Family Medicine Research Research Articles

Research consultation clinic: impetus towards facilitating primary care research

BackgroundIn Singapore, SingHealth Polyclinics (SHP) is an accredited Family Medicine (FM) training centre which managed 1.8 million primary care patient-visits in 2012. To promote research in the institution, research consultation clinics (RCC) are being introduced in 2010 to enable free face-to-face consultation between experienced and novice researchers on specific research topics. Each RCC session allows about an hour or more for the SHP staff, medical undergraduates and general practitioners to seek advice and clarification on key research areas, ranging from research question refinement, study design and execution, data analysis, result presentation to publication. The consultants comprise of two FM researchers with postgraduate research qualification.AimThis article aims to review the implementation of RCC from 2010 to 2012 and its impact on research activities and outcome indicators in the same period of time.MethodsThe study comprised of two segments. Part I was a three-year retrospective review of the RCC administrative record. The total number of RCC sessions, hours utilised, participants’ profiles, the number of research studies initiated by them and their research presentations at local and overseas scientific meetings/conferences were computed. Part 2 was an anonymous web-based questionnaire survey fielded to RCC participants to collect their feedback on the RCC service and their self-reported initiation and completion of research study after the RCC consultation.ResultsThe RCC sessions increased from 17 to 40 sessions, resulting in increment of 2 to 14 research presentations and from 2 to 6 initiations of new research studies per annum from 2010–2012. The response rate to the questionnaire survey was 70.3%, with the majority of multi-disciplinary respondents rated the RCC service to be accessible, adequate and were satisfied with its quality. Study design, data management and study execution were ranked as important areas of research for consultation. 79% of them had started a research project and 36% had completed their studies.ConclusionsThe RCC is a feasible model to catalyse multi-disciplinary research in primary care institutions. Further study is needed to evaluate its relevance when research advances and novice researchers become experienced investigators to take on more complex projects.

Family Medicine’s academic contributions. Family Medicine Research Days, İzmir, Turkey

Summary In this paper which is mainly based on my speech in the Family Medicine Research Days, ‹zmir, Turkey, in November, 2012, I have tried to place family medicine in the wider landscape of academic medicine and provide some sense of how it has grown in its own right as an academic discipline with unique contributions to provide. In order to understand the unique contributions of Family Medicine, I have first explained two concepts that will help to build a framework to understand where we fit into the larger academy of medicine. Following that I have presented some further details of the specific contributions of academic Family Medicine and concluded with what I see as some key challenges ahead. As an academic discipline, it has established a firm foundation over the past 40 years. Ozet Esas olarak Kas›m 2012'de ‹zmir, Turkiye'de gerceklefltirilen Aile He

Improving the quality of care for patients with chronic diseases: What research and education in family medicine can contribute

Background: The theme of the EGPRN conference in Ljubljana 2012 was ‘Quality improvement in the care of chronic disease in family practice: the contribution of education and research.’Objective: In this contribution, we summarize our key note lectures and provide reflections on the theme.Results: Many countries have established programmes for training of primary care professionals and quality improvement in family medicine. Research and development has focused on new educational methods, practice accreditation, patient safety in primary care, models of structured chronic care, and tailored improvement.Conclusion: An international academic network of physicians, teachers and researchers in primary care should be nurtured to address the challenges of chronic illness care.

How core competencies are taught during clinical supervision: participatory action research in family medicine

The development of professional competence is the main goal of residency training. Clinical supervision is the most commonly used teaching and learning method for the development of core competencies (CCs). The literature provides little information on how to encourage the learning of CCs through supervision. We undertook an exploratory study to describe if and how CCs were addressed during supervision in a family medicine residency programme. We selected a participatory action research design to engage participants in exploring their precepting practices. Eleven volunteer faculty staff and six residents from a large family medicine residency programme took part in a 9-month process which included three focus group encounters alternating with data gathering during supervision. We used mostly qualitative methods for data collection and analysis, with thematic content analysis, triangulation of sources and of researchers, and member checking. Participants realised that they addressed all CCs listed as programme outcomes during clinical supervision, albeit implicitly and intuitively, and often unconsciously and superficially. We identified a series of factors that influenced the discussion of CCs: (i) CCs must be both known and valued; (ii) discussion of CCs occurs in a constant adaptation to numerous contextual factors, such as residents' characteristics; (iii) the teaching and learning of CCs is influenced by six challenges in the preceptor-resident interaction, such as residents' active engagement, and (iv) coherence with other curricular elements contributes to learning about CCs. Differences between residents' and preceptors' perspectives are discussed. This is the first descriptive study focusing on the teaching of CCs during clinical supervision, as experienced in a family medicine residency programme. Content and process issues were equally influential on the discussion of CCs. Our findings led to a representation of factors determining the teaching and learning of CCs in supervision, and suggest directions for research, for faculty development, and for interventions with learners.

CERA: WHAT? SO WHAT? NOW WHAT?

Research is a word that intimidates many faculty and program directors and while the Review Committee for Family Medicine mandates the generation of scholarly output, we often shy away from research involving data collection and analysis. The lack of residency faculty-lead research contributes to the paucity of family medicine (FM) researchers and the diminishing FM research pipeline. The Council of Academic Family Medicine (CAFM) Educational Research Alliance (CERA) was designed to assist faculty in residency programs to conduct research. So, what is CERA? How does it benefit residency programs? What should we do next?

STFM LAUNCHES PROGRAMS AND SERVICES FOR RESIDENCY PROGRAMS

STFM’s strategic plan challenges the Society to be the leader in developing programs and services to help residencies improve family medicine education and teaching. STFM members have emphasized the need for cost-and time-effective ways to offer learning opportunities, meet ACGME requirements, and enhance the knowledge and skills of faculty. To meet this need, STFM introduced the Residency Faculty Boot Camp. This series of online, interactive learning experiences covers the most-requested teaching topics, including Dealing With Difficult Residents, Pearls of Precepting, and Providing Feedback to Learners. Each module includes a presentation, videos, and interactive quizzes. Residency programs that purchase the package receive instant updates as participants complete each course. For details, visit http://www.stfm.org/bootcamp. The new ACGME program requirements in family medicine (Milestones) will require competency assessment of residents. Residencies are being asked to focus more on resident performance and less on the numbers of procedures performed. In early 2012, STFM launched a Resident Competency Assessment Toolkit. The toolkit contains the background, tools, and training to help residency programs demonstrate resident competence and ensure that graduates have the knowledge, skills, and abilities required to perform their roles in society. More information can be found at http://www.stfm.org/rctoolkit. STFM has offered and will continue to offer train-the-trainer workshops on competency assessment at family medicine conferences and through personalized faculty development training, such as STFM’s On-the-Road workshops. STFM and the Association of Family Medicine Residency Directors (AFMRD) recently launched a multi-year collaborative to build an online resource of peer-reviewed, competency-based curriculum on core topics taught in family medicine residency programs. The Residency Curriculum Resource, which will be organized by post-graduate year (PGY), will serve as a repository of materials that can be implemented and used to satisfy ACGME requirements. Content will be managed by a senior editor and a 6-member editorial board. The project will include 2 phases. Phase 1 will convert AAFP’s “Recommended Core Curriculum Guidelines for Family Medicine Residents” into a dynamic web interface organized by PGY, with links to content to address core-learning objectives. Faculty will be able to use the content to standardize teaching and to ensure residents gain competence in the areas outlined in the guidelines. Phase 1 content will be free to all STFM and AFMRD members. During phase 2, AFMRD and STFM members will submit teaching materials they have developed for lectures and presentations or that they have created specifically for the Residency Curriculum Resource. Submissions will be peer reviewed and refined. Authors with accepted publications will update their content annually. Access to Phase 2 content will be subscription-based. Subscription fees will cover the costs of website updates, the editorial process, and the purchase of licensed content. In addition, STFM offers a number of valuable resources to help residency programs with faculty development, scholarship, and leadership: All levels of faculty can receive up-to-date faculty development training by attending the STFM Annual Spring Conference. It offers hundreds of presentations specifically geared for residency program faculty. The Conference on Practice Improvement offers residencies an opportunity to learn as teams about topics central to practice redesign and the patient-centered medical home. Faculty and residents can access tools and mentoring to meet ACGME scholarly activity requirements using the CAFM Educational Research Alliance. The STFM Resource Library offers instant access to more than 700 residency-specific resources on a variety of topics, including the patient-centered medical home and practice redesign. The Resource Library also offers interactive wikis on family medicine research, teaching teen health, and behavioral science basics. Residencies can develop faculty leaders through enrollment in one of STFM’s leadership development opportunities, such as the Emerging Leaders and the Behavioral Science/Family Systems Educator Fellowship. These leadership opportunities provide education and experience to help future faculty leaders rise to the next level. Current research on residency innovation is available through Family Medicine’s recent dedicated issue on residency redesign. TeachingPhysician.org connects residency programs with community preceptors. The web resource streamlines training with videos, tips, answers to frequently asked questions, and links to in-depth information on precepting. STFM is strengthening its offerings to help residencies successfully meet today’s challenges as they train tomorrow’s family physicians. We invite residency faculty to explore the wealth of STFM offerings and offer feedback on challenges that are not yet being met. We strive to be the go-to resource for all family medicine educators.

Research in the practice of family medicine: a lost cause or a pending challenge?

This article reflects on barriers to research in family medicine, particularly in Latin American countries. These difficulties are not only related to the lack of family physicians as clinical researchers, but also to their progressive relegation from research on specific diseases or conditions by specialists whose domain is an organ system or disease. In addition, family physicians in Latin America are also loaded with the difficulties imposed by the growing north-south divide between developed and developing countries given that, as compared with developed countries, few studies are conducted in Latin America. While research in Family Medicine is not a lost cause, it requires strong commitment from all academic, political, and social stakeholders dedicated to family medicine as a structural axis of healthcare services in Latin America, to offer primary care research the boost it needs.

Systematic Review Research in Family Medicine

A systematic review can be defined as a investigation that focuses on a specific question and uses explicit, prespecified scientific methods to identify, select, assess, and summarize the findings of similar but separate studies.1) Systematic reviews aim to minimize bias by using explicit and systematic methods. To reach such a goal, systematic reviews seek to collate all evidence that fits pre-specified eligibility criteria in order to address a specific research question. The key characteristics of a systematic review are 1) a clearly stated set of objectives with pre-defined eligibility criteria for studies; 2) explicit, reproducible methodology; 3) a systematic search that attempts to identify all studies that would meet the eligibility criteria; 4) an assessment of the validity of the findings of the included studies, for example through the assessment of risk of bias; and 5) a systematic presentation, and synthesis, of the characteristics and findings of the included studies.2) The number of systematic reviews is growing rapidly. In PubMed, the number of systematic reviews indexed increased from 2,167 in 2005 to 5,573 in 2011. However, the number of systematic reviews indexed in KoreaMed is less than 100, and the number published in the Korean Journal of Family Medicine or the Journal of Korean Academy of Family Medicine is less than 10. So it can be said that systematic review research had been increasing in foreign countries, but not in Korea, nor in family medicine in Korea. As a research methodology in family medicine field, systematic review has many advantages. First, the citation impact of systematic review is more than other study designs.3) Second, it is easier to be published in a Science Citation Index journal than other study design. Third, it does not require institutional review board approval for research. However, in order to be a trustworthy and reliable systematic review, the quality of the systematic review process must be improved. Core standards for systematic review may include 1) writing the review protocol, 2) comprehensive literature search, 3) duplicate study selection and data extraction, 4) assessment of scientific quality of the included studies, 5) appropriate meta-analysis methodology, and 6) reporting according to guidelines (preferred reporting items for systematic reviews and meta-analyses4) checklist). Well-conducted systematic review will help make clear what is known and not known about the potential benefits and harms of interventions. Thus, systematic reviews are essential for clinicians who strive to integrate research findings into their daily practices. They must, however, meet certain standards in order to be of such use.

Aile Hekimliği Akademisi (AHAD) Aile Hekimliği Araştırma Günleri 2011 Bildiri Özetleri

Aile Hekimliği Akademisi (AHAD) Aile Hekimliği Araştırma Günleri 2011 Bildiri Özetleri

Aile Hekimliği Akademisi (AHAD) 2. Aile Hekimliği Araştırma Günleri Bildiri Özetleri

Aile Hekimliği Akademisi (AHAD) 2. Aile Hekimliği Araştırma Günleri Bildiri Özetleri

Obesity Treatment Recommendations in the Philippines:Perspective on their Utility and Implementation in Clinical Practice

This article briefly reviews the obesity practice recommendations of the Philippine Association for the Study of Overweight and Obesity (PASOO) and the obesity guidelines of the Family Medicine Research Group (FMRG) of the UP-Philippine General Hospital. The two treatment recommendations showed their focus on the primary care setting and several limitations in the development process. The implementation strategies centered on their dissemination among health care professionals although the PASOO included food and activity pyramid guides useful both as patient educational material and as a treatment tool. In spite of their limitations, both sets of recommendations are valuable resources because they effectively promote obesity awareness in the Philippine setting. However, the current sets of obesity recommendations need to be modified and updated to fulfill important requirements for high-quality recommendations backed by a strong Philippine evidence base. Collaboration among important stakeholders in the prevention and control of obesity and other noncommunicable diseases (NCD) is essential to arrive at an integrated approach to obesity.

Rural Health and Family Medicine: An Agenda for sub-Saharan Africa

The African Journal of Primary Health & Family Medicine welcomes submissions that encourage scholarly exchange between family medicine and primary health care researchers and practitioners across Africa and the developing world, whilst providing a contextual and holistic view of family medicine as practiced across the continent.

Journal of the American Board of Family Medicine Sixth Annual Practice-based Research Network Theme Issue -They Just Keep Getting Better and Better

We have quite a rich issue this month related to practice-based research networks (PBRNs)--reflections on where they have been, where they should go, how they should happen; lessons learned about recruiting physicians and patients and new research methods; and several clinical studies from existing PBRNs. We had an amazing number of manuscripts submitted this year for the PBRN issue; as a result, this is a powerful issue. Some are under revision for future issues of the Journal of the American Board of Family Medicine, just as we have some articles from PBRNs appearing in most issues. PBRNs have deepened the family medicine research tradition. The importance of primary care research to build the evidence base of our clinical practice, plus the useful work building the methods of primary care research, distinguishes the pioneers in PBRNs. PBRNs are Health Improvement Networks and national treasures to be nurtured.

Use of a CME workshop to introduce and promote the specialty of Family Medicine in Ethiopia

The African Journal of Primary Health & Family Medicine welcomes submissions that encourage scholarly exchange between family medicine and primary health care researchers and practitioners across Africa and the developing world, whilst providing a contextual and holistic view of family medicine as practiced across the continent.

The impact of research in primary care and family medicine: the Thomson Reuters Web of Science Subject Category 'Primary Health Care'

The impact of research in primary care and family medicine: the Thomson Reuters Web of Science Subject Category 'Primary Health Care'

Systems biology as a conceptual framework for research in family medicine; use in predicting response to influenza vaccination

To introduce systems biology as a conceptual framework for research in family medicine, based on empirical data from a case study on the prediction of influenza vaccination outcomes. This concept is primarily oriented towards planning preventive interventions and includes systematic data recording, a multi-step research protocol and predictive modelling. Factors known to affect responses to influenza vaccination include older age, past exposure to influenza viruses, and chronic diseases; however, constructing useful prediction models remains a challenge, because of the need to identify health parameters that are appropriate for general use in modelling patients' responses. The sample consisted of 93 patients aged 50-89 years (median 69), with multiple medical conditions, who were vaccinated against influenza. Literature searches identified potentially predictive health-related parameters, including age, gender, diagnoses of the main chronic ageing diseases, anthropometric measures, and haematological and biochemical tests. By applying data mining algorithms, patterns were identified in the data set. Candidate health parameters, selected in this way, were then combined with information on past influenza virus exposure to build the prediction model using logistic regression. A highly significant prediction model was obtained, indicating that by using a systems biology approach it is possible to answer unresolved complex medical uncertainties. Adopting this systems biology approach can be expected to be useful in identifying the most appropriate target groups for other preventive programmes.

Do Clinicians Tell Patients They Have Prehypertension?

the clinical utility of the prehypertension label is questionable. We sought to estimate how often patients with prehypertension are being told about it by their primary care clinicians. we conducted a cross-sectional study of adult patients visiting practices within the North Carolina Family Medicine Research Network in summer 2008. Non-hypertensive patients were asked whether a doctor or other health care provider had ever told them they had "prehypertension"; a subsample of patients with measured blood pressure (BP) in the prehypertension range was asked the same question. of 1008 non-hypertensive patients, 1.9% indicated being told they had prehypertension. Among a subsample of 102 patients with measured BP in the prehypertension range, 2.0% indicated being told they had prehypertension. few patients who probably have prehypertension are being told about it by clinicians.

Academic family medicine--redefining academic

This was a comment that I received for a seminar on research and teaching in family medicine that I gave to primary care doctors a few years ago. One of the meanings for ‘academic’ defined by the Oxford Dictionary is ‘abstract; theoretical; not of practical relevance’. Academic work especially research is traditionally regarded as the luxurious pursuit of professors working in University ivory towers. There is growing criticism that huge investments in biomedical research has resulted in very little, if any, benefits in people’s health. The term academic needs to find a new meaning. In the establishment as a scientific discipline, defined by Clarke as ‘ a body of knowledge acquired through research that can be transmitted by teaching’, academic family medicine has redefined academic to become the acronym for: Articulating the body of knowledge that informs practice, Conceptualizing the work of a doctor, Adapting to changing needs of the population, Developing medical education, Enjoying and valuing the doctor–patient relationship, Managing resources cost-effectively, Improving the quality of care and Contributing to the art and science of medicine.

THE CHALLENGE TO BUILD RESEARCH CAPACITY IN FAMILY MEDICINE: IS OUR DISCIPLINE READY?

Research in family medicine is critical to the success of our discipline. Research enables improved patient outcomes, more informed health policy, more effective education and training strategies, and enhanced academic credibility. As health care reform is implemented in the United States, there is

Quality and safety: Precision, accuracy and compliance with accepted standards of care

The African Journal of Primary Health & Family Medicine welcomes submissions that encourage scholarly exchange between family medicine and primary health care researchers and practitioners across Africa and the developing world, whilst providing a contextual and holistic view of family medicine as practiced across the continent.