Background and Objectives: A number of medical educators have called for an increased emphasis on medical informatics training, but few family practice residency programs have provided more than cursory teaching efforts in this area. This paper provides an overview of approaches to medical informatics education that have been implemented with some success by “pioneer” programs. A comprehensive review of the literature reveals many promising teaching applications of informatics tools, such as palmtop computing devices, e-mail, decision support software, and videoconferencing. However, barriers to the advancement of informatics training in residency remain, including low rates of computer ownership and use among residents, a lack of information regarding faculty computer skills, and lack of collaboration among programs teaching informatics. Based on the literature review and tempered by expert recommendations, an eight-step process for developing or refining a family medicine informatics curriculum is proposed: 1) conduct a needs assessment, 2) review expert recommendations, 3) enlist faculty and local institutional support, 4) espouse a human-centered approach, 5) integrate informatics training into the larger curriculum, 6) provide easy access to computers, 7) provide practical training, and 8) measure and report educational outcomes. Click here for a reference list of articles retrieved from this study's literature search.

Core Concepts in Family Medicine Education
(Fam Med 1999;31(7):465-72.)

Faculty Workload Assessment: A Case Study
Sue Rovi, PhD; Charles P. Mouton, MD, MS

Background: Because of the increasing work demands posed by the new supervisory requirements of IL 372, coupled with budget constraints resulting from decreasing external grant funding and shrinking practice revenues, departments must weigh workplace needs against faculty resources. Following a period of faculty shortage, the Department of Family Medicine at East Carolina University expected to achieve balance in staffing its department’s clinical services, teaching obligations, and scholarly activities once additional faculty were hired. While relief from work obligations was noted once new hires were in place, there remained inadequate faculty to meet all the identified demands of the department.

Methods: To deal with this dilemma, a new approach was created to assess workforce availability and workload demands. Instead of assuming faculty availability based on an average daily or monthly schedule, an actual assessment of faculty availability and workload demands was performed. The method calculated the actual availability and work demands using weeks per year as the unit of measure, ie, 1 half day per week of precepting requires 5.2 faculty weeks per year, and an average full-time faculty member is available 45 work weeks per year when vacation, national holidays, and departmental/educational leave time is accounted for. By calculating total weeks of departmental work demands and comparing to faculty availability, a true number of faculty members needed by a department can be accurately determined.

Results: During the period in question at East Carolina University, a comparison of work demands and faculty availability revealed that the department needed 2.8 additional faculty to cover the existing work requirements. If time were provided for leadership/management, research, and other administrative activities, then the actual need was for 8.25 additional faculty members.

Conclusions: To meet the increasing time demands on faculty in academic medical centers, departments need to have an accurate accounting of both workforce availability and work demands. The faculty workload assessment model described in this report can be used to generate such an accounting.

Faculty Development
(Fam Med 1999;31(7):473-6.)

Attitudes Regarding Tuberculosis in Immigrants From the Philippines to the United States
Clive D. Brock, MD; Alan H. Johnson, PhD

Background and Objectives: More than two thirds of the cases of tuberculosis (TB) in the United States occur in non-white minorities and immigrants. The Philippines is the Asian country of origin with the greatest numbers of TB cases among the foreign-born. This paper explores Filipino knowledge, attitudes, and practices concerning TB.

Methods: Four focus groups of Filipino immigrants were convened to discuss the participants’ explanatory models regarding TB. The results of these groups were reviewed by a panel of Filipino health workers.

Results: The focus group participants expressed a belief in the extreme contagiousness of TB. This leads to social stigma and isolation. The desire to avoid such consequences lead some to deny their illness, not seek attention, or attempt to hide their illness. While all agree that biomedical treatment is necessary, many believe in the effectiveness of traditional and popular treatments.

Conclusions: If explanatory models of illness are elicited from individual patients, an understanding of the shared beliefs regarding tuberculosis in Filipinos may contribute to treatment of these patients.

Clinical Research and Methods
(Fam Med 1999;31(7):477-82.)


Measuring Patient Distress in Primary Care
Lawrence E. Kay, MD; Frank D’Amico, PhD

Background and Objectives: This study examined the psychometric properties of a brief, easily administered mental health screening instrument, the Outcome Questionnaire Short Form (OQ-10), for use in primary care. The OQ-10 provides information to the primary care provider about patient distress and well-being and highlights areas that may require additional exploration and/or intervention.

Methods: The OQ-10 was administered to 292 outpatients in a family practice clinic, along with a standardized measure of functional status and mental health, the Duke Health Profile (DUKE).

Results: The patients’ mean age was 37.09 years, and 83% were Caucasian. OQ-10 scores were correlated with all subscales of the DUKE. A principal components analysis of the OQ-10 items revealed two factors: psychological well-being and psychological distress. Well-being was positively related to self-reported health, while distress was not. A subsequent specificity and sensitivity analysis was performed on the OQ-10 total score, and this provided preliminary evidence that the OQ-10 may be useful in gauging the psychological state of patients in primary care.

Conclusions: The OQ-10 can be used as a brief screening tool for patient psychological distress in primary care. The OQ-10 items reflect distress and well-being, which may be useful to physicians in treating the range of psychological problems seen in primary care settings.

Clinical Research and Methods
(Fam Med 1999;31(7):483-7.)

Practical Tools for Qualitative Community-oriented Primary Care Community Assessment
Robert L. Williams, MD, MPH; Benjamin F. Crabtree, PhD; Carolyn O’Brien, MEd; Stephen J. Zyzanski, PhD; Valerie J. Gilchrist, MD

Background and Objectives: The evolution of managed care is creating a need for feasible methods for clinical practices to perform community assessments. Since some types of clinically useful data are best obtained through a qualitative community assessment, practical methods of carrying out this type of assessment are needed. Such practical methods are also important for community-oriented primary care, an attractive model for the marriage of population perspectives and clinical primary care.

Methods: Using methods suitable for busy clinical practices, qualitative data useful for clinical purposes were collected either by mail surveys, telephone surveys, or during focus group discussions in a low-income community. Characteristics of data obtained through each method, together with the costs, advantages, and disadvantages of each approach, were examined.

Results: All three methods revealed similar themes in their responses, though the range and emotional content of the responses varied by approach. Clinically useful data were obtained, although the potential for sampling and response biases must be considered. Costs, primarily related to professional time, varied by as much as 50% among the methods examined; telephone surveys were the least expensive per enrolled subject.

Conclusions: The methods tested are potentially feasible in busy practices. However, practices should clarify their objectives and resources prior to using these methods.

Research Series
(Fam Med 1999;31(7):488-94.)

Protection Against HIV Infection for Medical Trainees Outside the United States
William H. Markle, MD

Background and Objectives: The increase in HIV infection rates around the world has created concern among medical educators for the safety of students and residents taking overseas electives. In some areas, the HIV adult positivity rate is 15%–20% or higher. Medical schools and residency programs need to make policies to protect their trainees serving abroad. This paper provides background for such policies. A key element is communication among the student, his/her advisor, and the overseas faculty. The student needs a knowledge of universal precautions and will need to have protective equipment that is often not available in developing countries. Which equipment and medication are available and which are needed will vary and must be clarified in advance. Sexual contact with the local populace must be avoided. In case of an emergency, the student must have adequate evacuation insurance. Centers for Disease Control and Prevention recommendations for determining the need for postexposure prophylaxis should be followed. Before the scheduled trip, students should assure themselves that enough medication will be available in the event of a mishap. If necessary, several days’ worth of prophylactic medication should accompany each student. Having these medicines will allow the student to begin treatment immediately in the event of a high-risk exposure and then return to the United States for completion of workup and therapy. With proper planning and education, a student or resident can have a safe and rewarding experience in the developing world..

International Family Medicine
(Fam Med 1999;31(7):495-500.)