Implementing Community-oriented Primary Care Projects in an Urban Family Practice Residency Program
Peter G. Harper, MD, MPH; Nancy J. Baker, MD; Christopher J. Reif, MD, MPH

Background: Clinics interested in pursuing community-oriented primary care (COPC) have struggled with the implementation of its theory. Although we are still early in the COPC transformation process, the HealthPartners Family Practice Residency Program has had several successful COPC projects during our 10 years of experience. This article describes these projects and the 8 lessons learned, including some that differ from traditional COPC teaching and practice. In our experience, clinics should select a topic or problem that creates a passion within their clinic. Projects can start small within the clinic and expand outward into larger portions of the urban community. Partnerships begin the process of extending into the community and increasing the project’s impact. The evaluation of projects should begin with clinic-based data. A physician champion and a nonphysician staff person increase the success of the project. Resident involvement is enhanced with concrete tasks and community connections. Ultimately, the project needs to be institutionalized within the clinic to survive. The whole COPC endeavor is a long, slow process that requires time, energy, and committed individuals. In our experience, COPC is a journey, not an end, and there are many rich rewards to be found along the way.

(Fam Med 2000;32(10):683-90.)

ENT Experience in a Family Medicine Clerkship: Is There Enough?
Brenda S. O’Hara, MD; Robert M. Saywell, Jr, PhD, MPH; Terrell W. Zollinger, DrPH; Christopher P. Smith, MPA; Jennifer L. Burba; David M. Stopperich

Background: Curriculum planning is an essential process at any institution of learning. Currently, at Indiana University, a 1-week required otorhinolaryngology clerkship is being considered for removal from the curriculum, and this exposure is planned for integration into other primary care clerkships. A data collection system for patient encounters was created to obtain objective quantitative data about ear, nose, and throat conditions in the family medicine clerkship.

Methods: A total of 445 students filled out 56,151 patient encounter forms that contained the diagnoses, patient age, student comfort levels, and student responsibilities.

Results: Of the 56,151 encounters, 22.9% involved a condition involving an ear, nose, or throat (ENT) diagnosis, and the overall top-10 diagnoses reflect a typical family practice. Few students reported being given the opportunity to perform procedures.

Conclusions: It appears that students are receiving sufficient practice in taking patient histories and performing initial patient physicals for ENT cases and that they see a sufficient number of ENT cases. However, students had more limited opportunity to perform and/or assist with ENT procedures or to be involved with patient education and ENT counseling. The number of ENT cases in the third-year clerkship is sufficient, and the experience is mostly more than adequate. Our study indicates that ENT training is a significant part of the family medicine clerkship, and curriculum integration is possible, though concerns about procedural skills will need to be addressed.

(Fam Med 2000;32(10):691-5.)

Web-based Education in Family Medicine Predoctoral Programs
Shou Ling Leong, MD; Constance D. Baldwin, PhD; Richard P. Usatine, MD; Alan M. Adelman, MD; Craig L. Gjerde, PhD

Background and Objectives: New technologies and widespread Internet access make Web-based education feasible for family medicine predoctoral programs. Offering educational activities and resources through the Web can support community-based education and improve communication. We assessed the status of Web-based education nationally and explored the interest and opportunities for collaboration.

Methods: A survey assessed the inclusion of Web-based educational methods in family medicine predoctoral programs and school-wide programs, the level of national interest in collaborative development, and common obstacles to progress. The survey was mailed to all US family medicine predoctoral directors.

Results: The response rate was 61%. Results showed nearly universal use of e-mail and Web pages. The most common educational use of the Internet was posting text information. One third of the responding programs used the Web for evaluation. Barriers to development of Web-based educational programs are faculty time and funding. Most respondents were interested in collaborative Web development and would value a national, Society of Teachers of Family Medicine-based network for this purpose.

Conclusions: Web-based educational activities are commonly offered by family medicine programs. To realize the full potential of Web-based education, collaborative development of new methods and materials will be needed to overcome the limiting factors of faculty time and funding.

(Fam Med 2000;32(10):696-700.)

Effect of Attendance at an Annual Primary Care Research Methods Conference on Research Productivity and Development
David A. Katerndahl, MD, MA

Background and Objectives: This study determined whether attendance at a research methods conference is associated with an increase in research productivity in conference participants and identified predictors in participants of postconference productivity measures.

Methods: We mailed survey instruments to 423 participants who attended the Primary Care Research Methods and Statistics Conference between 1986 and 1995 to document their professional characteristics, conference attendance, and preconference and postconference research productivity. In addition, respondents were asked to send us their curriculum vitae (CV) and the CV of a colleague with a similar interest in research who had never attended the conference.

Results: A total of 294 participants completed the survey, and 40 of these sent the CV of a colleague. Preconference and postconference changes in research publications and presentations were significant, especially in novice researchers. Regression analyses found that the number of conferences attended predicted postconference publications, presentations, and current research activity. Compared to colleagues who never attended the conference, postconference total publications and presentations were higher in conference participants.

Conclusions: Attendance at a research skills conference was associated with increased postconference research productivity, compared with preconference productivity and that of matched controls.

(Fam Med 2000;32(10):701-8.)

Pilot Test of Family Medicine Faculty Development Fellowship Accreditation Guidelines
Christopher B. Reznich, PhD; Brian E. Mavis, PhD

Background: We conducted a pilot test of accreditation guidelines for family medicine faculty development fellowship programs from September 1997 to March 1999. The accreditation guidelines included 8 application categories with 27 requirements and 5 self-study criteria. The process included completion of the accreditation application and self-study and a site visit. We selected 6 sites for participation in the pilot test, and 5 sites completed all steps. The results indicated that, while fellowship faculty felt that the requirements and criteria were valid for determining quality of faculty development fellowship programs, the process was time-consuming and could be shortened. Redundancy between information supplied on the application and on the self-study was also noted. Six recommendations were included in the final report, including streamlining the accreditation process, developing guidelines for probationary status, and considering alternatives to accreditation, such as peer review.

(Fam Med 2000;32(10):709-19.)