From dreamers to doers: Navigating the doctoral journey in family medicine and primary care.

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Pietrzykowska M, Nowicka-Sauer K, Siebert J. Respiratory tract infections in primary health care: prevalence and antibiotic prescribing in a primary care practice during one year. Family Medicine & Primary Care Review. 2021;23(2):203-208. doi:10.5114/fmpcr.2021.105924. APA Pietrzykowska, M., Nowicka-Sauer, K., & Siebert, J. (2021). Respiratory tract infections in primary health care: prevalence and antibiotic prescribing in a primary care practice during one year. Family Medicine & Primary Care Review, 23(2), 203-208. https://doi.org/10.5114/fmpcr.2021.105924 Chicago Pietrzykowska, Małgorzata, Katarzyna Nowicka-Sauer, and Janusz Siebert. 2021. "Respiratory tract infections in primary health care: prevalence and antibiotic prescribing in a primary care practice during one year". Family Medicine & Primary Care Review 23 (2): 203-208. doi:10.5114/fmpcr.2021.105924. Harvard Pietrzykowska, M., Nowicka-Sauer, K., and Siebert, J. (2021). Respiratory tract infections in primary health care: prevalence and antibiotic prescribing in a primary care practice during one year. Family Medicine & Primary Care Review, 23(2), pp.203-208. https://doi.org/10.5114/fmpcr.2021.105924 MLA Pietrzykowska, Małgorzata et al. "Respiratory tract infections in primary health care: prevalence and antibiotic prescribing in a primary care practice during one year." Family Medicine & Primary Care Review, vol. 23, no. 2, 2021, pp. 203-208. doi:10.5114/fmpcr.2021.105924. Vancouver Pietrzykowska M, Nowicka-Sauer K, Siebert J. Respiratory tract infections in primary health care: prevalence and antibiotic prescribing in a primary care practice during one year. Family Medicine & Primary Care Review. 2021;23(2):203-208. doi:10.5114/fmpcr.2021.105924.

Thamer Kadum Al Hilfi: looking ahead to a healthier Iraq

Family medicine (also known as general practice or primary health care) has undergone substantial growth accompanied by academic development in Western countries during recent years. In Europe, however, the situation is not uniform: although in Northern European countries family medicine is established in both the national health system (NHS) and the universities, and academic general practice looks promising in post-Communist Eastern European countries, in Southern European counterparts it is still considered a minor medical discipline. Even within Southern Europe the pattern of family medicine is not homogeneous, because several countries such as Croatia, Portugal, and Greece do include some academic curricula in family medicine. Yet this is not the case in Italy, where general practice is completely devoid of any academic features. In fact, Italian universities have no primary care departments at all, and general practice is not even included in the undergraduate curriculum of Italian medical schools. Only private foundations conduct primary care research in Italy. Italian GPs do not have the opportunity to pursue a PhD programme in family medicine, nor …

At the beginning of the 1990s, the situation was favourable for making changes in the Estonian health care system. Innovation was supported by physicians, patients, politicians, health care managers and the academic society. The most profound improvements were planned in the field of primary health care. Up to the 1990s, there was no specific training for and specialty of family doctor/general practitioner in the field of primary care. The primary health care system based on family physicians/general practitioners had existed for more than twenty years in several Western Europe countries and its efficiency for providing health care for the population had been proven. Countries with strong primary care provide high-level, cost-effective and prevention-orientated services for patients. The implementation of the family medicine system in Estonia was the result of different stakeholders’ cooperation. Initially, international experts were invited to provide specific training, especially Finnish colleagues from the Universities of Tampere and Turku. Professor Mauri Isokoski was later elected Honorary Doctor of the University of Tartu for support and cooperation in the field of family medicine. Academic lecturers and family doctors were sent to courses of family medicine in the Nordic countries, United Kingdom, Canada and elsewhere. In 1991 a specialised course for family doctors was launched. Previous district doctors and paediatricians were the first trainees. They were interested in reorganising their work to provide comprehensive care to patients. Training was conducted by the Department of Family Medicine in cooperation with other specialties. Family doctors who had been retrained step-by-step started teaching and they were the first supervisors of residency training in family medicine. The Estonian Society of Family Doctors was established. In 1992 the Department of Family Medicine in the Faculty of Medicine, University of Tartu was opened, including a professorship in family medicine. Family medicine was included in the basic programme of students in the medical faculty. Residency training in family medicine was organized according to European Union standards. Research in family medicine started; a PhD programme in family medicine was launched. During following decades, 15 PhD theses were prepared and defended. Family medicine in Estonia was recognized as an academic specialty. In 1993 the specialty of family medicine was included into the list of specialties in Estonia. It means that family doctor is a specialty with specific training, evidence and research-based practice in Estonia, equal with other medical specialties. The Estonian Health Project conducted by the Estonian Ministry of Social Affairs supported the development of instruction in family medicine, the training of family medicine lecturers abroad, and replacement of office equipment and the creation of a legal environment suitable for family medicine. In 1997 a regulation of the Estonian Ministry of Social Affairs was issued to control the implementation of patient lists, financing from the Health Insurance Fund, and specifying the job description of family doctors. In 2002 all those principles were included in the Health Services Organisation Act. Follow-up surveys of patients’ satisfaction with the family doctors’ system showed that patients were mostly satisfied and usually got help for their problems at family doctors’ offices. International cooperation within the World Health Organization, EURACT, WONCA, World Bank and other working groups allows to share Estonian experiences of developing family medicine as well as to learn from other countries. Implementing family medicine in the Estonian health care system was successful thanks to cooperation between physicians, the University of Tartu, Ministry of Social Affairs, local government institutions and patients.

To the Editor: We read your editorial from the May 2008 issue of Academic Medicine with great interest. We agree that it is time to look again at what premedical requirements are needed to attract the most appropriate students for a career in medicine. As family medicine teachers of medical students, we are concerned that the current premedical requirements particularly discourage students who may choose primary care as a career. We struggle with the declining interest in primary care, especially family medicine, every day. We feel that, given the importance of primary care for any health system,1 the declining numbers of primary care physicians represent a real crisis in health care. There are many areas, particularly in rural America, that have poor access to health care. Family physicians provide not only an invaluable service in underserved areas but also the most service compared with that given by other primary care specialists.2 In fact, family medicine physicians are currently the most-recruited physicians in the country. Students who are often attracted to family medicine are older, from rural areas, and come from a lower socioeconomic status,3 but in some schools, admission requirements that may be disadvantageous to these students exacerbate the lack of primary care interest. Also, bright, creative, and humanistic students, whether or not they aced organic chemistry,4 should be especially encouraged to apply to medical school, where, hopefully, they will choose primary care careers. We appreciate your bringing forward the discussion of medical school admission criteria, but we feel strongly that we need to expand the discussion to talk about how to recruit and what incentives medical schools can give to premedical students who are more likely to go into primary care and family medicine. Katherine Margo, MD Past chair, Group on Predoctoral Education (GPE) of the Society of Teachers of Family Medicine (STFM), and director of student programs, Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, 2 Gates/3400 Spruce St., Philadelphia, PA 19104; ([email protected]). Chantal Brazeau, MD Chair, GPE/STFM, associate professor of psychiatry and family medicine, and director of predoctoral education, Department of Family Medicine, UMDNJ–New Jersey Medical School, Newark, NJ. Christine Jerpbak, MD Chair Elect, GPE/STFM, and director of predoctoral education, Department of Family and Community Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA.

India has one of the most unequal healthcare systems globally, lagging behind its economic development. Improved primary care and primary health care play an integral role in overcoming health disparities. Family medicine is a subset of primary care—delivered by family physicians, characterized by comprehensive, continuous, coordinated, collaborative, personal, family and community-oriented services—and may be able to fill these gaps. This research aims to understand the potential mechanisms by which family physicians can strengthen primary health care. In this qualitative descriptive study, we interviewed twenty family physicians, identified by purposeful and snowball sampling, who are among the first family physicians in India who received accredited certification in FM and were identified as pioneers of family medicine. We used the Contribution of Family Medicine to Strengthening Primary Health Care Framework to understand the potential mechanisms by which family medicine strengthens primary health care. Iterative inductive techniques were used for analysis. This research identifies multiple ways family physicians can strengthen primary health care in India. They are skilled primary care providers and support mid and low-level health care providers’ ongoing training and capacity building. They develop relationships with specialists, ensure appropriate referral systems are in place, and, when necessary, work with governments and organizations to access the essential resources needed to deliver care. They motivate the workforce and change how care is delivered by ensuring providers’ skills match the needs of communities and engage communities as partners in healthcare delivery. These findings highlight multiple mechanisms by which family physicians strengthen primary health care. Investments in postgraduate training in family medicine and integrating family physicians into the primary care sector, particularly the public sector, could address health disparities.

Breast Cancer Risk Assessment and Chemoprevention: Results of a Survey

Editorial

Changing the health care workforce: lessons from foundation-sponsored programs.

Problem: Laboratory medicine, medical-biochemical diagnosis in primary health care is much represented. By organization of family medicine medical-biochemical diagnosis is defined as a branch of diagnostic services in primary health care. For these actions is necessary in the morning prior to admission of users and their demands that all jobs are properly prepared. On previous day should be provided and prepared: accessories, reagents and machines. Morning daily routine work of preceding control and calibration equipment, methods and process quality control of work in the laboratory. Only after the fulfillment of the procedures followed overview of search control of samples. After validating the results of daily quality control and after they met the criteria can be analytically examined samples from users. These procedures are not sufficiently familiar to users and doctors, for that are very often necessary the direct telephone communication between them. To make the results of laboratory tests needed are huge material resources. This is evident in the economic analysis where laboratory tests are valued with a score of: search by type and material resources expended for analytical examination. These technical and financial performances of laboratory medicine are not appropriately classified as blatant as that in other industries, technology and other primary health care (PHC) and family medicine (FM). Goal: The overall objective of the research is to define a model of efficiency (or effectiveness) of medical-biochemical diagnosis for users with the requirements of units of family medicine (FM), in a representative sample of patients in the unit for the laboratory diagnosis of the Primary Health Care Center Gracanica. Confirm what is the usefulness of the application of laboratory diagnosis in family medicine. Determine the frequency of the need for laboratory tests in the therapeutic treatment of major diseases. Evaluate the need for using laboratory diagnostics to try to prevent major diseases. Material and methods: The study included a total of 1000 respondents. All subjects were users of primary health care in Primary Health Care Center Gracanica (Tuzla Canton) in primary health care units have received requests for laboratory diagnosis. This paper is an analysis of the representation requirements for the laboratory diagnosis by doctors in primary health care and the most frequent diseases in primary care. An analysis is made of laboratory test results, based on requests for laboratory diagnosis by doctors and illnesses in primary care. Made is analysis of the presence of normal and pathological laboratory test results from the request for the laboratory diagnosis by doctors in primary health care. Made is an analysis of the most common laboratory tests requests, and based on requests for laboratory diagnosis by doctors in primary health care and the most frequent diseases in primary health care. Incorporated is the economic analysis of labor

The United States is facing a severe shortage of physicians providing access at the front lines of care access. Specialties with provider shortages include general medicine, family medicine, and other fields providing longitudinal primary and comprehensive care.1,2 In fact, because nearly one-half of visits to subspecialists actually involve primary and general medical care services,3,4 the insufficient supply of front-line physicians to meet patient care demands may be even more extreme than current projections suggest. Despite this impending crisis, student and resident interest in these front-line longitudinal care fields has been stagnant at best in recent years and has declined drastically during the past 2 decades.5,6 For example, in 2012, only 6% of graduating medical students planned careers in family medicine.6 Additional data suggest only 2% of graduating medical students plan to practice general or primary care internal medicine,7 and only 1 in 5 internal medicine residents plans a career in general medicine after graduation.8

PurposeThe purpose of this study is to explore which insights the hero’s journey framework provides to the micro-level perspective of the process a project manager goes through in a project.Design/methodology/approachThe study design involves a longitudinal qualitative case study in which we follow a project manager over the course of two projects. In Canada, the project manager undertook the world’s first hotel rooftop honeybee garden project. Later, he implemented a rooftop honeybee garden at the Waldorf Astoria New York. The stages and archetypes within the hero’s journey framework are used as an analytical grid for analysis.FindingsOur research reveals how the hero’s journey framework can be utilized as a lens to understand the process of a project from the viewpoint of the project manager. The research shows that projects can have comprehensive stages and transform the project managers themselves.Research limitations/implicationsThe research investigates small-scale projects that are peripheral to the core business of the case organizations. A limitation is that the findings may not be applicable for bigger, more complex and core business projects. Another limitation is that the research relies on secondary data only. Two managerial implications: For a project manager to start out on a hero’s journey, triggers that make the project manager respond to “a calling” need to be present. The project manager must be able to deal with different archetypes, whether helpful or harmful, along the process.Originality/valueThe research extends existing knowledge on a project manager’s decisions, obstacles, opportunities, thoughts, emotions and actions through the project process by showing how the hero’s journey framework can be used as a supplement to the well-known metaphor of a project as a temporary organization. Further on, the research demonstrates how an analytical framework can enhance the understanding of the process of a project manager from a micro-level perspective. In addition, the research deals with corporate social responsibility (CSR) related projects that are of high relevance in the contemporary society.

BackgroundThe wars that ravaged the former Socialist Federal Republic of Yugoslavia in the 1990’s resulted in the near destruction of the healthcare system, including education of medical students and the training of specialist physicians. In the latter stages of the war, inspired by Family Medicine programs in countries such as Canada, plans to rebuild a new system founded on a strong primary care model emerged. Over the next fifteen years, the Queen’s University Family Medicine Development Program in Bosnia and Herzegovina played an instrumental role in rebuilding the primary care system through educational initiatives at the undergraduate, residency, Masters, PhD, and continuing professional development levels. Changes were supported by new laws and regulations to insure sustainability. This study revisited Bosnia and Herzegovina (B-H) 8-years after the end of the program to explore the impact of initiatives through understanding the perspectives and experiences of individuals at all levels of the primary care system from students, deans of medical schools, Family Medicine residents, practicing physicians, Health Center Directors and Association Leaders.MethodsQualitative exploratory design using purposeful sampling. Semi-structured interviews and focus groups with key informants were conducted in English or with an interpreter as needed and audiotaped. Transcripts and field notes were analyzed using an interpretative phenomenological approach to identify major themes and subthemes.ResultsOverall, 118 participants were interviewed. Three major themes and 9 subthemes were identified including (1) The Development of Family Medicine Education, (subthemes: establishment of departments of family medicine, undergraduate medical curriculum change), (2) Family Medicine as a Discipline (Family Medicine specialization, academic development, and Family Medicine Associations), and (3) Health Care System Issues (continuity of care, comprehensiveness of care, practice organization and health human resources).ConclusionsDespite the impact of years of war and the challenges of a complex and unstable postwar environment, initiatives introduced by the Queen’s Program succeeded in establishing sustainable changes, allowing Family Medicine in B-H to continue to adapt without abandoning its strong foundations. Despite the success of the program, the undervaluing of Primary Care from a human resource and health finance perspective presents ongoing threats to the system.

OUR TIME IS NOW: AAFP PRESIDENT PLEDGES TO FIGHT FOR RESPECT AND RESOURCES

Community-based education is an important strategy for training students appropriately for delivering primary health care services. A community-based training rotation in Family Medicine and Primary Care was introduced at the University of Stellenbosch, South Africa, in January 1998. The aim of this study was to explore the perceptions of final year medical students about the new rotation and to provide feedback on the value of this experience to the Faculty. In this article we explore the influence of differing world views held by biomedically oriented training institutions and the systems view of life adhered to by the discipline of Family Medicine on attempts to reform medical education. Quantitative and qualitative curriculum evaluation methods, including a questionnaire and focus groups discussions, were used. Students rated the value of the block as 7.8 out of 10. Eighty-eight percent of students felt that there should be an earlier exposure to Family Medicine and Primary Care in their training. The main themes identified from the qualitative results supported the literature findings and included the difference in type of practice between tertiary and primary levels of care and the value of learning a new approach to patient care. Despite the fact that the results emphasized the importance of including community-based training in Family Medicine and Primary Care at an early stage in the medical curriculum, resistance to implementation was encountered. This led to reflection on possible reasons on why the recommendations of the study were not immediately adopted into the curriculum.