Family Medicine Abstracts
Volume 39 Issue 9
October 2007
Abstracts
Advanced Life Support in Obstetrics (ALSO®) International Development
BACKGROUND: The Advanced Life Support in Obstetrics (ALSO®) program helps pregnancy care
providers learn the information and skills necessary to deal with urgent and emergent conditions
that arise during pregnancy and delivery by using mannequins, mnemonics, and evidence-based
approaches. Since its origin, the program has been disseminated internationally. Outside of North
America, more than 18,000 clinicians have taken the ALSO® course, and more than 1,200 ALSO®
individuals have been approved as ALSO® instructors. Some of the international programs have
become self-sustaining, others have not. METHODS: Features of ALSO® programs were analyzed in
all countries in which ALSO® has been introduced to identify characteristics associated with the
program becoming self-sustaining. RESULTS: Characteristics of self-sustaining ALSO® programs
include a strong organizational structure, use of a train-the-trainer model to introduce the course,
and encouragement of competing groups to work together. Overall, the program has been sustained
by drawing on the expertise of international collaborators for medical content and by balancing
customization of content against preservation of core information and skills. CONCLUSIONS: When the
ALSO® program is introduced to a new country or region, methods that have resulted in programs
becoming self-sustaining should be used.
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Family Medicine's Role in Health Care Systems in Sub-Saharan Africa: Uganda as an Example
Sub-Saharan Africa is probably the region with the worst health indices in the region. Although
health problems in this region are largely preventable through a good primary health care system,
efforts to implement such a system have not been so successful and neither have reforms suggested
by the World Bank. However, there are new efforts to improve delivery of health care by introducing
family medicine in the region through decentralized health care systems. Uganda is at the forefront
of these efforts, and ways to integrate family physicians into the health system are still being debated.
This paper reviews the potential role of family medicine/general practice in the health care systems
of sub-Saharan Africa and in Uganda in particular and offers suggestions based on successes made
in other countries.
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The Emergence of Family Medicine in Kyrgyzstan
BACKGROUND AND OBJECTIVES: In post-Soviet Central Asia, Kyrgyzstan has emerged as the leader in
family medicine reform. This paper examines the factors that have allowed family medicine to become
the foundation of primary care and the rationale for retraining specialists in primary care. METHODS:
Critical elements of successful family medicine reform have included national policy, international
cooperation, training programs, support structures, and quality measures. The national policy has
contributed to an environment that has allowed many international organizations to participate in the
process of reforming the health care system. The 9-year training process was a momentous nationwide
development task that was supported by various structures, organizations, and events and included
the implementation of quality measures. Analysis: Various reports, studies, and evaluations support
the positive impact family medicine has had on patient satisfaction, physician attitude, and scope of
practice. Further, one study indicates improved health outcomes in terms of decreased years of potential
life lost. RESULTS: The national policy of reform that is in favor of family medicine, and international
donor agencies-supported training, produced the following results: a group of family medicine teachers,
98% (2,691) of the country's primary care doctors retrained in family medicine, and there were
372 family medicine resident graduates. To ensure quality, objective structured clinical exams were
implemented in all levels of training. CONCLUSIONS: It will take many more years to fully establish family
medicine in the medical culture of Kyrgyzstan and reap its full benefits, but already it is contributing
toward improvements in the quality of patient care.
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Creation of Postgraduate Training Programs for Family Medicine in Vietnam
BACKGROUND AND OBJECTIVES: The Vietnam Family Medicine Development Project has successfully
created postgraduate training programs for family medicine in Vietnam. This paper's objective is to
report on the project's progress and provide initial evaluation results. METHODS: A training network
of medical schools in Vietnam partnered with family medicine departments in the United States to
accomplish the goal of establishing family medicine as a specialty in Vietnam with assistance from
the Ministry of Health. Together they created a curriculum and ambulatory training sites. Faculty
development was accomplished, and training programs were implemented. RESULTS: A preliminary
assessment of some of the graduates demonstrates that family physicians in Vietnam provide enhanced
primary care with better patient satisfaction. A more-complete evaluation is underway. CONCLUSIONS:
Initial establishment of the specialty of family medicine in Vietnam has been successful. Ongoing
support for the development of this new primary care specialty has been garnered in each of the
medical schools and at the ministerial level throughout the country.
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Just as China has struggled with bringing an expanding economy to a country with large areas of
economic underdevelopment, the Chinese health care system is experiencing tension between tradition
and modernization. Because of this tension, health care in the Peoples' Republic of China has
been undergoing significant reform since the beginning of the 1980s. Experiments in market-based
health systems have been unsuccessful and have exacerbated disparities. New reforms, announced
in 2006, stress the role of family physicians in leading the health care system. This paper discusses
the history of the developments that led up to the new reforms and the educational challenges of
training sufficient numbers of family physicians to meet the requirements of the new system.
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The Shoulder to Shoulder Model—Channeling Medical Volunteerism Toward Sustainable Health Change
BACKGROUND: Rapid growth in medical volunteerism in resource-poor countries presents an opportunity
for improving global health. The challenge is to ensure that the good intentions of volunteers
are channeled effectively into endeavors that generate locally acceptable, sustainable changes in
health. METHODS: Started in Honduras in 1990, Shoulder to Shoulder is a network of partnerships
between family medicine training programs and communities in Honduras and other resource-poor
countries. The program involves short-term volunteering by US health professionals collaborating
with community health boards in the host countries. The program has been implemented in seven US
family medicine training programs and is supported by a small international staff. RESULTS: During
the 16 years of program operation, more than 1,400 volunteers have made visits to host countries,
which include Honduras, Ecuador, and Tanzania. Clinics have been established, school-based food
programs and community-based water filtration programs developed, and cancer screening and
pregnancy-care programs put in place. These and other programs have been implemented on a
budget of less than $400,000, raised through donations and small grants. CONCLUSIONS: The Shoulder
to Shoulder model allows health care professionals to channel short-term medical volunteerism into
sustainable health partnerships with resource-poor communities. The resulting network of partnerships
offers a powerful resource available to governments and foundations, poised to provide innovative
interventions and cost-effective services directly to poor communities.
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Family Medicine in Switzerland: Training Experiences in Medical School and Residency
BACKGROUND AND OBJECTIVES: A shift away from family medicine to medical specialties is noticed in
many of the competition-based health care systems in Western countries. Our study's objective was
to learn about career development of young physicians in German-speaking countries, with a particular
focus on Switzerland. METHODS: We performed a qualitative assessment of data on physicians'
training experiences in family medicine during medical school and residency. Data were obtained
through a focus group interview with 12 participants, six of whom were family medicine residents,
and data were analyzed by content analysis. RESULTS: The results indicate that family medicine is
not well established in medical school curricula, that family physicians are often discriminated
against by specialists with regard to their professional competence, that there are no structured
residency programs and a lack of information about residency posts in family medicine as well as
family practices to be taken over, and that the competition-based health care system does not foster
a gatekeeper model and favors financially the specialists' work to the detriment of that of family
physicians. CONCLUSIONS: Suggestions for improvement of the situation of family medicine include
providing well-trained family physicians as educators in medical schools, early training courses in
family practices in medical school for all students, well-structured residency programs, support by
the Swiss Society of Family Medicine in planning to open a family practice, financial incentives for
family physicians, and implementation of gatekeeper models.
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Experiences of a Support Group for Interns in the Setting of War and Political Turmoil
BACKGROUND AND OBJECTIVES: Intern support groups have been instituted in many residency programs
to improve resident well-being. In this article, we discuss the themes that emerged in intern support
group meetings in a family medicine program operating in a setting of war and political instability.
METHODS: We held support groups, led by a family physician and a psychologist, that met monthly.
Participants were residents in the family medicine program at the American University of Beirut.
These residents began their training days after the commencement of the 34-day war between Israel
and Hizbollah in 2006. Themes and issues discussed by the residents were noted and are reported
in this article. RESULTS: We found that despite the stressors of the political situation, our interns
focused on the usual stress of internship, such as the difficulties of functioning as interns in other
departments and dealing with the time demands of internship as their main sources of stress at the
beginning of internship. The stresses associated with the war did not emerge in the group until later
in the year. These included tension with patients and political confrontations with staff, as well as
personal struggles with the lack of political stability and depressed mood. CONCLUSIONS: This paper
serves to share our experience and highlight some areas of concern that residents experience when
training in a country or region that is at war.
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Going Global: Considerations for Introducing Global Health Into Family Medicine Training Programs
Medical students and residents have shown increasing interest in international health experiences.
Before attempting to establish a global health training program in a family medicine residency,
program faculty must consider the goals of the international program, whether there are champions
to support the program, the resources available, and the specific type of program that best fits with
the residency. The program itself should include didactics, peer education, experiential learning in
international and domestic settings, and methods for preparing learners and evaluating program
outcomes. Several hurdles can be anticipated in developing global health programs, including
finances, meeting curricular and supervision requirements, and issues related to employment law,
liability, and sustainability.
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Developing an International Health Area of Concentration in a Family Medicine Residency
BACKGROUND AND OBJECTIVES: We sought to develop an Area of Concentration (AOC) in international
health to inspire and better prepare interested residents for such experiences during residency and in
the future. METHODS: The curriculum has three phases: pre-experience preparation, the international
experience, and post-experience debriefing. In the last 2 years, residents and faculty have worked in
Sri Lanka, Pakistan, Mexico, and Tanzania. The three main types of experiences have been disaster
relief, clinical care, and community-based primary health care. RESULTS: Compared to only two or
fewer residents participating annually prior to the establishment of the AOC, more than 30 residents
and faculty have participated in an international experience in the last 2 years. Our department now
has at least two established annual international experiences and has developed educational and
process manuals. CONCLUSIONS: An AOC curriculum can nurture interest and provide relevant skills
that can be used in the care of vulnerable populations in the United States and abroad.
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