Family Medicine Abstracts
Volume 41 Issue 1
January 2009
Abstracts
Student Attitudes: Potential Barriers to Implementing a Community Medicine Field Activity
OBJECTIVE: Clerkship-year medical students may have complex attitudes regarding communities in which they train. Our objective was to assess medical students' attitudes following implementation of a community medicine experience in their clerkship year. METHODS: We analyzed transcripts of audiotaped medical student group discussions following a community field activity. A multidisciplinary team coded the transcripts using content analysis techniques to identify key features of student narratives regarding students' attitudes and attributions regarding their community medicine experiences. RESULTS: Students expressed several important perceptions regarding the community in which they conducted their field experience. These included strong insider/outsider themes, resentment that historical legacies shape the doctor-patient relationship, and concerns over personal safety and educational relevance of the activity. Some students noted improvement in understanding of patients within their communities. CONCLUSIONS: Negative attitudes and attributions expressed by students can act as obstacles in the development of community medicine initiatives, hinder professional development if unaddressed, and have the potential to contribute to health disparities. Further work on how to incorporate community medicine training is needed.
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First-year Medical Students Can Demonstrate EHR-specific Communication Skills: A Control-group Study
BACKGROUND AND OBJECTIVES: Graduating medical students will universally use electronic health records (EHRs), yet a June 2007 literature search revealed no descriptions of EHR-specific communication skills curricula in US medical schools. We designed and tested methods to teach first-year medical students to optimally integrate EHRs into physician-patient communication in ambulatory encounters. METHODS: We randomly assigned 17 volunteer students to control (n=8) and intervention (n=9) groups. Both groups learned the mechanics of documenting patient histories using the EHR. Additionally, we taught the intervention group EHR-specific communications skills using guided discovery, brief didactics, and practice role plays. We compared both groups' general and EHR-specific communications skills using a standardized patient (SP) case. RESULTS: Students receiving EHR communication skills training performed significantly better than controls in six of 10 EHR communication skills. In 10 of 11 general communication skills, there were no significant differences between groups. CONCLUSIONS: First-year medical students can demonstrate EHR communication skills early in their medical training. However, in our setting, students did not spontaneously demonstrate EHR skills without instruction, and such skills did not correlate with general communication skills.
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The Central City Site: An Urban Underserved Family Medicine Training Track
BACKGROUND AND OBJECTIVES: We describe the development of an urban track in family medicine residency designed to recruit a high percentage of minority students and promote their future practice in urban, underserved areas of Milwaukee. We report here on the residents and their first practice location and compared this information to what occurred in our original "main" residency program.METHODS: Information about the program's development was obtained through testimonials from faculty and residency graduates and review of the original accreditation application to the Residency Review Committee. Information about the residents and their practice locations was obtained from the National Resident Matching Program and graduate placement data. RESULTS: The goal of training more minority doctors in Milwaukee was met, with eight of 16 (50%) residents at our urban-track site from minority groups. This compared to only 12% at our main program. Thirty-eight percent of graduates stayed to practice in an underserved area, compared to only 21% in our main program.CONCLUSIONS: Development of an urban track for our family medicine residency increased the number of minority physicians trained and the number of physicians practicing in underserved areas after graduation.
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BACKGROUND AND OBJECTIVES: Successful colonoscopy is contingent upon adequate bowel preparation, which is often achieved using either an oral sodium phosphate preparation or a polyethylene glycol-based preparation. Comparison of the relative performance of these two classes of agents has been assessed only in the context of clinical trials (and with mixed findings). However, efficacy measured in clinical trials often is not reflective of effectiveness in clinical practice. We undertook this analysis to determine the relative clinical effectiveness of oral sodium phosphosoda versus polyethylene glycol in clinical practice. METHODS: Subjects (n=343) were selected from among patients receiving outpatient colonoscopy at our institution between January 2004 and February 2006. Demographic, biochemical, and comorbid disease data were abstracted from the electronic medical record. Colonoscopy preparation, indication, and preparation quality were abstracted from colonoscopy reports. RESULTS: As compared to subjects receiving polyethylene glycol, those receiving oral sodium phosphosoda had an adjusted odds ratio (OR) (95% confidence intervals [CIs]) for adequate/good/excellent bowel preparation quality of 2.23 (1.18--4.22) and an adjusted OR (95% CIs) for good/excellent bowel preparation of 2.24 (1.26--3.97). There was no interaction on the basis of colonoscopy indication. CONCLUSIONS: Oral sodium phosphate-based purgatives were associated with significantly better bowel preparation quality among outpatients at our center.
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Decreased Continuity in a Residency Clinic: A Consequence of Open Access Scheduling
BACKGROUND AND OBJECTIVES: Open access scheduling decreases waiting time to see physicians by using same-day appointment scheduling. In primary care residency training, continuity of care may be difficult to preserve with this method of scheduling because requirements for rotations often results in residents being unavailable in their primary clinic practice. Our objective was to examine continuity of care in a family medicine residency clinic during a 1-year period prior to implementation of open-access scheduling and during a 1-year period after open access scheduling started. METHODS: Two indices to measure continuity were used: the Usual Provider Continuity Index (UPC) and the Modified Modified Continuity Index (MMCI). The Mann-Whitney test was used to determine differences in the UPC and MMCI between groups. RESULTS: The mean UPC and MMCI scores decreased with open access scheduling. Mean UPC was 0.59 with traditional scheduling versus 0.55 with open access scheduling. Mean MMCI was 0.51 for traditional scheduling and 0.44 with open access. CONCLUSIONS: Continuity of care decreased in our clinic after implementation of open access scheduling. Our results have implications for all primary care residency training programs since one of the hallmarks of primary care is maintaining continuity in the physician-patient relationship.
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The Effect of a Carve-out Advanced Access Scheduling System on No-show Rates
BACKGROUND AND OBJECTIVES: The relationship between advanced access scheduling and no-show rates in academic settings is unclear. The purpose of this analysis is to assess the effect of moving to a carve-out model of an advanced access scheduling system on no-show rates in an academic practice. METHODS: A multivariable logistic regression with repeated measures analysis of patient visits was used to assess the relationship between the time to third-next available appointment and no-show rates. RESULTS: The time to third-next available appointment was not a significant factor in appointment-keeping behavior. Rather, provider-patient continuity, wait time for an appointment, the number of previous appointments, and type of provider were strong predictors of a patient no-show. CONCLUSIONS: Implementation of the concepts of advanced access scheduling does not directly result in a reduction in no-show rates; rather, provider-patient continuity, wait time to an appointment, and other factors may be a more important measure.
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