Family Medicine Abstracts
Volume 43 Issue 3
March 2011
Abstracts
March 2011
Abstracts
Gender and First Authorship of Papers in Family Medicine Journals 2006--2008
BACKGROUND: Despite increasing numbers of women attending medical school and completing residencies, women continue to lag behind men in academic achievement. Other specialties have found that women publish fewer journal articles than men. While family medicine is becoming increasingly gender balanced, the aim of this study was to evaluate the gender balance of published material within family medicine journals. METHODS: All original articles were reviewed in five family medicine journals published in the United States (Family Medicine, Journal of Family Practice, Journal of the American Board of Family Medicine, Annals of Family Medicine, and American Family Physician) between 2006--2008. The articles were categorized based on type of publication and gender of first author. The editorial boards of each of the journals were examined to determine gender breakdown.RESULTS: A total of 2,126 articles were included in the study. Females were first author on 712 (33.5%) of the articles, and males authored 1,414 (66.5%). There was no significant difference between years. More female authors wrote original research, and fewer wrote letters to the editor. Only Family Medicine had gender parity on its editorial board. CONCLUSIONS: Female authors wrote about a third of all original publications in family medicine journals between 2006--2009 even though they comprise 44% of the faculty. Further research can evaluate reasons for this gender disparity.
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Pregnancy and Childbirth During Family Medicine Residency Training
BACKGROUND AND OBJECTIVES: Family medicine residency programs are training more women; pregnancy and childbirth during residency have become more common. The purpose of this study was to examine childbirth during residency from the perspectives of the new mother, her female colleagues who did not give birth during training, and program directors.METHODS: We surveyed female residents and program directors of 457 family medicine residency programs in the United States by mail. Questions were primarily quantitative with Likert and yes/no responses. We analyzed data using Statit-EQC. RESULTS: Response rates were 40% (program directors), 25% (birthing residents), and 13% (non-birthing female residents), regionally reflecting program density. According to program directors, 52% of the residents were female, 17% of these had given birth and returned to work, and 75% of those who gave birth planned to extend their residency. The average time off for maternity leave was 6.5 weeks while the optimum time off was thought to be significantly greater (7--12 weeks). Higher satisfaction of birthing residents was associated with greater satisfaction with childcare. Lower satisfaction was associated with earlier termination of breast-feeding due to demands of residency. A smaller percentage of birthing residents plan to work full-time after graduation than non-birthing residents.
CONCLUSIONS: Perceptions that the newborns' needs are met influence the satisfaction and self-ranked performance of birthing residents. Programs with a higher percentage of women accommodate more time off after delivery. Childbirth during residency may influence future work plans.
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Trends in the Provision of Preventive Women's Health Services by Family Physicians
BACKGROUND AND OBJECTIVES: Family medicine has experienced variations in scope and comprehensiveness of care in recent years. To investigate whether these changes in practice have impacted women's health services, we measured trends in the proportion of preventive women's health visits provided by family physicians nationally. METHODS: We analyzed the National Ambulatory Medical Care Survey to identify the trend in the proportion of preventive women's health visits to family physicians and obstetrician-gynecologists and others between 1995 to 2007. RESULTS: A total of 6,088 sample records were included in the study, representing 239 million preventive women's health visits. The percentage of preventive women's health visits provided by family physicians remained stable over the 12-year study period from 18.6% in 1995--1996 to 20.3% in 2007. Family physicians provided care for 28% of total preventive women's health visits occurring in non-metropolitan statistical areas. CONCLUSIONS: Family physicians provided a stable amount of preventive women's health services between 1995 and 2007. Family medicine should continue to foster comprehensive residency training in preventive women's health care and inclusion of such services in future scope of practice.
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Students as Patients and Teachers: Evaluation of an Experiential Emergency Contraception Project
BACKGROUND AND OBJECTIVES: Students on a required family medicine clerkship participated in an experiential project designed to teach them about emergency contraception (EC). This study describes students' changes in knowledge and attitudes about barriers to care after assuming the patient role and presenting their findings to peers and after hearing a presentation about EC from their peers. METHODS: This mixed-methods study used quantitative measures of knowledge and attitudes about EC before and after the students' family medicine clerkship. Qualitative in-depth interviews were conducted with all students who self-selected the EC Project and assumed the role of a patient and then taught their peers. RESULTS: All student groups showed improvement in knowledge and attitude scores, though gains were not statistically significant. Students who participated in the EC Project reported multiple benefits related to (1) assuming the role of the patient, (2) engaging in an experiential learning process, (3) teaching their peers, and (4) considering their future role as clinicians. CONCLUSIONS: Our findings demonstrate that playing the role of a patient and teaching their peers are valuable learning experiences, and students can learn well during peer-taught sessions. Students increased their medical knowledge and sensitivity to the barriers that patients face and began to consider their role in improving systems of health care.
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Do the Five A's Work When Physicians Counsel About Weight Loss?
BACKGROUND AND OBJECTIVES: More than two thirds of Americans are overweight or obese. Physician counseling may help patients lose weight; however, physicians perceive these discussions as somewhat futile and time-consuming. An effective and efficient tool for smoking cessation is the Five A's (Ask, Advise, Assess, Assist, and Arrange). We studied the effectiveness of the Five A's in weight-loss counseling. METHODS: We audiorecorded primary care encounters between 40 physicians and 461 of their overweight or obese patients. All were told the study was about preventive health, not weight specifically. Encounters were coded for physician use of the Five A's. Patients' motivation and confidence were assessed before and immediately after the encounter. Three months later, we assessed patient change in dietary fat intake, exercise, and weight. RESULTS: Generalized linear models were fit adjusting for patient clustering within physician. Physicians used at least one of the Five A's often (83%). Physicians routinely Ask and Advise patients to lose weight; however, they rarely Assess, Assist, or Arrange. Assist and Arrange were related to diet improvement, whereas Advise was associated with increases in motivation and confidence to change dietary fat intake and confidence to lose weight.
CONCLUSIONS: Similar to smoking cessation counseling, physicians routinely Asked and Advised patients to lose weight; however, they rarely Assessed, Assisted, or Arranged. Given the potential impact of using all of these counseling tools on changing patient behavior, physicians should be encouraged to increase their use of the Five A's when counseling patients to lose weight.
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Developing Online Learning Modules in a Family Medicine Residency
BACKGROUND AND OBJECTIVES: Online modules offer an opportunity to overcome barriers to educational delivery. Such approaches can require significant investment dependent on the development model used. There is little in the literature on the formative assessment of design and development. Better understanding is needed to determine effective methods of training and supporting faculty authors. METHODS: The purpose of this study was to examine the effectiveness of Web-based modules developed by a Department of Family Medicine in delivering instruction to resident learners and to examine perceptions of the design and development process. Participants included 49 resident learners and 28 faculty and staff members as the development team. Data collection involved use of Web-based surveys, participant observation focus groups, and pretesting/posttesting. Frequency distributions and mean comparisons were used to analyze quantitative data. Participant comments were thematically analyzed. RESULTS: Residents felt that modules met their educational goals and contributed to understanding of core content. Pretest/posttest data showed statistical improvement for a majority of modules. The use of Web authoring software for Web-based learning and scheduling time to work on the modules posed the greatest challenges to module authors. CONCLUSIONS: Formative assessment methods can provide important information to module developers and support staff to shape training, content development, and improve module ease of use, navigation, and content for resident learners.
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Issues Important to the Research Mentoring Relationship
BACKGROUND AND OBJECTIVES: Family medicine lacks a critical mass of experienced, federally funded researchers to serve as research mentors for young investigators. The purpose of this study was to identify issues important when mentoring junior investigators. METHODS: Eight experienced primary care investigators, known for their excellence in mentorship, were recruited from the Primary Care Research Methods and Statistics Conference. After participation in a focus group exploring issues related to the quality, techniques, effectiveness, and efficiency of mentorship, subjects completed three rounds of Delphi using variables identified during the focus group to develop a comprehensive, stable list of 72 mentoring strategies. RESULTS: Five items received perfect ratings of agreement: (1) primary task to help protégé identify long-term goals and strategize to meet them, (2) difference exists between mentoring and collaboration, (3) assigning mentor is not a guarantee that the relationship will work, (4) mentor can provide expertise and encouragement but not ensure a desired outcome, and (5) mentor who does not care about the protégé is not likely to be effective. The strategies with which the mentors disagreed included mentor-protégé characteristics and differences.
CONCLUSIONS: Mentors emphasized the importance of long-term goals, difference between mentorship and collaboration, and commitment from the mentor.
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Smoking Cessation Knowledge, Attitudes, and Practice Among Community Health Providers in China
BACKGROUND: The smoking prevalence is high (32.5%) among male providers in community health centers in Beijing, China. The majority of providers self reported that they advise patients to quit smoking, yet they have low expectations that their counseling is effective in helping patients to quit. Many have not received training on how to advise patients to quit, and half lack knowledge about nicotine replacement. These findings suggest that surveyed providers need more training in tobacco cessation services.
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