Educational Research and Methods
(Fam Med 1998;30(7):482-6.)

The Accuracy of Patient Encounter Logbooks Used by Family Medicine Clerkship Students
Christopher T. Patricoski, MD; Kennard Shannon, MD, PhD; Gregory A. Doyle, MD

Background: Family medicine predoctoral programs frequently have medical students record patient diagnoses in logbooks. Little is known about the accuracy of such logbooks. No studies have compared patient records dictated by students with cases recorded in logbooks.

Methods: Over 2 years, all patient encounters dictated by 79 medical students during their 8-week family medicine rotations were recorded and compared with information in the students’ logbooks.

Results: Students dictated 2,520 patient encounters but only recorded 2,085 (82.7%) of them in their logbooks. Still, this rate of inclusion is higher than other studies where students did not dictate patient encounters. On the average, each student saw and dictated 32 patient encounters but omitted five to six from their logs. There were no significant differences between the 10 honors and 69 non-honors students in the proportion of patients omitted from log books.

Conclusions: Medical students underreport patient encounters in clerkship logbooks. Keeping a record of the patients dictated by medical students was helpful in determining the accuracy of students’ logbooks.

Educational Research and Methods
(Fam Med 1998;30(7):487-9.)

Using Practice Genograms to Understand and Describe Practice Configurations
Helen McIlvain, PhD; Benjamin Crabtree, PhD; Jim Medder, MD, MPH; Kurt C. Stange, MD, PhD; William L. Miller MD, MA

Background: Demands for change in medical practices are coming from multiple sources. Since interventions to change clinical practice continue to have limited success, understanding the functional structure of primary care practices and the dynamics of providing care have become increasingly important.

Methods: To portray and understand the primary care office system, we developed “practice genograms” that describe practice participants and their relationships with each other. Formal organizational structure is evaluated using family systems theory and family of origin genogram techniques.

Results: Practice genograms provided a more dynamic, relational model than the organizational chart and promoted identification of relationship strengths and weaknesses within a practice the same way that family genograms identify these characteristics in a family system.

Conclusions: Research implications for the use of the practice genogram include enhanced data gathering, increased understanding of the complexity of practices as adaptive systems, and increased understanding of current and potential approaches to changing practices.

Educational Research and Methods
(Fam Med 1998;30(7):490-6.)

Changes in Residents’ Attitudes and Achievement After Distance Learning Via Two-way Interactive Video
Yvonne LaRocca Lewis, EdD; Raymond P. Bredfeldt, MD; Steven W. Strode, MD, MEd; Karen W. D’Arezzo

Background and Objectives: Training family practice residents in communities remote from academic medical centers has been difficult because of the lack of available local subspecialists and the concomitant need for subspecialists to travel to each of the remote training sites. To alleviate these problems, the Area Health Education Centers Program at the University of Arkansas for Medical Sciences sought to deliver high-quality presentations to family practice residents at remote locations, using two-way interactive video. The study 1) assessed the differences in attitudes of residents before and after a series of presentations and 2) evaluated the differences in achievement of residents based on who received the information by two-way interactive video or with the instructor on-site.

Methods: Four conferences were broadcast to five remote residency programs, and two local programs received identical conferences on-site.

Results: There was no difference in achievement between the two groups, but attitudes toward learning by interactive video declined.

Conclusions: Interactive video is a viable instruction method for achievement. The negative attitude shift toward interactive video may have been because it was a new experience, or the preparation of the faculty was inadequate.

Educational Research and Methods
(Fam Med 1998;30(7):497-500.)

Creating a Research Culture: What We Can Learn From Residencies That Are Successful in Research
Mark J. DeHaven, PhD; George R. Wilson, MD; Patricia O’Connor-Kettlestrings

Background and Objectives: Despite a growing need for family practice to contribute to the national primary care research agenda, the specialty is ill-equipped to assume a more active role. Information about residency programs that are successful in research is a valuable resource for increasing family medicine’s research capacity.

Methods: A three-stage investigation was completed in May 1996, consisting of 1) a telephone survey of family practice residency program directors, 2) a mail survey of recent graduates from relatively successful programs identified in stage 1, and 3) in-depth interviews with the program directors or research directors identified by combining data from the first two stages.

Results: Most residents in the programs included in stage 2 completed a research project (68.7%) and currently have an interest in practice-based research (57.2%). Residents from programs selected for the study’s final stage were more likely to have published a research article (32% versus 20.3%) and to have completed a project while a resident (81% versus 60.1%) than those from the programs not selected. Virtually unanimous characteristics of successful programs include program director support of research, time for research, faculty involvement, a research curriculum, professional support, and opportunities for presenting research.

Conclusions: Individual family practice residencies can be considered to be at one of three levels with respect to their level of research activity: 1) relatively undeveloped, 2) developing, or 3) relatively developed. Programs can expect successful results if they make research a priority, and means are needed for communicating successful strategies between programs.

Educational Research and Methods
(Fam Med 1998;30(7):501-7.)

HITS: A Short Domestic Violence Screening Tool for Use in a Family Practice Setting
Kevin M. Sherin, MD, MPH; James M. Sinacore, PhD; Xiao-Qiang Li, MD; Robert E. Zitter, PhD; Amer Shakil, MD

Background and Objectives: Domestic violence is an important problem that is often not recognized by physicians. We designed a short instrument for domestic violence screening that could be easily remembered and administered by family physicians.

Methods: In phase one of the study, 160 adult female family practice office patients living with a partner for at least 12 months completed two questionnaires. One questionnaire was the verbal and physical aggression items of the Conflict Tactics Scale (CTS). The other was a new four-item questionnaire that asked respondents how often their partner physically Hurt, Insulted, Threatened with harm, and Screamed at them. These four items make the acronym HITS. In phase two, 99 women, who were self-identified victims of domestic violence, completed the HITS.

Results: For phase one, Cronbach’s alpha was .80 for the HITS scale. The correlation of HITS and CTS scores was .85. For phase two, the mean HITS scores for office patients and abuse victims were 6.13 and 15.15, respectively. Optimal data analysis revealed that a cut score of 10.5 on the HITS reliably differentiated respondents in the two groups. Using this cut score, 91% of patients and 96% of abuse victims were accurately classified.

Conclusions: The HITS scale showed good internal consistency and concurrent validity with the CTS verbal and physical aggression items. The HITS scale also showed good construct validity in its ability to differentiate family practice patients from abuse victims. The HITS scale is promising as a domestic violence screening mnemonic for family practice physicians and residents.

"HITS"

Please read each of the following activites and circle the dot that best indicates the frequency with which you partner acts in the way depicted.

How often does your partner?	Never	Rarely	Sometimes	Fairly often	Frequently
1. Physically hurt you	X	X	X	X	X
2. Insult or talk down to you	X	X	X	X	X
3. Threaten you with harm	X	X	X	X	X
4. Scream or curse at you	X	X	X	X	X
	1	2	3	4	5

Each item is scored from 1-5. Thus, scores for this inventory range from 4-20. A score of greater than 10 is considered positive.

Clinical Research and Methods
(Fam Med 1998;30(7):508-12.)