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ABSTRACTS
Distinguished Paper From the 2001 North
American Primary Care Research Group Meeting
Patient Perspectives
on the Doctor of the Future
DS main, C Tressler, A Staudenmaier, KA Nearing,
JM Westfall, M Silverstein
Background and Objectives: Health care reform has been
the subject of considerable debate, particularly among
those in politics, insurance, and business. Patients,
however, have largely been ignored in this discussion.
As the role of the health care consumer receives increased
attention, it is important to consider patient values
and preferences for a future system of care. This study
describes what patients want and value in a future doctor.
Methods: This study was conducted in 1999–2000,
using focus group methodology involving 78 members of
communities in seven regions of Colorado. Participants
were selected to ensure a distribution of rural/urban,
racial/ethnic groups and different regions of the state.
All participants had visited a health care provider
in the previous 10 years. Data were analyzed with a
team-based editing approach. Results: Participants identified
several primary domains and subthemes that describe
what they want in a doctor of the future. The primary
themes related to future doctors’ medical and contextual
knowledge of the patient, their personal characteristics
and philosophical approach to health and health care,
and desired qualities of the doctor-patient relationship.
Conclusions: Patients wanted their future doctors to
improve their experience of care and to be patient-centered,
family-oriented, and community-oriented doctors. Patient
perspectives of the doctor of the future should be considered
in decisions about health care policy.
(Fam Med 2002;34(4):251-7.)
Residency
Education
Factors
Affecting the Match Rate of Rural Training Tracks in
Family Practice
W Malaty, DE Pathman
Background and Objectives: Rural training track (RTT)
family practice residencies are designed to prepare
family physicians for rural practice. Residents in these
programs spend 1 year in an urban location, followed
by 2 years in a rural setting. Anecdotally, one hears
that some programs have problems filling their available
positions for residents. No published studies have systematically
evaluated this fill rate. This study determined the
match rate of rural track family practice residencies
and examined factors associated with higher rates. Methods:
Questionnaires were mailed to program directors of all
28 rural track residencies identified in 1998 by the
Residency Review Committee for Family Practice. Five
programs proved ineligible, and 22 of the 23 eligible
programs responded (96%). Directors provided information
on fill rates and program characteristics from 1996
through 1998. Programs’ reported fill rates
were compared to rates previously reported for family
practice residencies as a whole. Descriptive statistics
were used to compare rural track programs that did and
did not fill through and after the National Resident
Matching Program (NRMP) (the “Match”). We
also report data recently updated to reassess the situation
for the 2001 Match. Results: Rural track residency programs
offered 52 first-year positions in 1998. All positions
were offered through the NRMP. From 1996 through 1998,
programs had a mean Match rate of 61%, compared with
a rate of 86% reported previously for all family practice
residencies. RTT programs in more-desirable communities
(as determined by location near a listing in Fortune
Magazine’s “Best Places to Live”) and
those in the western and northeastern United States
filled more positions than programs in less-desirable
locations and in the southern and central United States.
There were no other differences in the characteristics
of programs or their faculty between programs that filled
their positions and those that did not. These same trends
held true for the 2001 Match. Conclusions: In recent
years, rural track residencies were less likely to match
their first-year positions than other family practice
residencies. Geographic and community characteristics
seemed to influence the Match rate, whereas characteristics
of programs and their faculty did not.
(Fam Med 2002;34(4):258-61.)
A
National Survey of Research Requirements for Maily Practice
Residents and Faculty
AV Neale
Background and Objectives: The Accreditation Council
for Graduate Medical Education recognizes that research
education is a fundamental, although not always required,
aspect of resident training. Since there is little information
available on family practice resident research requirements,
directors of US family practice training programs were
surveyed about their programs’ research requirements
and research curricula. Methods: A questionnaire survey
was mailed to directors of family practice residency
training programs listed in the American Academy of
Family Physicians Directory of Family Practice Residency
Programs. Seventy-five percent of residency program
directors participated in the study. Results: Almost
half (48.6%) of responding programs required a resident
research project, but only one fourth linked annual
resident promotions to progress on the research project.
Programs that required a project were more likely to
say they provide a research curriculum, but information
on these varied widely. Only 12.9% said faculty were
required to engage in research/scholarly activities.
The top two reasons for requiring resident research
were (1) to develop critical thinking and patient care
skills and (2) to understand the medical literature.
The top two reasons for not requiring resident research
were (1) attitude that it isn’t necessary and (2) lack
of faculty or time. Conclusions: The research requirement
during family practice residency appears to be growing.
However, the nature and benefit of family practice residency
research education still remains undefined.
(Fam Med 2002;34(4):262-7.)
Medical
Student Education
Identifying the Attributes of Instructional Quality
in Ambulatory Teaching Sites: A Validation Study of
the MedEd IQ
PA James, CD Kreiter, J Shipengrover, J Crosson
Background: Instructional quality in ambulatory settings
may vary. The MedEd IQ is an instrument that measures
unique aspects of the clinical instructional process.
This study assesses the construct and factorial validity
of the MedEd IQ. Methods: First-year students (n=764)
in Introduction to Clinical Medicine courses and third-year
students (n=711) in family medicine clerkships evaluated
249 clinical teaching sites affiliated with two medical
schools, using MedEd IQ questionnaires at the conclusion
of clinical training (1996–2000). Factor structures
were identified and relationally defined through exploratory
and confirmatory factor analytic techniques, and a measurement
model for assessing instructional quality was refined.
Results: Four unique factors were identified that contribute
to instructional quality: preceptor activities, learning
environment, learner involvement, and learning opportunities.
Of 33 items within the instrument, 22 were retained
in the final structural model. Two indices of fit, a
comparative fit index of .935, and a root mean square
error of approximation of .063 indicated close agreement
between the defined model and the observed relationships
between items. Conclusions: The MedEd IQ measures four
factors important to ambulatory medical education and
provides a basis for a new measurement approach to assessing
instructional quality.
(Fam Med 2002;34(4):268-73.)
Clinical
Research and Methods
Does
Continuity Between Prenatal and Well-child Care Improve
Childhood Immunizations?
JM
Gill, A Sandarriaga, AG Mainous III, D Unger
Background
and Objectives: Continuity of care has been associated
with positive health benefits, but the benefit of continuity
for the maternal-child unit has not been studied. This
study determined whether continuity from prenatal to
pediatric care is associated with higher immunization
rates for low-income children in Delaware. Methods:
This retrospective cohort study included 187 women who
received prenatal care in one of four clinics (predominantly
family practice) over a 2-year period. Each maternal-child
pair was defined as having provider continuity (same
provider for prenatal and pediatric care), clinic continuity
(same clinic but different provider), or no continuity
(different clinic). We measured the association between
continuity and completion of immunizations by 7 months
of age and by 12 months of age. Results: Provider continuity
was significantly associated with a higher immunization
rate both at 7 and 12 months of age. After controlling
for age, gender, ethnicity, insurance, birth order,
and language, this association persisted at 7 months
but lost statistical significance at 12 months. Those
with clinic continuity were not significantly different
than those with no continuity for any outcomes. Conclusions:
For lowincome persons in Delaware, provider continuity
for the maternal-child unit is associated with higher
completion rates for early childhood immunizations.
(Fam Med 2002;34(4):274-80.)
Research
Series
Guidelines for Constructing A Survey
C Passmore, AE Dobbie, M Parchman, J Tysinger
Many
researchers in family medicine use surveys to gather
data from colleagues, learners, and patients on their
demographics, personal histories, knowledge, behaviors,
and attitudes. Well-written surveys are easy for respondents
to complete, gather information accurately and consistently,
and obtain data that can be analyzed to answer research
questions. All levels of family medicine researchers
can follow eight steps to develop surveys that produce
useful and publishable results: (1) state the problem
or need, (2) plan the project, (3) state the research
question, (4) review the literature, (5) develop or
adapt existing survey items, (6) construct the survey,
(7) conduct pilot tests, and (8) administer the survey.
After completing this article, readers should be able
to (1) state the appropriate uses of survey instruments
as research tools and (2) construct and administer a
well-designed survey instrument.
(Fam Med 2002;34(4):281-6.)
Methods
for Continuing Medical Education
Can Internet-based Education Improve Physician
Confidence in Dealing With Domestic Violence?
JM Harris Jr, RM Kutob, ZJ Surprenant, RD Maiuro,
TA Delate
Background
and Objectives: Domestic violence (DV) is a common,
under-recognized source of visits to health care professionals.
Even when recognized, physicians are reluctant to deal
with DV, citing a lack of education and lack of confidence
in addressing issues presented by DV patients. Only
a small number of DV education programs have been shown
to lead to improvements in professional knowledge and
confidence, and these are intensive, multi-day courses.
We sought to develop an on-line DV education program
that could achieve improvements in physician confidence
and attitudes in managing DV patients comparable to
classroom-based courses. Methods: We created an interactive,
case-based DV education program targeted to physicians
caring for DV patients. We tested the effectiveness
of this program in changing attitudes and beliefs in
a randomized, controlled trial of Kansas physicians
who volunteered to participate in a study of on-line
continuing medical education. We measured program effectiveness
with an externally developed and validated pretest/posttest
instrument. Results: Sixty-five physicians completed
the pretest/posttest, 28 of whom were assigned to receive
the on-line DV program. We found a +17.8% mean change
in confidence (self efficacy) for physicians who took
the DV program versus a -.6% change for physicians who
did not take the program. We also found improvements
in other important areas associated with poor management
of DV patients. These changes were similar or greater
in magnitude to those reported by others who have used
the same survey tool to evaluate an intensive, multi-hour
classroom approach to DV education. User satisfaction
with the online program was high. Conclusions: An interactive,
case-based, on-line DV education program that teaches
problem-solving skills improves physician confidence
and beliefs in managing DV patients as effectively as
an intensive classroom-based approach. Such programs
may be of benefit to those seeking to improve their
personal skills or their health care delivery system’s
response to DV.
(Fam Med 2002;34(4):287-92.)
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