November-December 2002, Vol. 34, No. 10RESIDENCY EDUCATION
Objective: This study evaluated the effect of pharmaceutical samples on the prescribing habits of family practice residents and faculty in the treatment of hypertension. Methods: Charts from two time periods were reviewed for a diagnosis of hypertension-January and February 1997 when drug samples were available and January and February 1998 when sample distribution was prohibited. Progress notes were assessed for medication prescribed, patient age, and doctor seen. Prescribed antihypertensive medications were defined as first- or second-line drugs based on the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). Comparisons were made between the two time periods and between faculty and residents. Results: Overall, faculty were much less likely than residents to prescribe first-line medications: 43% versus 57%. Following prohibition of sample distribution, there was an increase in first-line antihypertensive use from 38% to 61%. Conclusions: The prescription of first-line drugs for the treatment of hypertension increased after drug sample distribution was prohibited. Studies are needed to determine the extent to which drug sample availability affects prescription practices.
(Fam Med 2002;34(10):729-31.)
Background and Objectives: Resident support groups are not universally accepted nor without controversy. Existing descriptive studies suggest the need for better evaluation methods. This study tests a quantitative method for assessing resident support groups using a standardized questionnaire to evaluate changes occurring during support group participation. Methods: The Group Environment Scale (GES) was used to quantitatively assess premeasures and postmeasures of group functioning for two combined support groups. Results: After analyzing the combined group's premeasures and postmeasures on 10 GES subscales, paired t tests revealed "expressiveness," "self discovery," and "anger and aggression" significantly increased, while "order and organization" decreased. The GES profile suggests that these intern support groups significantly promoted expression of feelings, self disclosure, and self-reflection about personal and professional problems and tolerance of anger in an environment that becomes significantly less formal and structured with strong leader support but low leader control. Conclusions: The GES is a useful tool for assessing intern support groups. This pilot study provides a quantitative baseline assessment of intern support groups for future comparisons.
(Fam Med 2002;34(10):732-7.)
Background and Objectives: We designed an interactive peer review process for our inpatient family practice residents using a faculty-facilitated group format. This paper describes and evaluates the method. Methods: During inpatient rotations, first-year residents evaluate second- and third-year residents, second-year residents evaluate first- and third-year residents, and third-year residents evaluate first- and second-year residents. Evaluations are conducted in discussion format, led by a faculty facilitator. Results are shared with the resident being evaluated. We surveyed residents and faculty regarding the usefulness of this review method and their comfort with the process using a 15-question survey. Results: A total of 90% of residents and 100% of faculty responded to the survey; 82% of residents and 100% of faculty felt that the peer-review process was useful. All faculty felt that peer comments correlated well with their own impressions of resident performance. Only 4% of residents felt uncomfortable knowing that peers were evaluating their performance, and 93% of residents and 100% of faculty felt that the peer-review process had supported the team environment. Conclusions: Interactive peer review is an excellent tool to obtain timely, specific, and useful information regarding resident performance and has been well accepted in our program.
(Fam Med 2002;34(10):738-43.)
Background and Objectives: Family medicine preceptorships are crucial to educating future physicians, but there is a lack of research on how well preceptors are following the principles of primary care. This study used the Primary Care Assessment Tool (PCAT)-Provider Edition to determine how well medical preceptors provide quality medical care. Methods: A total of 134 family medicine preceptors in the Maritime provinces of Canada answered questions about their practice behaviors, along with background information about themselves, their practice, and their practice population. Results: The highest scores were for "coordination: integration of care," and the lowest were for "cultural competence." PCAT scores improved with the number of patients seen weekly. Scores for first contact accessibility were higher for females and for those with 11-20 years experience as a preceptor, who saw more patients weekly, and in urban centers. "Longitudinality: relationship" scores were higher among those with at least 11 years of practice experience and who saw more patients weekly. "Community orientation" scores were higher for preceptors who saw more patients weekly and accepted new patients. "Cultural competence" scores were higher for preceptors with a culturally diverse practice population and who accepted new patients. "Coordination: integration of care" scores were higher among rural practices. "Coordination: medical records continuity" scores were higher in practices with less than 5 years' experience. Conclusions: Maritime preceptors report providing quality primary care, and the PCAT can be used to benchmark the quality of primary care provided by preceptors.
(Fam Med 2002;34(10):744-9.)CLINICAL RESEARCH AND METHODS
Background and Objectives: This study investigated the relationship between patient satisfaction and physicians' scores on a test of emotional intelligence. Methods: Faculty and resident physicians at a southern medical school completed the Bar-On Emotional Quotient Inventory (EQi). Patient subjects were recruited at the conclusion of an office visit and completed a patient satisfaction survey. Spearman rank order correlations and t tests were used to examine the relationship between global, composite, and subscale scores on the EQi and patient satisfaction. Race, gender, and resident/faculty status were compared via t tests. Results: When patient satisfaction scores were used to dichotomize physicians into two groups, those with 100% satisfied patients and those with less than 100% satisfaction, only one subscale of EQi, "happiness," was related to higher satisfaction. Conclusions: Findings suggest a limited relationship between physicians' scores on a test of emotional intelligence and patient satisfaction. Implications for physician training programs are offered in light of recent focus on physician-patient communication in medical education. Application of emotional intelligence concepts to physician skills and patient attitudes needs further research that may lead to further educational opportunities.
(Fam Med 2002;34(10):750-4.)FACULTY DEVELOPMENT
Background and Objectives: Faculty development has been an important part of academic family medicine for 3 decades. However, few studies examine the effectiveness of various faculty development delivery methods. With little quantitative data from the literature with which to recommend future directions, this study examined key stakeholders' perceptions. Methods: A total of 127 family medicine faculty participated in 14 different focus groups. Department chairs, full-time and part-time faculty, and volunteer preceptors responded to seven questions about delivery methods. Results: Discussants emphasized that future faculty development methods must be proven effective, woven into the fabric of clinical practice, and deal with increasing time and financial pressures. Much discussion was related to the need for national and regional strategies allowing for emphasis on outcome evaluation, flexibility, and access. Web-based delivery methods and preceptor needs were emphasized. Conclusions: Study participants called for a more rigorous evidence-based approach to faculty development. A more systematic and stable approach could include the establishment of new federal criteria for funding projects that address different levels of development and implementation. For example, one set of review criteria would be applicable to systematic case-control studies of new interventions while another set would relate to dissemination studies of proven methodologies.
(Fam Med 2002;34(10):755-60.)INTERNATIONAL FAMILY MEDICINE
Background and Objectives: While many resources have been invested in sending Japanese physicians for advanced training in family medicine abroad, no known research examines the nature of their experiences. The purpose of this research was to investigate the impact of family medicine faculty development training abroad on participating Japanese physicians. Methods: We distributed a self-administered, semi-structured questionnaire to physicians identified as having completed a faculty development program abroad. Results: Sixteen (response rate 94%) physicians participated. The participants' a priori goals included learning about family medicine and developing teaching skills. From observing precepting and small-group discussions, they learned new teaching approaches. Most reported their fellowship training as influencing current teaching, clinical, and research activities and as particularly enhancing their interest in clinical skills, learner-oriented teaching, and the doctor-patient relationship. They also reported formulating new ideas regarding teaching activities, department structure, and clinical care during their fellowships, though they have encountered barriers to implementing such reforms after returning to Japan. Conclusions: Faculty development training abroad contributes to all major aspects of physicians' professional lives after returning to Japan, although many report difficulties implementing new teaching ideas after their return.
(Fam Med 2002;34(10):761-5.)DEPARTMENTS
Innovations in Family Medicine Education
Doctor-Patient Communications: Using Concept Cards to Instruct
Scott S. Meit, PsyD
Less teaching time is available for many faculty, so innovation is needed if educators are to properly serve doctors in training and their patients. In this context, an offer of 1 hour to teach doctor-patient communications generated a simple yet effective teaching method-"concept cards." More than 100 third-year medical students have participated in an exercise where concept cards convey knowledge relevant to the practice of ambulatory primary care medicine. Student ratings establish the utility of the teaching method. Even in an hour, teaching designed for the adult learner can engage medical students and have a positive impact on learning.
(Fam Med 2002;34(10):721-3.)