Family Medicine Abstracts
Volume 41 Issue 7
July-August 2009
Abstracts
A Point System for Resident Scholarly Activity
Encouraging resident scholarly activity is challenging. One Army family medicine program was struggling to get residents to fulfill their requirements. Projects were not being completed, and publication or presentation of results was rare. A novel "scholarly activity point" system was introduced that expanded the types of scholarly activity residents could participate in while still encouraging clinical research. Since implementation, the number of residents successfully publishing and presenting scholarly projects has risen sharply. The point system has resulted in an increase in resident enthusiasm for scholarship, a change in the academic culture, and a dramatic rise in scholarly output.
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The University of Missouri Integrated Residency: Evaluating a 4-year Curriculum
BACKGROUND AND OBJECTIVES: Several approaches to merging residency training and medical school education have been attempted over the past 20 years. This study describes and evaluates an integrated family medicine residency programÂa 4-year program that overlaps with the final year of medical school. METHODS: We retrospectively analyzed multiple data sources, including In-Training Examination scores, patient visit profiles, resident demographics, and graduate surveys. RESULTS: Integrated residents (IRs) perform significantly better than traditional residents on In-Training Examinations at each year of residency training, with the difference in mean scores decreasing over time (67.8, 39.6, and 33.0 points better in the first, second, and third residency years). No evidence of increased patient continuity or panel size was noted. A higher proportion of IRs serve as chief residents, rate their residency experience as "excellent," and remain with the program through graduation. Practice characteristics immediately after residency do not significantly differ. Financial benefits are evident for the IRs as well as the hosting department. CONCLUSIONS: This integrated program offers several benefits for both the medical student and the residency program, and it is a potential model for academic residencies aiming to recruit and retain a higher percentage of their own schools' students.
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Elder Abuse Education in Primary Care Residency Programs: A Cluster Group Analysis
BACKGROUND AND OBJECTIVES: Elder abuse is a serious issue, affecting up to 10% of community-dwelling older adults. This project sought to understand if elder abuse under-reporting was related to physician specialty and residency training. METHODS: A 17-item survey focusing on program demographics, current curriculum, priority of elder abuse education, clinical and didactic experiences, and triage resources was mailed to directors of all Michigan primary care residencies approved by the Accreditation Council for Graduate Medical Education. RESULTS: Clustering by program type, family medicine programs were primarily represented in the high-intensity group (standard residual -1.6), while internal medicine programs were primarily represented in the low-intensity group (standard residual 2.5, X2=14.80, df=6). Emergency medicine comprised the mid-intensity groups. The high- intensity group scored very high or high on areas including knowledge of elder abuse facts, elder abuse curriculum and training, and awareness of community resources related to elder abuse. CONCLUSIONS: Family medicine residency programs appear to address elder abuse more comprehensively than do emergency medicine and internal medicine programs. These programs may need to consider additional curriculum and clinical experience in elder abuse.
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Implementation of STFM's "Smiles for Life" Oral Health Curriculum in a Medical School Interclerkship
BACKGROUND AND OBJECTIVES: While oral health is an important topic for medical education, it is often not covered in medical school. The Association of American Medical Colleges (AAMC) has recently set guidelines for oral health training in medical education. Our objective was to demonstrate how a mandatory interclerkship (half-day workshops taught between third-year clerkships) that covers pediatric, urgent care, examination skills, and prevention topics in oral health can lead to an increase in knowledge for medical students. METHODS: Teaching methods included the use of interactive lectures, an audience response system, and small-group workshops taught by medical and dental educators. The curriculum was based on the Society of Teachers of Family Medicine (STFM) Smiles for Life National Oral Health Curriculum. Students were given pretests and posttests, including a 6-month follow-up test. RESULTS: Students showed a significant improvement in knowledge between pretesting and immediate posttesting across a range of topics. Long-term knowledge retention was more limited. The majority of students reported enthusiasm for this topic and found the materials essential for their training. CONCLUSIONS: A brief interclerkship can improve medical students' oral health knowledge and be engaging. More research is needed to evaluate means to sustaining the knowledge.
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Practitioner Empathy and the Duration of the Common Cold
OBJECTIVE: This study's objective was to assess the relationship of empathy in medical office visits to subsequent outcomes of the common cold. METHODS: A total of 350 subjects ? 12 years of age received either a standard or enhanced physician visit as part of a randomized controlled trial. Enhanced visits emphasized empathy on the part of the physician. The patient-scored Consultation and Relational Empathy (CARE) questionnaire assessed practitioner-patient interaction, especially empathy. Cold severity and duration were assessed from twice-daily symptom reports. Nasal wash was performed to measure the immune cytokine interleukin-8 (IL-8). RESULTS: Eighty-four individuals reported perfect (score of 50) CARE scores. They tended to be older with less education but reported similar health status, quality of life, and levels of optimism. In those with perfect CARE scores, cold duration was shorter (mean 7.10 days versus 8.01 days), and there was a trend toward reduced severity (mean area under receiver-operator characteristics curve 240.40 versus 284.49). After accounting for possible confounding variables, cold severity and duration were significantly lower in those reporting perfect CARE scores. In these models, a perfect score also correlated with a larger increase in IL-8 levels. CONCLUSIONS: Clinician empathy, as perceived by patients with the common cold, significantly predicts subsequent duration and severity of illness and is associated with immune system changes.
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Effect of a Computerized Body Mass Index Prompt on Diagnosis and Treatment of Adult Obesity
BACKGROUND: In obese adults, physicians often fail to identify obesity and recommend treatments for it. We sought to determine whether a computerized body mass index (BMI) chart prompt would increase the likelihood that patients of family physicians would be diagnosed with obesity and referred for obesity treatment. METHODS: A total of 846 obese patients of 37 family physicians were randomly assigned to either have a patient's BMI chart prompt placed in their electronic medical record (intervention group) or not have a BMI prompt (comparison group) placed in the record. We then examined patient medical records for evidence of an obesity diagnosis and referral for specific obesity treatments. We also measured whether the presence of comorbidities in obese patients influenced the likelihood of diagnoses and treatments by the physicians. RESULTS: Obese patients of physicians who had a BMI chart prompt in their medical records were significantly more likely than obese patients of physicians who did not receive a BMI chart prompt to receive a diagnosis of obesity (16.6% versus 10.7%; P=.016). Patients of physicians who were provided with a BMI chart prompt were also more likely than patients of physicians who did not get a chart prompt to receive a referral for diet treatment (14.0% versus 7.3%, P=.002) and exercise (12.1% versus 7.1%, P=.016). Of the obesity comorbidities, only obstructive sleep apnea (OSA) was a predictor of a patient being diagnosed with obesity (OR=.49, 95% CI=0.281, 0.869, P=.014). CONCLUSIONS: Inclusion of a computerized BMI chart prompt increased the likelihood that physicians would diagnose obesity in obese patients and refer them for treatment.
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Adoption of Electronic Medical Records in Family Practice: The Providers' Perspective
BACKGROUND AND OBJECTIVES: The study's objectives were to explore Deliver Primary Healthcare Information (DELPHI) project participants' experiences, ideas, and perspectives regarding the adoption of electronic medical records (EMRs) into their primary health care practices and to examine perceived barriers and facilitators to EMR adoption. METHODS: This study explored the experiences of the 30 participants in the project. Semi-structured interviews were conducted. The analysis was both iterative and interpretive. RESULTS: Two key themes emerged: (1) barriers (ie, level of computer literacy, training required, and time) and facilitators (ie, having an in-house problem solver and the EMR's integrated messaging system), and (2) a continuum of EMR adoption (ie, levels of knowledge ranging from novice to advanced and responses to the EMR that included participants' reflections on their personal journey across the adoption continuum and that of their practice sites). CONCLUSIONS: It is important to be aware of and responsive to factors that can influence EMR implementation and adoption. They include paying attention to computer literacy; setting aside dedicated time for EMR implementation and adoption, as well as engaging in training activities; and supporting problem-solvers in the practice. Mechanisms should be put into place to promote the movement of practices across the continuum of EMR adoption.
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The Birth of a House Call Practice
Increasingly, physicians of all specialties are frustrated with the complex, unrewarding system of third-party billing in the United States. It has led many physicians to wonder how best to change their practice to ameliorate these challenges or leave their practice altogether. It is possible that family physicians suffer most because they are trained to provide comprehensive care to all comers, regardless of reimbursement status. What they may not know is that leaving the practice might be the best thing for everyone, and it doesn't necessarily mean leaving medicine! As I realized during my experiences working in South Florida, transitioning to a house call practice can be emotionally and financially rewarding.
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