturing resident participation in direct proportion to faculty support. Medical ethics teaching in family medicine is appropriate, important, and consistent with the principles of a good family practice residency. An illustration of a typical ethics noon conference on confidentiality is given.

Attitude of Health Personnel↗

PubMedDate not supplied

Teaching family psychodynamics in a family practice center: one experience.

This paper describes a method of teaching family psychodynamics in a new family practice center. Initially, there were difficulties in engaging staff because of inappropriate teaching methods and personal and professional identity conflicts. Ultimately, a sequential program of video playbacks, live interviews and case conferences was developed. The residents' four-month rotation in psychiatry proved essential for developing comfort with psychological and familial aspects of psyical illness.

Attitude of Health Personnel↗

PubMed1977

Some considerations in the design of family practice residency experiences.

A time-study of residents in a family practice training program is reported. Data concerning time with patients and time with attending physicians tended to be inversely associated with patient volume. The proportions of time spent in these two activities are compared with related activities reported for other participants in postgraduate medical education and for practicing physicians. Study results are used to illustrate and develop some issues involved in thd design of residency experiences for primary care physicians.

Curriculum↗