Family Medicine Doctors Research Articles

A Cross-Sectional Study about Knowledge, Attitude, and Practices among Primary Health Care Physicians in Jazan Province, Saudi Arabia, Regarding Rome IV Criteria for Diagnosis of Irritable Bowel Syndrome.

Background and objectives: Most individuals with irritable bowel syndrome (IBS) are diagnosed by primary health care (PHC) physicians. However, a significant percentage of patients remain undiagnosed or misdiagnosed owing to the lack of knowledge or a systematic strategy regarding the use of ROME IV criteria for the diagnosis of IBS. Thus, in this study, we aimed to assess the knowledge, attitude, and practices among primary health care physicians in Jazan Province, Saudi Arabia, regarding ROME IV criteria for the diagnosis of IBS. Methods: A cross-sectional study was conducted using a pretested self-administered questionnaire that determines participants' sociodemographic data and measures knowledge about ROME IV criteria, targeting PHC physicians in Jazan Province, Saudi Arabia. Data were analyzed using the Statistical Package for Social Sciences (SPSS) v.23. Results: We included 200 participants, and the majority of participants in our study (approximately 78%) were aware of the ROME IV diagnostic criteria for IBS; this awareness was associated with age, nationality, specialty, and classification. The participants' mean level of knowledge was 4.30 (out of 6). However, knowledge was higher among Saudi and family medicine doctors in this study, as compared to non-Saudi and doctors of other specialties. More than two-thirds of participants who were aware of ROME IV criteria thought that they are sufficient to diagnose IBS; however, only 47.5% of physicians reported using ROME IV frequently in their daily practice. Conclusions: Most of the participants of this study are aware of ROME IV criteria, and better knowledge was noted among Saudi and family medicine physicians. About 70% thought that ROME IV criteria are effective enough to diagnose IBS, and only about half of the participants use ROME IV criteria in their practice. Therefore, due to its high prevalence in the region, further efforts are required to disseminate basic knowledge and improve attitudes and practices related to ROME IV criteria among PHC physicians of all specialties.

Trigeminal Nerve Injuries in Correlation with Daily Dental and Maxillofacial Medicine

Oral and maxillofacial medicine is in close relation with trigeminal nerve, and such daily dental procedures, impacted teeth, dental implants placement, oral and oral maxillofacial medicine including trauma, even injection of local anesthesia can damage trigeminal nerve. Auspiciously, most nerve injuries will undergo natural recovery, with small portion of cases resulting in permanent sensory deficits. Many patents suffering trigeminal nerve problems, present at family medicine doctors as well, or direct to medical specialist like dentist, oral maxillofacial medical specialists, neurologist or neurosurgeons as well.Subsequently, early assessment and diagnosis, often involving multidisciplinary team optimize recovery in respect of time and minimize the complication. Keywords: Trigeminal nerve, oral, maxillofacial, medicine, damage, assessment, recovery DOI: 10.7176/ALST/95-07 Publication date: November 30 th 2022

Knowledge of obstetrician and family medicine doctors in Saudi Arabia about women with epilepsy

BackgroundWomen have a slightly lower prevalence of epilepsy and unprovoked seizures than men; however, women with epilepsy have several exceptional dilemmas, including the use of anti-seizure medications (ASMs) in addition to the effects of ASMs on sexual function, contraception, pregnancy, childbirth, congenital fetal malformations, and breastfeeding. This study assessed the knowledge of obstetricians and family medicine physicians about relevant topics and concerns of women with epilepsy (WWE) in Saudi Arabia.ResultsOut of 108 participants recruited for the study, the largest percentage (62%) was residents, while 17.6% were consultants and the remaining 20.4% were specialists or fellows. In terms of specialty, 61.1% of the participants were obstetricians, while the remaining 38.9% were family medicine physicians. The participants showed varied levels of knowledge about important health issues ranging from 71.3% (ASMs and breastfeeding) to 11.5% (percent of children at risk for major birth defects) for WWE. Knowledge scores of health issues for WWE were significantly higher among obstetricians compared to family medicine physicians (6.16 ± 2.75 vs. 4.29 ± 1.95; p < 0.001). Similarly, scores were significantly higher among consultants/fellows compared to residents/specialists (7.27 ± 1.62 vs. 4.65 ± 2.56; p < 0.001).ConclusionsInadequate knowledge about several vital WWE issues was observed, particularly the hormonal influence of estrogen and progesterone on the control of convulsions, high likelihood of osteomalacia among WWE, and high rate of sexual dysfunction among them. This insufficient knowledge among healthcare providers could negatively influence epilepsy-related counseling for WWE.

The Case for Medicine-Pediatrics Training in the U.S. Military.

Residency programs in the combined specialty of Internal Medicine-Pediatrics (Med-Peds) are not offered in the military graduate medical education system despite existing in the civilian sector for over 50 years. This residency consists of 4 years of training and results in the development of board-certified internists and pediatricians who can care for patients from infancy to death. This versatility, combined with an emphasis on the transition from childhood to adulthood, would be valuable to the Military Health System. Med-Peds physicians could serve in a variety of settings depending on the needs of the military: in the outpatient clinic, in the hospital, or in an operational setting. Specifically, Med-Peds doctors could operate as critical care extenders in austere or operational environments to patients of all ages. This could improve outcomes of pediatric casualties in war because of specific training in both medical and pediatric intensive care units. Med-Peds physicians would integrate seamlessly into the Military Health System to work alongside family medicine doctors, internists, and pediatricians to provide high-quality primary care to service members; this may also allow for the increased flexibility of the medical corps. As there are already military residency programs in pediatrics and internal medicine, the required infrastructure for such a training program exists. The addition of this residency may also lead to more interest in military medicine from prospective applicants to medical school. This essay uses personal experience to explain how the addition of this specialty to the military would benefit the medical mission domestically and abroad.

General practitioners’ views on retaining Singapore’s primary care doctors: a cross-sectional survey and qualitative analysis

BackgroundTo support its ageing population and the increasing need for chronic care in the community, Singapore needs to boost the number of doctors in its primary care workforce. To better understand how to improve doctor retention and build a more robust primary care system, we conducted a cross-sectional survey with doctors in general practice and family medicine to explore their career satisfaction, their career plans, factors related to their plans to leave, and their view on retaining GPs in primary care.MethodsAn anonymous online survey was distributed to general practitioners working in the public and private sectors. The survey contained questions on career satisfaction, career plans in the next 5 years, and factors important for retaining doctors in primary care. In addition, there were open-ended questions for respondents to elaborate on retention initiatives and other factors that may improve engagement among primary care doctors. Quantitative data was analyzed with descriptive statistics, principal component analysis, χ2 tests, t-tests, and Pearson’s correlations; qualitative data was analyzed thematically.ResultsThe survey was attempted by 355 general practitioners and completed in full by 303. The respondents were most satisfied with rapport with patients and their current professional role; they were least satisfied with the amount of paperwork and the status of general practice in society. In terms of their career plans in the next 5 years, 49/341 (14.4%) of the respondents plan to leave general practice permanently, 43/341 (12.6%) plan to take a career break, and 175/341 (51.3%) plan to reduce their clinical hours. Higher remuneration, recognizing general practice and family medicine as a medical specialty, and reducing the litigious pressures on medical practice were rated as the most important factors for retaining primary care. Free-text responses also revealed a growing dissatisfaction with the Third-Party Administrators that manage insurance arrangements.ConclusionWhile the proportion of doctors who intend to leave is smaller than that reported in overseas studies, our findings highlight an urgent need for targeted interventions to engage and retain primary care doctors. Increasing recognition and support for general practitioners and their professional practice may contribute to strengthening community care for the ageing population.

Discussion on Current Consensus and Ambiguity of Renal Biopsy Based on the Case of a Male Patient with Type 1 Diabetic Nephropathy

本個案為37歲男性，患第一型糖尿病及糖尿病腎病變，一年內腎功能逐漸下降、並出現噁心及食慾減退等尿毒症狀，經家庭醫學科醫師轉介腎臟科門診，進行腎臟切片之適應症評估與透析準備。本個案報告從第一型糖尿病腎病變之自然史進而探討現今腎臟切片適應症及禁忌症的共識，以期第一線醫師對有需要經腎臟切片診斷、且能受益於此的族群有所覺察並適時轉介。A 37-year-old man with type 1 diabetes and diabetic nephropathy was followed at a family medicine clinic. His renal function had declined in the past year while uremic symptoms of nausea and anorexia also developed. As causes other than diabetes leading to deterioration of his renal function were suspected, he was referred to a renal specialist for discussion on receiving renal biopsy. After initial assessment with serology tests, sonography, as well as follow-up serum creatinine and blood urea nitrogen, renal biopsy was deferred given the chronicity of his condition and the inevitability of dialysis at the point. Current consensus and ambiguity concerning indications and contraindications of renal biopsy were examined via the case. Family medicine doctors are front-line physicians who should be able to detect the slightest change in manifestation of patients’ renal function. The importance of timely referral in yielding greatest possible benefits from renal biopsy for patients in need should be emphasized.

General Practice/Family Medicine Portuguese doctors: “technicists” or “systemics”?

To study if the consultation's problems classification of a fictitious case by General and Family Medicine doctors, showed the characteristics of being a mechanistic or a systemic approach. Exploratory cross-sectional observational study in a convenience sample of the General Practice/Family Medicine population, internees included, in April 2020, applying a modified real world clinical case. Central Portugal and the Autonomous Region of Azores. General Practice/Family Medicine specialists and internees. Electronic Doctors invitation to participate, anonymously, in specific doctor's social networks. A self-fulfilling questionnaire was used to verify the classification of a clinical case in Subjective, Assessment and Plan (from the SOAP methodology) with the response options of the International Classification of Primary Health Care (ICPC2) in chapters P (Psychological) and Z (Social) possible for this case. “Technicists” doctors, only classifying “P” codes and “Systemics” classifying “P+Z” or only “Z” ICPC2 codes were defined. Differences between genders, work place, being an internee or specialist and being a tutor in specialized formation were studied. A sample of 227 30% (n=68) males, specialists represented 66% (n=149), of whom 49% (n=73) were internee's tutors and 34% (n=78) were internees, was studied. In the Subjective chapter of the SOAP methodology, 44.1% (n=100) were “technicists”, for Assessment n=93 (40.8%) were “technicists” and for P chapter classification 56.8% were “technicists”. For S, A and P chapters classification there was no significant difference between the considered variables. In this sample General Practice/Family Medicine Portuguese doctors were more “systemic” for the S and A chapters of the SOAP model, And “technicists” in the P chapter.

Recommendations and best practice on the management of hemorrhoidal disease in Saudi Arabia

ABSTRACT Background Several techniques were developed for managing hemorrhoidal disease, but their use in clinical practice and the general management of the condition seems highly variable in Saudi Arabia. Consensus panel To develop consensus recommendations that ensure the best possible diagnosis and treatment of hemorrhoidal disease in Saudi Arabia, the consensus panel consisted of experts in surgery in Saudi Arabia who met from December 2017 to September 2018. Consensus findings The discussions focused on the need: to set up a proctology society in Saudi Arabia to assess the prevalence of hemorrhoidal disease and to regulate the role of health-care professionals (HCPs) in the management of the disease; to initiate guidelines to ensure proper diagnosis (considering symptoms, medical history, and physical/clinical examination) and treatment (topical creams and suppositories should be limited as no strong evidence supports their efficacy); to educate patients on diet and lifestyle modifications using education materials and social media during and after the treatment (regular physical activity, drinking enough fluids, regular meal time with food rich in fibers, and regular bowel habit with non-straining defecation); to refer patients to a general/colorectal surgeon when needed; and to teach junior surgeons the best use of surgical techniques. Conclusion These recommendations can be a step forward toward a recognized guidance for all HCPs in Saudi Arabia for a better management of hemorrhoidal disease. They will be of a great value for general practitioners, family medicine doctors, junior surgeons, and pharmacists who are the gate keepers and first contact with patients.

Problematic issues of system of training for primary link of health care and a way of their decision

In this article survey of modern scientific approaches to the organization of effective system of training is provided. New approaches to application of educational clusters, transmitting medicine are provided. Efficiency of formation of educational, research and production clusters in a health care system for ensuring high-quality preparation and further professional activity of the doctor on the basis of integration of medical science, education and practical health care is shown. Legal aspects of implementation between sectorial interaction are analyzed. Development of the main approaches to the organization of training for system of the general practice - family medicine on the basis of science integration, education and practice became a research objective. Materials and methods. In the course of the research methods of scientific documents semantic estimation, and also a method of the structural and logical analysis have been used. Results. Modern problems of staffing of rendering primary medical care are analyzed. The special attention is paid to questions of requirements changes to quality of the general practice - family medicine doctor preparation with emphasis on introduction of modern educational methods and technologies, such as distance learning, the training centers, etc. is. Conclusion. Ensuring quality of medical education in Ukraine has to happen constantly with taking into account the best domestic and international experience by results of which, this process remains multidimensional and demands constant improvement in the evidence-based directions.

Nasilje na radu nad ljekarima porodične medicine kao dio globalnog fenomena u sektoru zdravstva

Objective. Violence against healthcare workers is a significant global problem and is prevalent in both developed and underdeveloped countries. In the Republika Srpska, there is also a problem of violence against health workers and it occurs in the public and private health sector. Most attacks come from patients or their family members who have a mental illness or have harmful behavioral habits such as alcohol or drug abuse. Aim of the work is to examine the prevalence of violence at work against family medicine doctors, the most common forms of violence, the consequences of violence on the professional work of doctors, as well as prevention measures. Methods. The research was conducted in 16 health institutions in the Republika Srpska in the period from January to December 2018 according to the type of cross-sectional study on a randomized sample of 287 respondents, doctors who worked in the service of family medicine. The research instrument was a specially created questionnaire that was created for this research, and the obtained data were statistically processed in the program package SPSS 19. Results. Doctors of both sexes participated in the research, and the majority of respondents were women, 77,8% of them, while 22,2% were men. The majority of respondents are employed in public health care, 97,11% of them. Of the total number of doctors surveyed, 84,48% of them experienced violence at work during their working life. The analysis of the representation of certain types of violence showed that the most common form of violence is verbal violence in the percentage of 40,7%. A total of 73,62% of respondents believe that violence at work affects further professional work. Conclusion. Violence at work against family medicine doctors in Republika Srpska is significant. The most common forms of violence are verbal violence and rude or disrespectful behavior, and as the most important prevention measures, family medicine doctors point out a lower workload with the number of examinations, the introduction of stricter criminal liability for offenders and the introduction of the status of an official.

Prevalence of burnout and its impact on self-reported patient care among primary health care physicians at King Abdul-Aziz Medical City in Riyadh region.

Burnout is known worldwide as a work-related syndrome associated with physical illness and mental health problems. It has a significant impact on doctors' health and patient care. To assess the prevalence of burnout, its associated risk factors, and its impact on self-reported patient care among the doctors of the Family Medicine Department in King Abdul-Aziz Medical City (KAMC), Riyadh. A cross-sectional study was conducted among 150 physicians. Data were collected using the 22-items Maslach Burnout Inventory (MBI) to measure emotional exhaustion, depersonalization, and personal achievement as well as questions about demographic factors, work characteristics, and impact of burnout on self-reported patient care. A total of 150 physicians responded to the questionnaire. In terms of high burnout, 32 doctors (21.3%) had emotional exhaustion, 57 doctors (38%) had depersonalization, and 41 doctors (27.3%) scored low for personal achievement. Staff physicians had high emotional exhaustion (27.8%, P = 0.028), family medicine residents, however, reported higher depersonalization and low personal achievement (42.9%, 45.7%, P = 0.675, P = 0.009, respectively). Being a staff physician, military, with long years in practice, working more than 8 hours per day, and covering ER shifts were strongly associated with a high level of burnout. High-level burnout demonstrated a statistically significant impact on patient care with suboptimal performance among the doctors of this study. Burnout seems to be a common problem in family medicine doctors at KAMC. It was associated with personal and workload indicators affecting their self-reported patient care significantly.

Updated principles of prevention, diagnosis and treatment of COVID-19 in children in Poland – recommendations for paediatricians and family medicine doctors

Updated principles of prevention, diagnosis and treatment of COVID-19 in children in Poland – recommendations for paediatricians and family medicine doctors

The Use of Expert Systems and Information and Communicaton Tchnologies (ICT) in Laboratory Practice–an Economical Aspects

Background: Biochemistry is the science of the chemical composition of living things and of chemical changes in living things. Biochemical–laboratory diagnostics occupy a prominent place in medicine. Today's knowledge in the field of laboratory diagnostics enables reliable diagnostic verification of the physiological and pathological condition of the subject and monitoring of the patient's therapy. Objective: The aim of this article is to look at the economic and communication aspect of laboratory diagnostics in family medicine and present some statistically relevant data related to the already mentioned topic. Methods: Author used a few important sost analysis to assess every diagnostic and therapeutic procedure which should be analyzed from the aspect of its profitability, i.e. To determine their effectiveness and safety of application as stated in the Accreditation Standards for Health Centers. Results: A total of 5333 laboratory tests are represented in 1000 requests. The percentage representation of the most frequent individual laboratory tests in the requests of all teams of doctors involved in the health care system was in order; GUK (14%), BS (14%), urine (13.9%), SE (10.3%), total cholesterol (8.5%), triglycerides (8.4%), aminotransferases (6.7 %), creatinine (6.7%), urea (4.8%), bilirubin (0.9%), fibrinogen (0.9%), CRP (0.8%), AF (0.8%), HDL cholesterol (0.7%), calcium in serum (0.6%), phosphorus in serum (0.5%), acidum uricum (0.5%). Of the general practitioners, the largest number of patients referred to the biochemical and hematology laboratory were diagnosed with diabetes, followed by diseases of the urinary system and hypertension. The same is the case with family medicine doctors, while from specialist doctors, the largest number of patients are sent to the biochemical and hematology laboratory with diseases of the urinary tract, followed by diseases of the respiratory tract, endocrinological system and anemia. Conclusion: An economic analysis of the number of required laboratory tests by disease indicates a different number of points per required test and by disease. The highest costs are related to diabetes, followed by the costs of respiratory diseases, urinary diseases and finally hypertension.

Effectiveness of a Walking Football Program for Middle-Aged and Older Men With Type 2 Diabetes: Protocol for a Randomized Controlled Trial.

BackgroundStudies on walking football have found positive effects on health; however, there are still several research gaps when applying walking football programs for patients with type 2 diabetes.ObjectiveThis study aims to test the effectiveness of a walking football exercise program on glycemic control and cardiovascular risk factors in middle-aged and older men with type 2 diabetes.MethodsThe study will be run as a randomized controlled trial with a 6-month duration in Portugal. Eligible participants will be randomized using a 1:1 ratio for intervention or control groups and compared using an intention-to-treat analysis. The intervention will consist of a walking football exercise program. The control group will continue with usual care in primary health care units. The primary outcome will be the mean difference in glycated hemoglobin between intervention and control groups after 6 months. Secondary outcomes include the mean differences in fasting blood glucose, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, systolic and diastolic blood pressure, body mass index, waist circumference, fat-free mass, and fat mass. Additionally, secondary outcomes include the incidence of exercise-related injuries and adverse events and the walking football exercise program’s cost-utility.ResultsThe study protocol is being prepared to be submitted to the Health Ethics Committee of the Northern Regional Health Administration, Portugal. After approval, participant recruitment will start in primary health care units in Porto's metropolitan area by family medicine doctors.ConclusionsWalking football might have the potential to be effective in improving glycemic control and cardiovascular risk factors, with a low rate of exercise-related injuries and adverse events and a good cost-utility ratio. Therefore, walking football may be a sustainable intervention strategy for type 2 diabetes management.International Registered Report Identifier (IRRID)PRR1-10.2196/28554

Antithrombotic Therapy in Elderly Patients with Atrial Fibrillation: The State of the Problem in the Real Clinical Practice of a Family Medicine Doctor

Introduction. The research aimed at studying the efficacy and safety of anticoagulant therapy in patients with atrial fibrillation (AF), especially in older age groups, is now increasingly relevant.The aim of the study is to analyze the situation with prescribing anticoagulant therapy in elderly and senile persons with atrial fibrillation in real clinical practice and to demonstrate the possibility of improving the quality of observation and management of a group of patients as part of the work of a specialized team.Materials and methods. A total of 2,770 medical records of outpatient patients with atrial fibrillation were studied for the period from 2017 to 2019. Of this number, 320 patients with AF of nonvalvular etiology were selected, the average age of which was 70.3 ± 8.15 years. There were 270 women and 50 men. An observational prospective study in 45 elderly and senile patients with AF of non-valvular etiology was carried out by a team of specialized doctors for 12 months.Results. Of the 301 patients, anticoagulant therapy was prescribed to 166 (55.1 %), of which only 17 (10.2 %) people received proper anticoagulant therapy. The excessive activity was observed in 114 (37.9 %) patients, who underwent antiplatelet therapy with aspirin, and 21 (7.0 %) patients remained without any treatment with anticoagulants nor antiplatelet agents. Although, in the case of both, prescribing aspirin and not prescribing, anticoagulants have been indicated. In the prospective part of the study (for 12 months), all 45 patients continued to take anticoagulants and were systematically monitored. The INR in the target range over 60 % of the time was achieved in 37 % of patients receiving warfarin therapy.Conclusion. In the actual clinical practice of Kyrgyzstan family medicine centers, older patients with atrial fibrillation receive inadequate antithrombotic therapy. The main drug of choice for specialists remains warfarin, a therapy that can be recognized as adequate only in a small number (16 %) of patients. The ability to improve the quality of surveillance and management of a group of patients with AF and high adherence to treatment was demonstrated by the work of a specialized team of doctors.

Professionalism of Family Medicine Doctor

Professionalism of Family Medicine Doctor

Management of mitochondrial leukoencephalopathy-related ataxia and cognitive impairment in a primary health care setup

Abstract Rationale: Ataxia is defined as an impaired coordination of voluntary muscle movement. In cases of slowly progressing ataxia in young people, we should first consider a genetic origin. Herein, we describe the case of a 25-year-old patient with severe and advanced neurological disease which was diagnosed and treated by a family medicine physician, leading to the discovery of a new form of hereditary ataxia. Patient concerns: In 2016, a 25-year-old professional driver arrived at our family medicine office with a gait disorder that he had been struggling with for the past 5 years. During clinical examination, gait ataxia was evident. In 2018, the patient returned to our family medicine office, with difficulty in speaking and could no longer retain urine. During the examination, he was not oriented in time and space, no longer recognized the staff, and responded only in a few words. Clinically, we observed postural and action tremors, bradykinesia, and increased muscle tone. Diagnoses: The patient was sent to a neurologist for further management. There, a magnetic resonance imaging scan of the head was prescribed, leading to a diagnosis of adrenoleukodystrophy; however, genetic testing and biochemical analysis performed in 2016 did not confirm that. With additional testing in 2018, we confirmed a hereditary mitochondrial leukoencephalopathy (the identified version c.2884C&gt;T in the AARS2 gene has not been previously reported as a pathogen in relation to human diseases). Interventions: Unfortunately, no specific treatment is available, therefore, the reluctance of neurologists to provide treatment is understandable. Family medicine doctors are long-term companions to patients and are sometimes the only support for them and their families when it comes to such an incurable disease. Outcomes: Currently, the patient only needs palliative care. The diagnostic path was completed but no specific therapy is in view. Lessons: Our case shows a 25-year-old patient with severe and advanced neurological disease diagnosed and treated by a family medicine physician. Family doctors play an important role due to their long-term relationship with the patient and the comprehensive care they provide, even in cases where the disease is severe, and the prognosis is unfavorable.

Medical education reform in Tajikistan: comparison of the conventional one-year family medicine residency program and the new two-year residency program for postgraduate medical education

IntroductionThe last two decades have seen a shift in former Soviet countries from highly specialized to more family medicine-focused systems. Medical education has slowly adjusted to these reforms, although the region is still at risk to have a chronic shortage of family doctors. This paper presents the evaluation of a new post-graduate family medicine program in Tajikistan, focused on competency-based training. The findings are relevant for policy makers, international organizations and practitioners participating in similar medical education reform programs.MethodsWe employed a quasi-experimental control group design and compared intervention residents, control group residents with traditional training, and 1st year residents with no training in two outcomes, clinical knowledge and competencies. We employed two objective measures, a written multiple-choice question test (MCQT) and an Objective Structured Clinical Examination (OSCE), respectively. We report reliability and validity of the measures along with ANOVA, planned contrasts and effect size estimates to examine differences across groups.ResultsWe found statistically significant differences in both clinical knowledge and competencies between intervention and control groups. We also detected a large intervention effect size. Participants in the intervention outperformed control group participants in the two measures. Our analysis suggests that intervention and control group participants are comparable in terms of initial knowledge and competencies, strengthening the argument that the intervention caused the improvement in the program outcomes.DiscussionReceiving tailored training and structured opportunities to practice knowledge and competencies in clinical settings have a positive effect on the education of family medicine doctors in Tajikistan. Our results support curriculum reform and investment in medical education in the form of longer and supervised on-the-job preparation designed to be more in line with international standards. We discuss suggestions for future studies and potential requirements to inform replicability in other countries.ConclusionFamily medicine is well recognized as central to health systems throughout the world, but high quality residency training lags behind in some countries. Our study showed that investing in family medicine residency programs and structured training is effective in increasing critical clinical competencies. We encourage promoting comprehensive post graduate family medicine doctor training so that the goals of a family medicine centered health system are attainable.

Perspectives on expert generalist practice among Japanese family doctor educators: a qualitative study.

BackgroundExpert generalist practice (EGP) is increasingly being viewed as the defining expertise of generalist care. In Japan, several prominent family doctors consider it important and relevant in the Japanese context. However, no study has examined Japanese family doctor educators’ perceptions of EGP.AimTo explore Japanese family doctor educators’ perceptions of EGP.Design & settingA qualitative study among family doctor educators in Japan.MethodFocus group interviews were conducted using a semi-structured interview guide following a short lecture on EGP. A qualitative description method was adopted and the framework method was used to conduct thematic analysis.ResultsParticipants were 18 family medicine doctor educators, including 11 directors and six associate directors of family medicine training programmes. The results suggested that the concept of EGP was important and applicable to primary care in Japan. Participants’ perceptions on EGP pertained to the following four areas: impact of EGP, triggers for EGP, enablers for EGP, and educational strategies for EGP.ConclusionThe concept of EGP may be useful in clinical practice in Japan, especially in complex patient care. A clearer framework for or description of EGP, and of non-traditional methods, such as ascetic practice and awareness of the self, were proposed as possible educational strategies.

Teaching procedural skills to family medicine residents: Preliminary report of the Bori experience.

Introduction: Proficiency in procedural skills is a prerequisite for graduating residents in Family Medicine. The acquisition of these skills required for clinical practice remains an ongoing challenge. In order to overcome the challenge of resident doctors in Family Medicine in acquiring competence in procedural skills, rural posting was added in their curriculum. Aim: The aim of this study was to evaluate the effect of dedicated teaching of procedural skills on the residents’ performance at the end of their rural posting. Method: A hospital based cross-sectional study in which respondents were recruited by convenient sample of all consenting residents (n = 29) from two training institutions who reported to the Bori Zonal Hospital for rural posting from 2018-2020. A questionnaire was administered to the respondents. A two sample t-test was used to compare the means and P-value of &lt;0.05 was considered statistically significant. Result: A total of 728 procedures were performed during the period. The most common procedure performed was caesarean section and the least was repair of vesicovaginal fistula. The mean procedural rating score at the beginning and the end of the rural posting were 1.68±0.70 and 3.94±0.64 respectively. There was a significant difference between the procedure mean scores at the beginning and end of the rural posting (t=11.91, p&lt; 0.0001, 95% confidence interval: -2.6414 to -1.8786). Conclusion: Given the right training in an enabling environment, the Family Medicine resident graduates proficient in the right mix of skills needed to run district Hospitals and other health institutions.