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ABSTRACTS
Special
Articles: Pharmacists in Family Practice Residency Programs
The
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 III
Background:
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
Education
Accounting
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 Rosenblatt
Background
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 Crespo
Background:
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 Education
Effect
of Generalist Preceptor Specialty in a Third-year Clerkship
on Career Choice
JD Gazewood, J Owen LK Rollins
Background
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 Association of Family Medicine Organizations
REaserach Subcommittee
The
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 Nelson
Medical
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.)
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