January 2003, Vol. 35, No. 1

Geriatric Medicine Training for Family Practice Residents in the 21st Century: A Report From the Residency Assistance Program/Hartford Geriatrics Initiative
Gregg Warshaw, MD; John Murphy, MD; James Buehler, MD; Stacy Singleton

Increasing the quality and quantity of geriatric medicine training for family practice residents is a particular challenge for community-based programs. With support from the John A. Hartford Foundation of New York City, the American Academy of Family Physicians (AAFP) implemented in 1995 a multi-part project to improve the amount and quality of geriatric medicine education received by family practice
residents. This report summarizes the initial results of the regional geriatric medicine curriculum retreats for residency directors. The goals of the retreats were to build recognition among the residency directors of the skills that future family physicians will require to be successful providers of primary care to older adults and to allow the residency directors to identify and develop solutions to barriers to improving
geriatric medicine training for residents. Forty-six program directors participated in the three retreats between February 2000 and February 2001. The participants represented 52 programs and rural tracks in all geographic regions, small and large programs, and urban and rural settings. The program directors developed a consensus on the geriatric medicine knowledge, skills, and attitudes that should be expected of all family practice residency graduates; developed a list of basic, required educational resources for each family practice residency program; and proposed solutions to common obstacles to successful curriculum development.

(Fam Med 2003;35(1):24-9.)

Geriatrics in Family Practice Residency Education: An Unmet Challenge
John D. Gazewood, MD, MSPH; Bruce Vanderhoff, MD;
Richard Ackermann, MD; Ch arles Cefalu, MD, MS

The aging of the US population poses one of the greatest future challenges for family practice residency graduates. At a time when our discipline should be strengthening geriatric education to address the needs of our aging population, the Group on Geriatric Education of the Society of Teachers of Family Medicine believes that recent guidelines from important family medicine organizations suggest that our discipline’s interest in geriatric education may be waning. Barriers to improving geriatric education in family practice residencies include limited geriatric faculty, changes in geriatric fellowship training, competing curricular demands, and limited diversity of geriatric training sites. Improving geriatric education in family practice residencies will require greater emphasis on faculty development and integration of geriatric principles throughout family practice residency education. The Residency Review Committee for Family
Practice should review the Program Requirements for Residency Education to ensure that geriatric training requirements are consistent with current educational needs. The leadership of family medicine organizations should collaboratively address the need for continued improvement in training our residents to care for older patients and the chronically ill.

(Fam Med 2003;35(1):30-4.)

A National Survey on the Current Status of Family Practice Residency Education in Geriatric Medicine
Ina Li, MD; Christine Arenson, MD; Gregg Warshaw, MD; Elizabeth Bragg, PhD, RN;
Ruth Shaull, MSN, RN; Steven R. Counsell, MD

Background and Objectives: The dramatic increase in the elderly population expected over the next few decades will place a heavy strain on the current health care system. Family practice residents need to be prepared to take care of this geriatric population. In this study, we document the past, current, and future trends of geriatric education in family practice residency programs. Methods: A survey was mailed to all family practice residency directors in the United States (n=471). Results: The response rate was 75%. Ninety-two percent of family practice residencies have a required geriatrics curriculum. Nursing homes, assisted living facilities, and home care are the predominant training sites for geriatrics. Training is most often offered in a longitudinal format. The mean number of physician faculty available to teach geriatrics is 2.6 per program (.83 full-time equivalent). Conflicting time demands with other curricula was ranked as the most significant barrier to geriatric education. Directors rated geriatrics as one of the three most important curriculum topics. Conclusions: Faculty development to enhance the number of faculty who can teach geriatrics and broadening the exposure of residents to the elderly in a variety of settings will be important to ensure that future generations of family physicians are adequately equipped to care for the geriatric population.

(Fam Med 2003;35(1):35-41.)

Family Medicine Training in the Care of Older Adults—Has the Retreat Been Sounded?
Charles P. Mouton, MD, MS; Robert W. Parker, MD

The population of adults ages 65 or older in the United States has steadily increased over the last several decades. This population has grown from 3.1 million in 1900 (4.1% of the total population) to 35 million in 2000 (12.4% of the total population), with estimates showing an increase to 70 million by 2030 (20.6% of the population). Of particular interest to the specialty of family practice, 25% of office visits to family physicians were made by adults ages 65 or older; projections show that by 2020, 30% of office visits to family physicians and 60% of family practice hospitalizations will consist of these older adults. In addition, with Medicare payments accounting for 26.7% of all physician income, knowing how to care for older adults is an essential skill for family practice survival. Despite these statistics, a consistent cry across the landscape of family practice training has been“How do we (and in some cases, should we) appropriately train our residents in geriatrics?” It has been argued that geriatrics is an integral part of family practice training. The trend in family practice training, however, and in particular the trend

(Fam Med 2003;35(1):42-4.)

Integrating Population Health Into a Family Medicine Clerkship: 7 Years of Evolution
Mark Unverzagt, MD; Nina Wallerstein, DrPH; Jeffrey A. Benson, MD, MPH; Angelo Tomedi, MD; Toby B. Palley, MD

A population health curriculum using methodologies from community-oriented primary care (COPC) was developed in 1994 as part of a required third-year family medicine clerkship at the University of New Mexico. The curriculum integrates population health/community medicine projects and problem-based tutorials into a community-based, ambulatory clinical experience. By combining a required population health experience with relevant clinical training, student careers have the opportunity to be influenced during the critical third year. Results over a 7-year period describe a three-phase evolution of the curriculum, within the context of changes in medical education and in health care delivery systems in that same period of time. Early evaluation revealed that students viewed the curricular experience as time consuming and peripheral to their training. Later comments on the revised curriculum showed a higher regard for the experience that was described as important for student learning.

(Fam Med 2002;34(10):45-51.)

Behavioral Risks Associated With Tattooing
Mark B. Stephens, MD, MS

Background and Objectives: Tattoos are an increasingly prevalent form of self-expression, especially for adolescents. This study was conducted to determine health-risk behaviors associated with tattoos in young men and women entering military service. Methods: We surveyed a cohort of 550 military recruits using a modification of the Youth Risk Behavioral Survey (YRBS), a validated instrument used to assess health risk behaviors in adolescents. All individuals entering basic training in the US Marine Corps or the US Air Force from June through September 1999 were eligible to participate. The primary outcome variables of interest were tobacco use, alcohol use, seatbelt use, suicidal behaviors, depression, and physical violence. Results: The survey response rate was 91% (n=499 of 550). Overall, 27% of respondents had tattoos (n=125) when entering military service. Women entering military service were more likely to have a tattoo than men. Controlling for age and gender, individuals with tattoos were more likely to smoke, drink heavily, use smokeless tobacco, and ride in a vehicle with someone who had been drinking than non-tattooed individuals. Conclusions: In a population of military recruits, tattoos were associated with predictable adverse health-risk behaviors. This represents an important opportunity for targeted preventive counseling.

(Fam Med 2003;35(1):52-4.)

Introducing Personal Digital Assistants to Family Physician Teachers
David Topps, MB, ChB; Roger Thomas, MD; Rodney Crutcher, MD

Background and Objectives: In our previous projects, students and residents have readily adopted personal digital assistants (PDAs), but faculty have generally been reluctant. The objective of the project reported here was to maximize adoption of PDAs by our faculty, using a combination of strategies. Methods: Through cost-shared funding, we provided full-time and community teachers with PocketPCs or Handspring Visors, along with preinstalled medical software. Use patterns and satisfaction were assessed by structured questionnaire and focus group discussions. Results: For the calendar, address book, and pharmacopoeia, we found that 83% of faculty use these two to three times per day. Cost sharing and software preinstallation were popular. Device synchronization and e-mail showed potential but caused problems. Easy access to technical support from peers and a variety of information-sharing structureseased maintenance issues. Point-of-care data access was important to faculty. Conclusions: With the right support structures, faculty adopt PDAs in clinical and teaching settings.

(Fam Med 2003;35(1):55-9.)

Cervical Cancer Rates and the Supply of Primary Care Physicians in Florida
Robert J. Campbell, MD; Arnold M. Ramirez, MD; Kimberly Perez; Richard G. Roetzheim, MD, MSPH

Background and Objectives: This study’s aim was to determine if an increased supply of primary care physicians is associated with lower incidence and mortality rates for cervical cancer. Methods: We determined cervical cancer incidence and mortality rates for each of Florida’s 67 counties over the 3-year period of 1993–1995 using data from Florida’s population-based tumor registry. Data on physician supply were obtained from the 1994 American Medical Association Physician Masterfile. We used multiple linear regression analysis to examine the relationship between physician supply and cervical cancer incidence and mortality rates, adjusting for other county-level characteristics. Results: In regression analysis that adjusted for other county-level characteristics, each increase in the supply of family physicians of one physician/10,000 persons was associated with a corresponding drop in the incidence rate of 1.5 cases/100,000 persons and a corresponding drop in mortality rate of .65 cases/100,000 persons. Conclusions: Our results indicate that a greater supply of primary care physicians is likely associated with a lower incidence of cervical cancer and a lower cervical cancer mortality rate. More studies are needed at the individual patient level to confirm this association.

(Fam Med 2003;35(1):60-4.)

The Summer Assistantship in Patient Education: A Preclinical Preceptorship
Jesse Crosson, PhD; Caryl J. Heaton, DO; Linda Boyd, DO

Objectives: The Summer Assistantship in Patient Education was developed to teach principles and techniques of brief preventive health counseling and patient education to medical students who have finished their first year. Description: Students complete an intensive training program and are then placed in family practice settings to educate and counsel patients full-time for 5 to 7 weeks. Evaluation: Students evaluated the program after completion each year. A survey of participants was conducted in fall 2000. Conclusions: Participants gained valuable experience with patient education and counseling techniques and a favorable experience in a family practice setting; many entered family practice residency training.

(Fam Med 2003;35(1):15-7.)