Multicultural Curricula in Family Practice Residencies
Kathleen A. Culhane-Pera, MD, MA; Robert C. Like, MD, MS; Patricia Lebensohn-Chialvo, MD; Ronald Loewe, PhD

Background and Objectives: In 1985, results from a national survey indicated that 25% of family practice residencies taught about multicultural issues in their programs. Our current study identified the current status and content of the curricula and determined facilitating and impeding factors to multicultural curricula.

Methods: In 1998, the Society of Teachers of Family Medicine’s Group on Multicultural Health Care and Education conducted a cross-sectional mail survey of all 476 family practice residency programs.

Results: With a 59% response rate, 58% of responding programs have an informal curriculum on multicultural issues, 28% have a formal curriculum, and 14% have no curriculum. Programs with a formal curriculum teach more content, employ more educational methods, use more evaluation techniques, and feel more successful than programs with an informal curriculum. Important factors that facilitate curricula include cultural diversity of communities and residents, multicultural interests of faculty and residents, and faculty’s multicultural expertise. Factors that impede curricula include lack of time, money, resources, faculty expertise, and cultural diversity in the community. Programs with formal, informal, and no curriculum identify different facilitators and impediments.

Conclusion: There was a marked increase in the prevalence of multicultural curricula in family practice residencies from 1985 to 1998.

Residency Education
(Fam Med 2000;32(3):167-73.)

Rural Residency Tracks in Family Practice: Graduate Outcomes
Thomas C. Rosenthal MD; M. Holmes McGuigan; Galvin Anderson, MD

Background: Because the distribution of physician services in the rural United States continues to be a problem, rural residency tracks in family practice have been developed as a strategy to acculturate residents into a rural practice model. Residents complete the first year of training in an urban-based program and the last 2 years in a rural community.

Methods: We surveyed all 77 graduates of 13 nationally distributed rural training tracks that had graduates between 1988 and 1997.

Results: The response rate was 83% (n=64). Seventy-six percent of respondents practice in a rural community, and 61% practice in federally designated health professional shortage areas. A total of 69% of respondents admitted patients to rural hospitals, 67% provided labor and delivery services, and 48% performed Cesarean sections. Existing physician groups were major influences on practice location. Thirty-nine percent were near their hometown, and 45% were near the community in which they completed residency training. Only 14% had a financial obligation to the community, and 94% reported that their rural training was adequate or better.

Conclusions: Most graduates of rural training tracks have located their practice sites in rural communities, and most graduates provide labor and delivery services. Location decisions were associated with existing physician groups, hospitals, hometowns, and proximity to training sites.

Residency Education
(Fam Med 2000;32(3):174-7.)

Complementary/Alternative Medicine: Comparing the Views of Medical Students With Students in Other Health Care Professions
Jessica Baugniet; Heather Boon, PhD; Truls Østbye, MD, MPH

Objective: We compared the opinions, knowledge, and attitudes of final-year medical, physiotherapy, occupational therapy, nursing, and pharmacy students about complementary/alternative medicine (CAM).

Methods: A cross-sectional study questionnaire (n=442) was administered on site at the University of Western Ontario and the University of Toronto to fourth-year health professions students. Outcome measures were self-reported knowledge, attitude, and perceived usefulness of CAM therapies, the perceived importance of scientific inquiry for the acceptance of CAM, and educational exposure to the topic.

Results: Educational exposure to CAM was correlated with the perceived usefulness of CAM. Medical students reported the least amount of education about CAM and viewed CAM therapies as less useful than did their health professions student peers. Medical students and pharmacy students were more likely than the other health professions students to view traditional scientific forms of evidence as necessary before accepting CAM therapies.

Conclusions: Perceptions differed among the different health professions student groups about the usefulness of CAM therapies and the kind of evidence needed before they should be incorporated into standard care. This may have important implications for multidisciplinary care.

Medical Student Education
(Fam Med 2000;32(3):178-84.)

Evaluating Faculty Development Outcomes by Using Curriculum Vitae Analysis
Jeffrey A. Morzinski, PhD; David B. Schubot, PhD

Background and Objectives: Many faculty development (FD) programs depend on external private and public sponsors that routinely require systematic studies on FD outcomes. The results of evaluation studies can influence whether or not programs continue to be funded. To better evaluate program outcomes on academic productivity, this paper presents and illustrates an evaluation method that uses the curricula vitae (CVs) of FD program graduates.

Methods: The evaluation method is implemented by first preparing a record-review template of coding categories that is applied to FD graduates’ updated CVs. Next, semi-structured interviews are held with subjects to resolve uncertain CV codes. Finally, coded data are entered into standardized forms and analyzed to yield descriptive findings. The method was piloted with two groups of FD graduates (n=17) to determine its utility and limitations.

Results: Results show excellent inter-rater reliability (Cohen’s Kappa=.79). There was an overall increase in productivity, measured by the CV, during and after the FD program.

Conclusions: CV analysis can be a useful method for assessing FD program outcomes. Several limitations of the method, such as incomplete CVs and self-report bias, must be considered.

Faculty Development
(Fam Med 2000;32(3):185-9.)

How to Write a Case Report
Laine H. McCarthy, MLIS; Kathryn E.H. Reilly, MD, MPH

Background: Since before Hippocrates, case reports have provided a rich resource for teaching and research in medicine. Case reports are published by many prominent journals—more than 140,000 case reports are indexed in MEDLINE from 1996 to present—and a number of narrative guidelines for the preparation of case reports have appeared in the medical literature. To facilitate the preparation of case reports, we reviewed the existing guidelines and a random sampling of published case reports and created a fill-in-the-blanks worksheet for physicians to use to capture unique scientific observations. Although originally developed to assist family practice residents to write case reports, the case report worksheet can be used by physicians in any practice setting and any discipline to collect and report interesting, unusual, or newsworthy cases.

Faculty Development
(Fam Med 2000;32(3):190-5.)

Changing Practices in the Use of Pneumococcal Vaccine
Robyn A. Latessa, MD; Doyle M. Cummings, PharmD; Sandra H. Lilley, PharmD; Susan L. Morrissey, MA

Background and Objectives: An important issue facing primary care practices is how to best improve preventive services to patients. We sought to determine if an intervention designed by a continuous quality improvement (CQI) process (reminder sticker and patient education sign in each examining room) or a patient education intervention (sign only) could increase the rate of pneumococcal vaccination.

Methods: These two interventions were administered over a 6-month period in a controlled, prospective study design in a family practice residency program clinic. The study targeted patients ages 65 and older and patients ages 2–64 with diabetes mellitus who had never received the pneumococcal vaccine. The main outcome measure was the vaccination rate in the targeted population.

Results: A total of 1,647 patient encounters involving 778 patients were documented during the study period. Overall, the reminder and sign module had higher percentages of pneumococcal vaccination in this target population (20% versus 11% for sign only, versus 7% control). Chi-square analysis revealed a statistically significant difference for this group, compared with placebo, but not for the sign-only group.

Conclusions: An intervention designed from a CQI process to impact the office patterns of primary care physicians can produce measurable changes in pneumococcal vaccination rates.

Clinical Research and Methods
(Fam Med 2000;32(3):196-200.)

Understanding Patients From the Former Soviet Union
Linda Grabbe, PhD, RN

Background: Increasing numbers of immigrants from the former Soviet Union (FSU) are coming to the United States. Educated and resilient, this population has many ethnic origins, but all have shared a common experience under the Soviet system and the deterioration of health care since the collapse of the Soviet Union. An ethnomedical approach was used to review published work and integrate material obtained in interviews with physicians in the FSU. Information is organized into concepts of causality, therapists, and forms of therapy. FSU medicine incorporates many Western treatments but also uses natural and spa remedies. Mainstream FSU physicians make diagnoses and use therapies that are unknown in the West. In addition, the active traditions of folk medicine and magical curing persist. US health care practitioners need to go to extra lengths to understand the perspectives and experiences of these patients and must explain basic concepts of health care in this country that will be new. An open approach to the patients’ non-Western beliefs and remedies will support a successful patient-practitioner interaction.

International Family Medicine
(Fam Med 2000;32(3):201-6.)