Family Medicine Abstracts
Volume 42 Issue 1
January 2010
Abstracts
January 2010
Abstracts
Patient Satisfaction in a Student-run Free Medical Clinic
BACKGROUND AND OBJECTIVES: There are currently more than 100 student-run medical clinics in the United States, operated in conjunction with various allopathic medical schools. However, there have been no reports regarding patient satisfaction with these free clinic services. METHODS: Fifty-two of 60 patients seen at the C.A.R.E.S. clinic over a 4-week period in the winter of 2007 completed a questionnaire. RESULTS: Patients were highly satisfied with laboratory services, staff friendliness, amount of time spent being interviewed, and the depth of the explanations. They were less satisfied with the hours of operation and wait time. CONCLUSIONS: Patients seen at a student-run clinic are very satisfied with the services they received.
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FaMeS: An Innovative Pipeline Program to Foster Student Interest in Family Medicine
BACKGROUND AND OBJECTIVES: There is a national shortage of primary care physicians; many medical school departments of family medicine are searching for new ways to attract and retain students who may be interested in primary care. In 2004, our department began a "pipeline" program targeted at entering first-year students that incorporates curricular, extracurricular, summer, and career-planning elements. METHODS: The program was evaluated and data collected on the numbers of students who were regular attenders of events, who expressed intent to apply in family medicine at the end of third year, and who ultimately matched in family medicine. Qualitative measures of program success were also noted (comments from students outside the department and the influence of the family medicine interest group). RESULTS: Data are preliminary but suggest that the Family Medicine Student Track (FaMeS) has increased the numbers of students matching in family medicine from Boston University (BU) during a period when the national average was decreasing. The odds of a BU student matching in family medicine were nearly double (1.94) the odds compared with before the program. The family medicine interest group substantively increased its presence at the medical school and won a national Program of Excellence award. CONCLUSIONS: The FaMeS program appears to be associated with a significant increase of numbers of students matching in family medicine during a time period when the national average decreased. The program is young, and results may be most generalizable to schools, like BU, with a strong specialist presence.
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BACKGROUND AND OBJECTIVES: The study's objective was to determine medical students' knowledge of and attitudes toward family medicine before and after completing a course in primary care. METHODS: Before and after a course in primary care, 81 medical students were asked to respond to a self-administered, anonymous questionnaire, comprising 34 items that measured students' attitudes and knowledge about primary care that uses a 5-point Likert response scale. RESULTS: Forty-four (54.3%) students completed both the pre-course and post-course questionnaires. Before the course, 38.6% looked favorably upon the specialty of family medicine. After the course, the percentage increased to 70.4%. Nevertheless, only 11.4% initially considered family medicine as a first career option, and their attitude did not change after the course. CONCLUSIONS: After completing the course, the students showed an improvement in their knowledge of and attitudes toward family medicine and primary care, but only a small percentage considered a career in family medicine as a first-choice option.
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Being in the Room: Reflections on Pregnancy Options Counseling During Abortion Training
BACKGROUND AND OBJECTIVES: The Residency Review Committee requires that family medicine residents learn options counseling for women with unintended pregnancies. This qualitative study identifies important domains for future formal evaluations of pregnancy options counseling by exploring the relevant benefits reported by residents who underwent routine abortion training. To our knowledge, this is the first study of abortion training in family medicine to include an in-depth examination of its benefits in areas that may be important for pregnancy options counseling. METHODS: Residents from two urban family medicine residency programs received training in first-trimester aspiration abortion at a high-volume abortion clinic during a routine women's health rotation. Thirty-minute semi-structured interviews were conducted with all 28 residents who rotated between July 2005 and November 2006. A coding scheme was developed and applied to transcripts for analysis. RESULTS: Through exposure to routine abortion training, residents reported improved knowledge, attitudes, and skills that are likely to be important for providing open and informed pregnancy options counseling. These include an understanding of the context of women's lives when they seek abortion care, familiarity with the procedure, and improved self-reported pregnancy options counseling skills. CONCLUSIONS: Our findings suggest that exposure to abortion training benefits residents in areas that may be important for providing effective pregnancy options counseling. In addition, residents' reflections on their involvement with patients during the abortion process highlight key domains for future formal evaluations of accurate and nonjudgmental options counseling for unintended pregnancy.
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BACKGROUND AND OBJECTIVES: Darker skin pigmentation and aging are known factors influencing the body's ability to synthesize adequate amounts of vitamin D (25OHD). The objective of this study is to determine the 25OHD insufficiency in elderly African American females of low socioeconomic status (SES) in a southern latitude during springtime sun exposure. METHODS: Patients > 70 years old who did not have disorders that might affect vitamin D and calcium absorption/metabolism were enrolled at a community health center. Serum calcium, 25OHD, and intact parathyroid hormone were measured and repeated 6--8 weeks later. Bone mineral density (BMD) scan results were obtained from clinic records. RESULTS: Most subjects (86.4%) had inadequate 25OHD levels < 32ng/mL, and no clinically significant rise in levels was seen after 6--8 weeks of sun exposure. A quarter of subjects had truly deficient 25OHD levels < 15ng/mL. 25OHD levels were positively correlated with BMD only at the lumbar spine. Fifty-two percent of subjects were osteopenic, and 9% were osteoporotic. CONCLUSIONS: 25OHD insufficiency is common among low SES elderly African American women, and springtime sunlight exposure does not cause significant increases in 25OHD. Additionally, this population has low calcium and vitamin D intake from diet, and more women than expected had reduced BMD.
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A Randomized Trial of Increased Intravenous Hydration in Labor When Oral Fluid Is Unrestricted
BACKGROUND AND OBJECTIVES: Increased intravenous (IV) hydration is associated with decreased labor duration and oxytocin augmentation in nulliparous women when oral fluid is restricted. The objective of this study was to determine the effect of increased IV hydration on the duration of labor when access to oral fluid was unrestricted. METHODS: Term, nulliparous women with uncomplicated singleton pregnancies were randomly assigned to receive lactated ringers at 250 ml per hour (IV fluid group) throughout active labor or usual care. All women were allowed unrestricted access to oral fluids. RESULTS: Eighty women completed the study, 37 in the IV fluid group and 43 in the usual care group. There was no difference in the primary outcome of total duration of labor (9.5 versus 9.4 hours) or in the secondary outcomes of duration of the first stage (7.9 versus 8.0 hours), duration of second stage (1.6 versus 1.4 hours), or rate of oxytocin augmentation (51% versus 44%). CONCLUSIONS: Increased IV hydration does not decrease labor duration in nulliparous women when access to oral fluid is unrestricted.
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