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Special
Article
The Role of Race in the Clinical Presentation
What role, if any, should
race play in clinical presentations? While race is widely
used as a way of identifying patients, this practice
has been challenged as conceptually flawed, potentially
misleading, and possibly prejudicial to the patient.
There are, however, important reasons for not excluding
information about race. This article includes a set
of guidelines for the inclusion of racial data in presentations:
(1) Race is a social construct and, if used, should
be recorded in the social history, not the opening sentence
of the presentation. (2) Patients should self-identity
their race or races. (3) Race should not be used as
a proxy for genetic variation, social class, or other
elements of the social history. (4) Clinicians should
be mindful of the potential influence of racism in the
clinical encounter. (Fam Med 2001;33(6):430-4.)
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Medical
Student Education
Does a Reduction in Family Medicine Clerkship Time Affect
Edcuational Outcomes?
Background and Objectives: Little is known about the
relationship between the length of a family medicine
clerkship and its educational outcomes. After our family
medicine clerkship time decreased from 6 weeks to 4
weeks in July 1997, we studied how this change in clerkship
length affected educational outcomes. Methods: Educational
outcomes for the 2-year periods before and after the
change were examined and compared whenever possible.
Outcome measurements included student ratings of different
aspects of the clerkship and student performance on
clerkship examinations. Results: Students’ exposure
to common clinical problems was unaffected by the change.
For the 4-week clerkship, there was a slight increase
in student ratings of the adequacy of number of patients
seen, the opportunity to follow-up with patients, the
ability to develop health promotion plans, and overall
satisfaction. Because the combinations of examinations
used differed each year, student performance on clerkship
examinations could not be directly compared. Conclusions:
Educational outcomes of the 4-week clerkship were similar
to the 6-week clerkship. A few key outcomes improved.
Various curricular and structural changes instituted
for the 4-week clerkship contributed to the stability
in outcomes. Reports from other medical schools may
give additional insight into understanding this relationship.
(Fam Med 2001;33(6):435-40.)
Residency Education
Deception By Applicants to Family Practice Residencies
Background and Objectives: Our residency program experienced
applicants who actively misrepresented qualifications,
background, or abilities. The experiences of other family
practice residencies were unknown. This study 1) determined
what information family practice residency directors
required from applicants, 2) assessed whether this information
was confirmed or verified, and 3) describes the deceptive
application information discovered by program directors.
Methods: A questionnaire was sent to directors of all
accredited family practice residencies. Information
was collected about required information, data confirmation,
and the deception and misrepresentation perceived. Results:
Thirty-two percent of the directors responded. Eight
of 13 items on the Electronic Residency Application
System were designated as required by more than half
of responding directors. Only two of the items (licensure
and certain facts in the personal statement) were confirmed
by a majority of directors who required them. Deception
was recognized by nearly half of respondents within
the past 5 years. Most cases involved specialty choice
or the personal statement of candidates and were recognized
during the interview or by direct confirmation of data.
Conclusions: Most directors appear to accept application
information at face value. Recognition of deception
about application information was reported. Misrepresentation
by applicants may be a more common event than previously
realized and may require more thorough verification
of application credentials. (Fam Med 2001;33(6):441-6.)
Residency Education
EKG Analysis Skills of Family Practice Residents in
the United Arab Emirates: A comparison With US Data
Background and Objectives: Concern has been raised
about the electrocardiogram (EKG) analysis skills of
family practice residents in the United States. This
study examined EKG analysis skills of family practice
residents, medical students, interns, and general practitioners
(GPs) in the United Arab Emirates (UAE), a different
environment. Methods: The measurement instrument was
a set of 10 EKGs, used in a study of US family practice
residents. Two of the EKGs were normal, and there were
14 clinical abnormalities in the remainder. Results:
There was no significant difference in the correct diagnosis
of acute myocardial infarction between US family practice
residents and UAE family practice residents, medical
students, or GPs. Interns’ diagnoses were significantly
poorer. The mean score for correctly identifying acute
myocardial infarction and both normal EKGs was not significantly
different between groups: 2.50 medical students, 2.35
interns, 2.58 UAE family practice residents, 2.67 FD,
and 2.55 US family practice residents. However, the
US family practice resident mean score of 11.26 for
all 16 clinical findings was significantly higher than
any group in the UAE: 5.35 medical students, 5.87 interns,
6.08 UAE family practice residents, 5.69 family physicians.
Conclusions: Difficulty in EKG interpretation transcends
geographic boundaries, suggesting that new approaches
to teaching these skills need to be explored. Improved
EKG reading skills by family physicians are generally
needed in both the United States and the UAE. (Fam Med
2001;33(6):447-52.)
Residency Education
Development of a Residency/MPH Program
Background and Objectives: Public health complements
the care physicians provide to patients. Few residencies,
with the exception of preventive medicine residencies,
offer trainees the opportunity to obtain a public health
degree. The University of California, San Fransisco-Fresno
(UCSF-Fresno) Family Practice Program and California
State University-Fresno (CSU-Fresno) spearheaded the
creation of a combined residency/MPH program at the
UCSF-Fresno Medical Education Program. Methods: We developed
a combined residency/MPH program that allows family
practice residents to obtain an MPH degree during their
residency training years. We describe the development
process, which included initiation of the program, setting
goals and objectives, identifying MPH course content
and funding, and selecting applicants for entry into
the program. Results: The program was successfully funded,
and the course content was developed. Participant selection,
registration, and enrollment procedures have now been
developed. Performance standards have been established,
and scheduling conflicts have been addressed. The program
has thus far enrolled 29 residents and faculty. Nearly
one third have dropped out of the MPH component of the
program, mostly because of the workload involved in
simultaneous residency and MPH training. Conclusions:
Other training programs can replicate a combined residency/MPH
program if a strong relationship with a nearby university
offering a MPH degree can be forged. The experience
at UCSF-Fresno can help guide others contemplating a
combined residency/MPH program. (Fam Med 2001;33(6):453-8.)
Faculty Development
Development of a Residency/MPH Program
Background: Several studies have shown that the percentage
of women represented in senior academic positions at
US medical schools is lower than the percentage of men
in senior positions. Similarly, the percentage of minority
faculty members represented in senior academic positions
is lower than that of their majority counterparts. This
study assessed whether these findings were also present
in departments of family medicine and identified any
factors related to the institution or department that
favored academic success for women and minorities. Methods:
Data regarding faculty workforce composition, including
faculty rank and rank for women and underrepresented
minorities, were extracted from a comprehensive survey
of departments of family medicine at US allopathic medical
schools. The data are based on faculty workforce in
1997 and include responses from 58 (51%) of all schools
with a department of family medicine. Results: Faculty
in departments of family medicine were more likely to
be female (41% versus 25%) and an underrepresented minority
(9% versus 4%), compared with all academic medicine
disciplines. However, women in full-time positions were
less likely than men, and minorities were less likely
than nonminorities, to be either an associate or full
professor. We could find no institutional or departmental
characteristics that were associated with academic success
for women or minority faculty members. Conclusions:
While women and underrepresented minorities are more
common to the faculty workforce in family medicine,
members of both of these groups are not well represented
in senior faculty ranks. (Fam Med 2001;33(6):459-65.)
Clinical Research & Methods
A Telephone Needs Assessment for Potential High Utilizers
Background and Objectives: We conducted a telephone
needs assessment of patients at risk for high utilization
of health services to determine the type of intervention
that might be most responsive to their needs. Methods:
Family practice patients who were classified as at high
risk based on self-reported health-related quality of
life (HRQOL), age, and gender received a structured
telephone interview to ask about their health problems,
difficulties with their health care, and types of help
programs that might be useful to them. Results: Of 867
adult patients randomly selected as eligible for the
study, 352 completed the Duke Health Profile to measure
HRQOL, 122 were classified at risk for high utilization,
and 104 were interviewed by telephone. Patient-reported
health problems were similar to provider-reported problems.
High-risk patients reported difficulties receiving help
from the clinic on issues of communication and logistics
(43.9%), limitations of clinic facilities and services
(26.3%), and financial concerns (26.3%). Of the highest
risk patients, 45.8% expressed willingness to participate
in help programs conducted over the telephone. Conclusions:
Many high-risk patients might benefit from participation
in a telephone intervention program. A future study
is needed to measure the effectiveness of such a program
to improve utilization of health services. (Fam Med
2001;33(6):466-72.)
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