| ABSTRACTS Special
Articles: Pharmacists in Family Practice Residency ProgramsThe
State of Clinical Pharmacy Practice in Family Practice Residency Programs
LM
Dickerson, AM Denham, T Lynch Background:
Clinical pharmacists have been involved with family practice residencies for more
than 20 years. This survey was designed to evaluate the current state of clinical
pharmacy services in the family practice residency program (FPRP) in the United
States. Methods: All FPRPs were contacted to identify clinical pharmacists involved
with their programs. These pharmacists were directed to a password-protected Web
address where the survey was posted. Completed surveys were submitted on-line,
and data were retrieved for analysis. Results: Of the 579 residencies, 155 (26.7%)
acknowledged 174 clinical pharmacists working within their program. Responses
were received by 130 of the pharmacists (74.7% response rate). These pharmacists
held academic appointments in both their institution’s school of pharmacy (80%)
and the school of medicine (53.2%). The mean age of the respondents was 36.5 ±
8.2 years, and the mean salary was $66,000 (range $46,000–$125,000). A majority
of the pharmacists received their funding from a single source, and 32.2% received
full salary support from the FPRP. The respondents spent more than half of their
time with the residency program. Overall, their time was divided into teaching
responsibilities (42.7%), patient care activities (37.1%), research (12.1%), administrative
functions (11.8%), and drug distribution (<5%). Conclusions: Pharmacists are actively
involved in 26.7% of FPRPs. This survey demonstrates increased salary support
from the FPRP in comparison to past surveys. Additionally, more pharmacists hold
academic appointments within schools of medicine. (Fam
Med 2002;34(9):653-7.) The
Clinical Pharmacists As a Preceptor in a Family Practice Residency Training Program
AZ Ables, OL Baughman IIIBackground:
According to a recent survey, 27% of 579 family practice residency programs in
the United States employ a full-time clinical pharmacist. The majority of pharmacists’
time is spent teaching, usually at the point of care either on inpatient rounds
or precepting in the outpatient clinic. This paper describes the precepting activity
of a full-time clinical pharmacist in a community-based family practice residency
training program. Methods: A computer program written in Microsoft Access® captured
the following data on each pharmacist-physician encounter: date, time, requestor,
topic, therapeutic category, type of question, summary of question and answer,
resources used to answer the question, and time spent answering the question.
The database was updated daily to include all encounters. Results: Between February
1, 1999, and January 31, 2001, we documented 2,260 precepting encounters. Almost
half of the questions related to general pharmacotherapeutic management of chronic
or acute diseases. The most common therapeutic categories encompassed cardiovascular,
psychiatric, infectious disease, and neurologic disorders. Seventy-six percent
of questions were answered using clinical knowledge and experience, while 24%
were based on published resources. Conclusions: Based on more than 2,000 precepting
encounters between a faculty pharmacist and family practice residents, most encounters
represented requests by residents for information on general drug management of
diseases. The pharmacist answered most questions based on clinical knowledge and
experience. Evaluations of the pharmacist by the residents indicated that she
is an effective teacher and useful in helping take care of patients. (Fam
Med 2002;34(9):658-62.) Residency
EducationAccounting
for Graduate Medical Education Funding in Family Practice Training
FM chen, RL Phillips Jr, R Schneeweiss, CHA Andrilla, LG Hart, GE Fryer
Jr, S Casey, RA RosenblattBackground
and Objectives: Medicare provides the majority of funding to support graduate
medical education (GME). Following the flow of these funds from hospitals to training
programs is an important step in accounting for GME funding. Methods: Using a
national survey of 453 family practice residency programs and Medicare hospital
cost reports, we assessed residency programs’ knowledge of their federal GME funding
and compared their responses with the actual amounts paid to the sponsoring hospitals
by Medicare. Results: A total of 328 (72%) programs responded; 168 programs (51%)
reported that they did not know how much federal GME funding they received. Programs
that were the only residency in the hospital (61% versus 36%) and those that were
community hospital-based programs (53% versus 22%) were more likely to know their
GME allocation. Programs in hospitals with other residencies received less of
their designated direct medical education payment than programs that were the
only residency in the sponsoring hospital (-45% versus +19%). Conclusions: More
than half of family practice training programs do not know how much GME they receive.
These findings call for improved accountability in the use of Medicare payments
that are designated for medical education. (Fam
Med 2002;34(9):663-8.) The
Accelerated Residency Program: The Marshall University Family Practice 9-Year
Experience
SM Petrany, R CrespoBackground:
In 1989, the American Board of Family Practice (ABFP) approved the first of 12
accelerated residency programs in family practice. These experimental programs
provide a 1-year experience for select medical students that combines the requirements
of the fourth year of medical school with those of the first year of residency,
reducing the total training time by 1 year. This paper reports on the achievements
and limitations of the Marshall University accelerated residency program over
a 9-year period that began in 1992. Methods: Several parameters have been monitored
since the inception of the accelerated program and provide the basis for comparison
of accelerated and traditional residents. These include initial resident characteristics,
performance outcomes, and practice choices. Results: A total of 16 students were
accepted into the accelerated track from 1992 through 1998. During the same time
period, 44 residents entered the traditional residency program. Accelerated residents
tended to be older and had more career experience than their traditional counterparts.
As a group, the accelerated residents scored an average of 30 points higher on
the final in-training exams provided by the ABFP. All residents in both groups
remained at Marshall to complete the full residency training experience, and all
those who have taken the ABFP certifying exam have passed. Accelerated residents
were more likely to practice in West Virginia, consistent with one of the initial
goals for the program. In addition, accelerated residents were more likely to
be elected chief resident and choose an academic career than those in the traditional
group. Both groups opted for small town or rural practice equally. Conclusions:
The Marshall University family practice 9-year experience with the accelerated
residency track demonstrates that for carefully selected candidates, the program
can provide an overall shortened path to board certification and attract students
who excel academically and have high leadership potential. Reports from other
accelerated programs are needed to fully assess the outcomes of this experiment
in postgraduate medical education. (Fam
Med 2002;34(9):669-72.) Medical
Student EducationEffect
of Generalist Preceptor Specialty in a Third-year Clerkship on Career Choice
JD Gazewood, J Owen LK RollinsBackground
and Objectives: An association exists between student participation in a family
medicine clerkship and student selection of family practice as a career. The effect
of student exposure to other generalist specialties on career choice is unknown.
This study determined if the specialty of an assigned generalist preceptor during
a third-year ambulatory clerkship affected medical students’ choice of a generalist
career. Methods: We conducted a retrospective cohort study of 464 medical students
who were randomly assigned to either a family physician or a general internist
for a 4-week, third-year ambulatory clerkship. Results: There was no significant
relationship between preceptor assignment and students’ generalist career choice.
Students assigned to general internal medicine preceptors were not more likely
to choose careers in general internal medicine, nor were students assigned to
family medicine preceptors more likely to select careers in family practice. Conclusions:
Previous studies have suggested that generalist experiences during medical school
can influence students’ career preference. This study, however, indicates that
the type of generalist experience received during the third year did not affect
students’ choice of a generalist career, nor did it influence their career choice
between the generalist specialties. (Fam
Med 2002;34(9):673-7.) Faculty
Development What
Does It Mean to Build Research Capacity?
NAPCRG Committee
on Building Research Capacity and the Academic Family Medicine Organizations REaserach
SubcommitteeThe
family of family medicine organizations has identified clinical and practice-based
research as a high priority for our specialty. This is based on the vision that
all family physicians have a role in the generation and application of new knowledge
to improve the health of individuals, families, and communities. This goal can
only be achieved by increasing the number of trained and experienced family medicine
researchers and enhancing the value of research to practicing family physicians,
their patients, and the public. To meet this goal, the Committee on Building Research
Capacity of the North American Primary Care Research Group and representatives
from all of the Academic Family Medicine Organizations groups developed a strategic
plan. The plan focuses on the training, funding, infrastructure, and linkages
required to develop new family physician researchers and to change the culture
of family medicine to accept research as integral to our specialty. In addition,
the plan acknowledges the need to enhance the reputation of family medicine research
and increase family medicine research publications by assuring that we ask the
right questions. (Fam
Med 2002;34(9):678-84.) Medical
Infomatics A
<edoca; Omfpr,atocs Cirroci;i, fpr 21st-century Family Practice Residencies
CJ Zelzink, DAF NelsonMedical
informatics1 includes many processes Background and Objectives: An informatics
curriculum was developed by integrating evidence-based medicine, communication
and behavioral sciences, patient education, and computer skills. Introduction
of an electronic medical record (EMR) to our family practice center was a focal
point of this training. Our objective was to measure whether the new curriculum
improved our residents’ informatics skills and computer knowledge. Methods: Before
and after institution of the curriculum, residents’ self-rated skills and attitudes
were measured with a questionnaire. They also took an objective test of informatics
skills after the curriculum was implemented, and their scores were compared to
scores from five other control residencies that did not use the curriculum. Results:
The curriculum, including use of the electronic record, was successfully implemented
and tested. The curriculum improved residents’ self-ratings of informatics knowledge
and computer skills, but the objective test did not show a significant difference
between programs. Conclusions: After implementation of a medical informatics curriculum,
residents self-reported an improvement in computer and informatics skills. The
objective measurement of knowledge did not demonstrate the benefit of our curriculum
compared to other programs. (Fam
Med 2002;34(9):685-91.) |
