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ABSTRACTS
Special Articles: From the Robert Graham
Center
The
Increase in International Medical Graduates in Family
Practice Residency Programs
NN
Koehn, GE Fryer Jr, RL Phillips, JB Miller, LA Green
Background
and Objectives: The number of filled positions in family
practice residency programs decreased by 18.6% from
1997–2001. This study sought to determine the degree
of reliance on international medical graduates (IMGs)
to fill family practice residency positions and the
relative proportion of US citizen IMGs. Methods: We
analyzed the 1992–2001 National Resident Matching
Program results, the 2000 American Medical Association
Masterfile, and the 1992–2001 American Academy
of Family Physicians Annual Survey of Family Practice
Residency Programs. Results: The percentage of IMGs
matching in family practice remained stable between
the years of 1992–1996 (10.0%–11.8%) but since
1997 has increased to a high of 21.4% in 2001. This
rise in IMGs corresponds with a drop in the total percentage
of family practice residency positions filled in the
Match from 90.5% in 1996 to 76.3% in 2001. Despite the
drop in Match numbers, the percentage of first-year
family practice positions filled in July has remained
in the range of 95.5%–97.8% since 1996. IMGs account
for an increasing percentage of post-Match fills from
16.7% in 1996 to 47.9% in 2001. In 1999, a majority
of family practice programs (279 [55.6%]), had at least
one IMG. Of these, 48 programs (9.6%) had at least 50%
of residents who were IMGs, and eight programs (1.6%)
were entirely composed of IMGs. In five states (Connecticut,
Illinois, Michigan, New Jersey, and New York), more
than 25% of family practice residents were IMGs. Conclusions:
Family practice is becoming increasingly reliant on
IMGs to fill residency positions.
(Fam
Med 2002;34(6):429-35.)
The
Association of Title VII Funding to Departments of Family
Medicine With Choice of Physician Specialty and Practice
Location
GE Fryer Jr, DS Meyers, DM Krol, RL Phillips, LA
Green, SM Dovey, TJ Miyoshi
Background:
Title VII predoctoral and departmental grants for departments
of family medicine are intended to increase the number
of family and primary care physicians in the United
States and increase the number of practices in rural
and underserved communities. This study assessed the
relationships of Title VII funding with physicians’
choices of practice specialty and location. Methods:
Non-federal direct patient care physicians who graduated
from US medical schools from 1981–1993 were identified
in the 2000 American Medical Association Masterfile.
A grant history file was used to annotate Masterfile
records with Title VII funding data for the physicians’
4-year medical school enrollment. Characteristics of
the county in which they practice were taken from the
Area Resource File. Title VII funding variables were
then related to practice specialty and location. Results:
Predoctoral training and departmental development funding
were strongly related to attainment of each of the Title
VII program objectives evaluated. Conclusions: Title
VII has been successful in achieving its stated goals
and legislative intent and has had an important role
in addressing US physician workforce policy issues.
(Fam
Med 2002;34(6):436-40.)
Residency
Education
An
Observational Study of Precepting Encounters in a Family
Practice Residency Program
H Chumley Jones
Background
and Objectives: Family practice residents spend substantial
time in their family health centers. Little is known
about the area of focus of discussions between preceptors
and residents. In this study, we describe the percentages
of time that preceptors spent in various focus areas
in one family practice residency program. Methods: We
conducted a direct observational study of four purposefully
selected half-day sessions, one at each of four continuity
sites, which included 80 precepted encounters and 451
minutes. Percentages of precepting time were calculated
by overall, by common or uncommon diagnoses, by postgraduate
level, and by clinical or academic faculty. Results:
Preceptors discussed diagnosis or management 90% of
the time; use of consultants and tests 6%; pathophysiology,
pharmacology, other basic science 2%; and psychosocial
factors 2%. There were no significant differences between
percentage of time spent in each of the focus areas
when comparing clinical to academic faculty or postgraduate
year (PGY)-1, PGY-2, and PGY-3. Precepting about common
problems had a higher percentage of time devoted to
psychosocial issues than did precepting about uncommon
problems (3.8% versus .4%). Conclusions: Preceptors
focused on diagnosis and management in this family practice
residency program. Further study is needed to determine
if this unbalanced focus is a problem or is present
in other programs.
(Fam
Med 2002;34(4):441-4.)
Reach
Out and Teach Someone: Generalist Residents' Needs For
Teaching Skills Development
EH Morrison, J Hollingshead, FA Hubbell, MA Hitchcock,
L Rucker, MD Prislin
Background
and Objectives: Family practice residents and students
receive substantial teaching from senior residents.
Yet, we lack data about residents’ needs for teaching
skills development, particularly in generalist training.
This multicenter, interdisciplinary study describes
the learning needs of generalist residents for becoming
more effective teachers. Methods: One hundred medical
students, residents, and faculty in family medicine,
internal medicine, and pediatrics participated in 11
focus groups and 4 semi-structured key informant interviews
at the University of California, Irvine and the University
of California, Los Angeles in 2000–2001. Results:
Participants agreed that resident teachers fulfill critical
roles in medical education, providing powerful, skills-based
teaching that can tangibly benefit both residents themselves
and their junior learners. House staff often facilitate
students’ best learning experiences despite inherent
risks in serving as teachers and professional role models.
Residents need teaching skills training that prepares
them to lead clinical teams and teach students essential
skills that include history taking and physical examination,
critical reasoning, charting, and procedures. Conclusions:
Generalist residents fulfill important roles as practical
clinical teachers and role models for junior learners.
Future research should address how resident teachers
affect learners’ clinical skills, academic performance,
and professionalism.
(Fam
Med 2002;34(6):445-50.)
Medical
Student Education
Evaluations
of Medical Students' Clinical Experiences in a Family
Medicine Clerkship: Differences in Patinet Encounters
by Disease Severity in Different Clerkship Sites
FW Markham, S Rattner, M Hojat, DZ Louis, C Rabinowitz,
JS Gonnella
Background
and Objectives: Evaluation of medical students’ clinical
encounters is an essential component of optimizing their
educational experience. In this study, we collected
data on the diagnoses and disease severity in student-patient
encounters at different family medicine clerkship sites.
Methods: Participants were 582 third-year medical students
who completed a total of 7,515 specially designed patient
encounter cards in a 6-week family medicine clerkship
at five training sites over 3 years. Results: Variation
was found in the average number of encounters in different
clerkship sites. The findings for three frequently encountered
diseases (essential hypertension, diabetes mellitus,
and upper respiratory infection) showed significant
differences in the proportions of patients at different
stages of the disease in different clerkship sites.
Conclusions: Students at different clerkship sites experience
different numbers of encounters with patients and significant
variation in the illness severity of patients seen in
those encounters.
(Fam
Med 2002;34(6):451-4.)
Faculty
Development
Predictors
of Short-term and Long-term Scholarly Activity by Academic
Faculty: A Departmental Case Study
RL Ferrer, DA Katerndahl
Background
and Objectives: What leads to individual success or
failure in family medicine scholarly activity? We prospectively
studied predictors of short-term (2 years) and long-term
(5 years) scholarly productivity in the faculty of one
university family medicine department. Methods: All
department faculty (n=37) between 1986 and 1998 completed
an annual survey of their scholarly activities (238
person years). Using bivariate and multiple regression
analyses, we examined the influence of faculty demographics,
professional degrees and training, academic rank, and
responsibilities in areas such as patient care, teaching,
and administration on 2-year and 5-year output of presentations,
publications, and grants. Results: Productivity (defined
as publications, external presentations, and funded
grants) declined with time since medical school graduation.
PhD and MD/MS faculty were more productive than MD faculty.
Fellowship training was also associated with greater
productivity, as was national service to journals and
grant review panels. Administrative activity below the
level of department chair or vice chair did not detract
from scholarly activity. Clinical time demonstrated
only a weak, nonsignificant negative correlation with
most of our scholarly activity measures. Conclusions:
As previously noted, research training through advanced
degrees or fellowships enhances scholarly activity.
The effect on scholarly productivity of time spent in
clinical work or on administrative tasks requires further
study across different departments.
(Fam
Med 2002;34(6):455-61.)
The
Importance of Interpersonal Relationship Factors in
Decisions Regarding Authorship
AG Mainous III, MA Bowman, JS Zoller
Background
and Objectives: Authorship on scientific articles is
an important form of academic productivity. We examined
the influence of personal and professional relationships
on authorship decisions, particularly as they may conflict
with stated criteria of the International Committee
of Medical Journal Editors (ICMJE). Methods: We conducted
an anonymous e-mail survey of corresponding authors
of original research articles in the Archives of Family
Medicine, British Medical Journal, New England Journal
of Medicine, and the American Journal of Psychiatry
in 1999. Assessments were made of how often concerns
about personal and professional relationships enter
authorship decisions as well as factors affecting authorship
if that person does not meet ICMJE criteria. Results:
Of 578 eligible individuals, 292 participated, for a
response rate of 50.5%. Personal and professional relationship
concerns enter into decisions about who should be named
as an author. Junior faculty and individuals whose job
is dependent on publications were significantly more
likely to feel obligated to consider adding an author
who doesn’t meet ICMJE criteria when that person
has administrative power over them. Current strategies
to improve the veracity of authorship were endorsed
as moderately effective. Conclusions: Authors are faced
with the difficult task of negotiating interpersonal
relationships while allocating authorship according
to ICMJE criteria. Mechanisms should be explored to
provide greater protection of junior faculty from pressure
by senior faculty.
(Fam
Med 2002;34(6):462-7.)
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