Accuracy of Electrocardiogram Reading by Family Practice Residents
Denise K.C. Sur, MD; Lily Kaye, PharmD; Michael Mikus, MD; Jeffery Goad, PharmD; Anthony Morena, MD

Objectives: This study evaluated the electrocardiogram (EKG) reading skills of family practice residents.

Methods: A multicenter study was carried out to evaluate the accuracy of EKG reading in the family practice setting. Based on the frequency and potential for clinical significance, we chose 18 common findings on 10 EKGs for evaluation. The EKGs were then distributed to residents at six family practice residencies. Residents were given one point for the identification of each correct EKG finding and scored based on the number correct over a total of 18.

Results: Sixty-one residents (20 first year, 23 second year, and 18 third year) completed readings for 10 EKGs and were evaluated for their ability to identify 18 EKG findings. The median score out of 18 possible points for all first-, second-, and third-year residents was 12, 12, and 11.5, respectively. Twenty-one percent of residents did not correctly identify a tracing of an acute myocardial infarction. Data analysis showed no statistically significant difference among the three groups of residents.

Conclusions: We evaluated the accuracy of EKG reading skills of family practice residents at each year of training. This study suggests that EKG reading skills do not improve during residency, and further study of curricular change to improve these skills should be considered.

Residency Education
(Fam Med 2000;32(5):315-9.)

Rejecting Family Practice: Why Medical Students Switch to Other Specialties
Sean Schafer, MD; William Shore, MD; Lloyda French, MS; Jason Tovar; Susan Hughes, MS; Norman Hearst, MD

Background and Objectives: Medical schools have been encouraged to increase the number of primary care graduates. This study determined the proportion of medical students who change specialty preference during the clinical years and explored how ultimate choice is affected by perceptions of medical specialties acquired during this period.

Methods: A survey was mailed to 397 graduating medical students at the University of California, San Francisco (UCSF) after the National Resident Matching Program Match and before graduation in 1996, 1997, and 1998.

Results: The response rate was 81% (320/397). Of 41 respondents who reported that family practice had been their first specialty choice prior to beginning clinical rotations, only 15 (37%) eventually matched in family practice. Comparable numbers for internal medicine and pediatrics were 50% and 69%. Students rejecting family practice were more likely than their colleagues rejecting other specialties to cite insufficient prestige, low intellectual content, and concern about mastering too broad a content area as reasons.

Conclusions: At UCSF, family practice retains fewer interested students than other primary care specialties. To reverse this trend, schools such as UCSF need to raise the prestige of family practice and counter concerns about its intellectual content being impossible to master.

Medical Student Education
(Fam Med 2000;32(5):320-5.)

Responding to Patients’ Emotions: Important for Standardized Patient Satisfaction
Amy V. Blue, PhD; Alexander W. Chessman, MD; Gregory E. Gilbert, MSPH; Arch G. Mainous III, PhD

Background and Objectives: Several experts have emphasized the need to respond to a patient’s emotions as an essential component of effective medical interviewing. This study examined the relationship of faculty observers’ scores of students’ performance in standardized patient (SP) interviewing stations in a family medicine clerkship objective structured clinical examination (OSCE) with SP satisfaction measures.

Methods: The faculty observers scored students in the following performance domains: 1) interviewing skills, 2) negotiating the diagnosis or plan, 3) gathering case-specific content information, 4) responding to the patient’s emotions, and 5) student’s overall performance. Pearson Product-Moment correlations were calculated for each of these domains and the Standardized Patient Satisfaction Questionnaire (SPSQ) scores.

Results: There were moderate correlations between the SPSQ score and the overall OSCE score (.45) and the response to patient’s emotions skill score (.36). The faculty observer’s response to patient’s emotion score correlated highly with the student’s overall OSCE score (.75).

Conclusions: A student’s ability to respond to the patient’s emotions appears to be an important skill for successful medical interviewing from both the faculty observer’s perspective and the SP’s perspective. Results also demonstrate that the SP’s perspective is similar, but not identical, to the faculty observer’s perspective, suggesting that SPs have an important evaluative role in student assessment.

Medical Student Education
(Fam Med 2000;32(5):326-30.)

US Medical Schools and the Rural Family Physician Gender Gap
Kathleen E. Ellsbury, MD, MSPH; Mark P. Doescher, MD, MSPH; L. Gary Hart, PhD

Background: Women comprise increasing proportions of medical school graduates. They tend to choose primary care but are less likely than men to choose rural practice.

Methods: This study used American Medical Association masterfile data on 1988–1996 medical school graduates to identify the US medical schools most successful at producing rural family physicians and general practitioners of both genders.

Results: The number of listed rural female family physician or general practitioner graduates among schools ranged from 0–27 (0% to 4.4% of each school’s 1988–1996 graduates). There were approximately twice as many male as female rural family physicians and general practitioners. Publicly funded schools produced more rural female family physicians and general practitioners than their privately funded counterparts.

Conclusions: Our findings suggest that a few schools, most of them public, may serve as models for schools that aim to train women who later enter rural practice.

Medical Student Education
(Fam Med 2000;32(5):331-7.)

Improving Pneumococcal Vaccination Rates: A Three-Step Approach
Juanita R. Redfield, MD; Thomas W. Wang, MD

Background: Streptococcus pneumoniae is the cause of significant preventable morbidity and mortality each year, especially among the elderly. This study evaluated the effectiveness of a three-step strategy to improve pneumococcal vaccination rates in patients ages 65 and older.

Methods: We obtained a baseline vaccination rate by chart review of a randomized list of patients ages 65 and older. Interventions that included physician education, a system of office prompts, and patient education were instituted for 1 year. We performed a second chart review to determine the success of the intervention.

Results: Vaccination rates increased significantly from 56.7% to 75.8%. No significant difference in initial vaccination rates between men and women was found. Although rates improved for both men and women, only the increase in vaccination for men was significant.

Conclusions: This study shows that an easy and inexpensive intervention can substantially impact pneumococcal vaccination rates. Specifically, a three-step approach that combines provider education, office prompts, and patient education has proven effective.

Clinical Research and Methods
(Fam Med 2000;32(5):338-41.)

Israel Under Threat of Biological Warfare—The Reactions of Our Patients During the 1998 Persian Gulf Crisis
Simon Zalewski, MD; Shlomo Vinker, MD; Shlomo Monnickendam, MD; Orli Cohen, MD; Miriam Disegni, MD; Eliezer Kitai, MD

Background and Objectives: During February 1998, there was heightened tension in the Persian Gulf area. Iraq’s ruler, Saddam Hussein, threatened Israeli citizens with the use of biological weapons. This study observed the use of health care services by patients visiting our clinics during this period.

Methods: During the period of February 17, 1998, through March 1, 1998, 12 family physicians classified all clinic visits as “related” or “unrelated” to the crisis. The participating clinics were situated in (A) high-risk and (B) low-risk areas, according to their location as related to missile hits during the 1991 Gulf War.

Results: A total of 1,841 visits were recorded during the crisis period (February 17–23). There were 934 visits in Area A and 907 in Area B. Overall, 194 visits related to the crisis were recorded, of which 155 were in Area A. The rate of crisis-related visits was higher in Area A (16.6% versus 3.4%). There were more visits for authorizations for special masks (8.2% versus .8%), requests for information (3.9% versus 1.3%), and tranquilizers (2.1% versus .5%). In the period subsequent to the agreement reached on February 24, crisis-related visits declined sharply in both areas.

Conclusions: During the crisis, there was an increase in visits related to the threat of biological warfare. The phenomenon was more pronounced in areas that had sustained missile hits during the 1991 Gulf War.

International Family Medicine
(Fam Med 2000;32(5):342-5.)