General Preventive Medicine Research Articles

Occupational and environmental medicine in preventionist residency training programs.

In the United States today, there remains a need to train physicians with expertise in occupational medicine and its corollary, environmental medicine. To determine whether preventive medicine residency training programs provide trainees with skills and knowledge in occupational and environmental medicine, we conducted a survey among directors of general preventive medicine and combined general preventive medicine/public health programs in the United States that listed such emphases in the Directory of Preventive Medicine Residency Programs in the United States and Canada. Of the programs surveyed, over 50% included occupational and environmental medicine training opportunities. Individuals who have trained in these settings have obtained employment in positions related to this training, and some have obtained certification. Our findings suggest that preventive medicine training programs may provide an avenue for training and certification in occupational and environmental medicine.

A Survey of Residency Management Training: General Preventive Medicine Graduates

General preventive medicine residents at the University of Arizona are introduced to management skills and issues during graduate medical training to prepare them for future administrative positions. Our objectives were to learn whether administration training was effective and if acquired skills are useful in present job duties of graduates. We mailed a questionnaire to former general preventive medicine residents who had graduated between 1983 and 1992. Twenty-one (81.8%) of the 26 graduates returned a completed questionnaire rating the extent to which certain training activities improved administration skills and assessing the extent to which residency training overall prepare them for administrative work. Ratings reflected adequate preparation and usefulness of skills on the job. The survey indicates that administrative training should begin during residency years and that a variety of short-term and long-term activities, organized throughout both academic and practicum years can produce reasonable success in graduates. Medical Subject Headings (MeSH): preventive medicine, training.

Training Physicians to Care For the Underserved: Preventive Medicine Residency-Community Health Center Linkages

The population of uninsured and underinsured individuals in the United States continues to grow, compounding problems of adequate access to medical care. Some of the medical needs of this population are met by community health centers (CHCs). However, CHCs often have difficulty recruiting and retaining physicians, especially those with skills in community medicine. This article describes a general preventive medicine residency program that has been successful in preparing physicians for practice in these settings-what we call training in community-oriented preventive medicine (COPM). At the heart of COPM training are mutually beneficial relationships between CHCs and the residency program. This process has been greatly facilitated through the use of Health Resources and Services Administration (HRSA) federal training grant support to "match" funds provided by CHCs. As of July 1994, 11 residents have entered the COPM track, with eight graduates and three current residents. Thus far, all graduates have remained involved in community-based medical care and preventive medicine activities for medically underserved populations. This training arrangement can serve as a model for other preventive medicine residency programs and for CHCs interested in enhancing physician recruitment and retention. Medical Subject Headings (MeSH): community-oriented preventive medicine, medically uninsured, preventive medicine residency training, community health centers.

Adequacy of training in preventive medicine and public health: a national survey of residency graduates.

To evaluate training in general preventive medicine and public health, determining which experiences and institutional sponsors best prepare residents for practice and where improvements are most needed. A 1991 survey of the 1,070 graduates of preventive medicine residencies from 1979 through 1989 asked the graduates to measure the adequacy of their training in preventive medicine topic areas by using a Likert-type scale of 1 (poor) to 4 (excellent). Adequacy was analyzed for variation against practice emphasis during training, training program sponsor, and other variables. The statistical methods included Student's t-test, analysis of variance and linear regression. A total of 797 graduates (74.5%) responded. The overall mean ratings of adequacy of training were 3.1 (SD, 0.9) for epidemiology, 2.5 (SD, 1.0) for clinical preventive medicine, 2.4 (SD, 0.9) for environmental health, 2.3 (SD, 0.9) for health administration, 2.3 (SD, 0.9) for health education and behavioral sciences, and 2.2 (SD, 0.9) for occupational medicine. Training was rated highest for topics emphasized during practice experiences. Adequacy varied by type of institution sponsoring the residency. Women rated their training as being less adequate than did men in all areas except clinical preventive medicine. The graduates tended ultimately to practice in topic areas emphasized during training. The graduates' ratings suggest that improvements are most needed in health administration, environment health, health education, and occupational medicine. Potential improvement strategies include highly focused practice experiences and increased emphasis on training in actual practice settings and community sites.

Practicing Preventive Medicine: A National Survey of General Preventive Medicine Residency Graduates—United States, 1991

We conducted a national survey of all physicians who graduated from preventive medicine residency (PMR) programs between 1979 and 1989. We mailed a self-administered questionnaire to all PMR graduates of the 43 U.S. programs in General Preventive Medicine and Public Health, requesting information on their current professional activities. Out of 1,070 PMR graduates, 797 (75%) responded to the survey. Overall, graduates were distinguished from other physicians by both work setting and work activities. PMR graduates worked predominantly in institutional settings: in federal or state health agencies, academia, or hospitals/clinics. In addition to maintaining their involvement in clinical medicine, PMR graduates were heavily involved in epidemiologic research and program management. This unique blend of organizational skills, expertise in population-based research, and clinical experience makes PMR graduates an increasingly important human resource as health care reform increases the population of patients being cared for in a managed care setting.

Meanwhile Back at the Ranch: Training Residents in Clinical Preventive Medicine

In view of the current growing interest in prevention as an integral part of health care, it is timely to consider clinical preventive medicine (CPM) training approaches that best prepare physicians to deliver appropriate and effective preventive services. During CPM training, skills residents most need to acquire include methods of counseling on health promotion and techniques for advising patients on reducing health risks by changing disease-promoting behavior. University of Arizona residents in the General Preventive Medicine program receive this training focus at Canyon Ranch, a Tucson health resort and university training site. This training is an important component of the CPM area of emphasis in the residency program. Training emphasizes risk reduction and health promotion with a large volume of patients whose aim is to effect lifestyle changes. Emphasis is placed on acquiring skills in clinical prevention. Counseling and patient education are the primary foci. Evaluation data indicate that residents' perception of the rotation's benefit to their education is high, and interest in considering practice in a similar setting is reinforced as a result of the experience. Medical educators in preventive medicine and primary care need to turn their attention to finding appropriate training sites with suitable role models to teach counseling and patient education skills.

Performance Indicators for Assessing Competencies of Preventive Medicine Residents

Heightened national interest in population-based medicine, clinical preventive services, and health care management underscores the current need for definition and assessment of physician competency in these areas. This article describes a project sponsored by the Health Resources and Services Administration (HRSA) to develop competencies for each of the three specialty areas in preventive medicine and appropriate measures for the achievement of those competencies. We discuss fundamental issues surrounding assessment that helped guide the process, types of measurement strategies, and criteria for effective competencies and performance indicators. The article also explains the Work Group process used to reach consensus and identifies concerns and challenges raised during this process. We include the list of specialty competencies and performance indicators developed by the project. The project, entitled "Improving Training of Preventive Medicine Residents through the Development and Evaluation of Competencies," served as a model for interorganizational collaboration between the federal government (HRSA); a specialty society, the American College of Preventive Medicine (ACPM); and a preventive medicine residency program, State University of New York (SUNY) at Stony Brook. The commonality of competencies expected of residents in all three specialty areas of preventive medicine--occupational medicine, general preventive medicine and public health, and aerospace medicine--reaffirmed the rationale for including all of these areas within the single specialty of preventive medicine.

Mass screening in occupational health from the practitioner's viewpoint

A practicing occupational physician presents his view of meaningful prophylactic examinations. Requirements for these examinations are summarized in 7 postulates: that priority be given to primary prevention, to efficiency, and to medical and occupational history taking, that conclusions from these examinations always be transformed into concrete measures at the workplace, that continuing bilateral exchange of information with the supervising governmental authorities be assured, that synergistic effects be taken advantage of for the goals of general preventive medicine, and that the collected data be evaluated epidemiologically.

Preventive Medicine Residents: A National Survey

Little is known about those physicians who pursue graduate medical education in preventive medicine, including aerospace medicine, general preventive medicine and public health, and occupational medicine. We surveyed resident physicians about their academic background, financial environment, clinical activities, and professional goals. A total of 147 residents (30%) responded from a population of 498 residents. The data suggest a lack of available information about preventive medicine training and careers among medical students who subsequently pursue such training. Their economic environment is extremely diverse, with a wide range of salary, "moonlighting" hours, educational loans, and service obligations. Although the median annual salary ($24,700) is similar to the national average resident salary, 32% of respondents earned less than $20,000, and 95% have educational debts averaging $30,900. Sixty-two percent of respondents perform clinical work in their residency, whereas 76% desire future clinical work as part of their practice. This gap is most pronounced in general preventive medicine and public health. The residents express a wide range of interests in future practice of preventive medicine; 54% are interested in government work, and 33% desire academic careers.

Career Choices of General Preventive Medicine Residency Graduates: 1981-1986

To identify career choices made by recent graduates of general preventive medicine residency programs, all funded residency programs in general preventive medicine (excluding federal and military programs) were surveyed. Eighty-two percent of programs responded and reported on the career choices of 241 graduates who graduated from 1981 to 1986. In order of preference, the categories of career choice were: program activities (36.5%), teaching (19.1%), clinical services (17.0%), and research (6.2%). About one-fifth (21.2%) chose other activities. The number of graduates more than doubled between the periods 1981-1983 and 1984-1986. There was a threefold increase in the percentage of graduates involved primarily in research; however, there was a 33% decrease in the percentage of graduates who became professional academicians.

Minimal intervention and arthritis treatment: Implications for patient and physician compliance

A rationale based on a public health perspective for using minimal intervention programs in the treatment of arthritis is presented. Minimal interventions are relatively inexpensive, relatively free from side effects, and produce therapeutic effects that range from statistically significant to clinically important. Empirical evidence regarding the relative efficacy of minimal intervention programs continues to accumulate in general preventive medicine. Extension to arthritis treatment and control is recommended. This will require (1) practitioners to recognize the public health perspective, (2) consensus judgment that a treatment is likely to produce therapeutic benefits at little cost and with minimal side effects, and (3) empirical validation of efficacy based on clinical trial results. It is concluded that the concept of minimal intervention could increase physicians' use of such treatments and thereby increase the therapeutic benefits to patients suffering from arthritic disease.

COMMENTARY: THE PROPOSED GENERAL PRACTICE DESCRIPTORS ‐ WILL THEY INFLUENCE PREVENTIVE MEDICINE?

The proposed descriptor bill to change Medicare rebates to general practice patients could have a benefit to general practice preventive medicine. This seems possible through rewarding practitioners who spend more time with their patients and the positive effects of continuing medical education. However, the potential exists for whittling away any rewards for these practitioners by future governments and the audit of general practices could become a method of political control of Australian general practice.

Management roles for physicians: training residents for the reality.

The University of Arizona has incorporated administrative training into general preventive medicine residency and occupational medicine residency training programs to provide preparation at the most appropriate time for future management roles for physicians. Training parallels future specialty choices and focuses on computer skills, fiscal control, budgeting, personnel management, political or regulatory process, program development, and planning and organization. Throughout the 2-year training period, residents are in a position to acquire management skills through course work, selected rotations, special projects, and a concentrated 1-month rotation in administration. Practical application is exercised in management settings within the department and in the community. A longitudinal training approach is advocated for similar programs and for other specialties to ensure successful management of health care with physicians as an integral component.

The Preventive Medicine Physician: A National Study

Following the 1980 Graduate Medical Education National Advisory Committee report, postal questionnaires were sent to a random sample of physicians self-designated as preventive medicine specialists primarily in an effort to verify the committee's assumption that preventive medicine is not a clinical specialty. The questionnaires represented each of the preventive medicine subspecialties: general preventive medicine, public health, occupational medicine, and aerospace medicine. After three reminders, 419 out of 942 (44%) responded. Seventy percent of the physicians who responded engage in clinical activities for at least part of their workweek. Preventive medicine is practiced in a wide variety of settings. For the majority of preventive medicine physicians, prevention plays an important role in their practice. They perceive that they practice medicine differently from their colleagues who are not preventive medicine specialists because of their prevention focus. Many of these physicians have made career changes, and some have made many such changes, as board certification in one of the subspecialties does not preclude practice in another subspecialty. The specialty appears to allow considerable flexibility. The preventive medicine physician is prepared to incorporate prevention into clinical practice and seems well equipped to integrate community and individual clinical approaches.

"IUD Insertion Practices in the United States and Puerto Rico, 1973."

Retrospective reports on IUD insertions during the first 6 months of 1973 were provided by 16893 physicians residing in the U.S. and Puerto Rico. This was 48.9% of the physicians listed in the master files of the American Medical Association and the American Osteopathic Association as having an interest in obstetrics and gynecology public health general preventive medicine or family practice. Information elicited by interviews with 1% of the nonrespondents mirrored that of the respondents. It is estimated that in the 6-month period there were 810000 IUD insertions. Regional rates varied from a high of 27.3/1000 in parts of the West to 11.8-12.4/1000 in the Midwest. The rate for the nation was 18/1000. The percentage of nonprivate patients receiving IUDs varied substantially by region too. 85% of all insertions were do ne by physicians; 6% by paramedical personnel. 90% of the physician-inserted IUDs were by doctors whose primary specialty was obstetrics-gynecology and more than 75% were by doctors engaged in direct patient care. Rates of insertion by individual physicians varied greatly. 1% of the obstetricians-gynecologists averaged more than 8 insertions a week.

IUD Insertion Practices in the United States and Puerto Rico, 1973

Retrospective reports on IUD insertions during the first 6 months of 1973 were provided by 16,893 physicians residing in the U.S. and Puerto Rico. This was 48.9% of the physicians listed in the master files of the American Medical Association and the American Osteopathic Association as having an interest in obstetrics and gynecology, public health, general preventive medicine, or family practice. Information elicited by interviews with 1% of the nonrespondents mirrored that of the respondents. It is estimated that in the 6-month period there were 810,000 IUD insertions. Regional rates varied from a high of 27.3/1000 in parts of the West to 11.8-12.4/1000 in the Midwest. The rate for the nation was 18/1000. The percentage of nonprivate patients receiving IUDs varied substantially by region, too. 85% of all insertions were do ne by physicians; 6% by paramedical personnel. 90% of the physician-inserted IUDs were by doctors whose primary specialty was obstetrics-gynecology and more than 75% were by doctors engaged in direct patient care. Rates of insertion by individual physicians varied greatly. 1% of the obstetricians-gynecologists averaged more than 8 insertions a week.

Residency Training in Public Health and General Preventive Medicine: A Preliminary Comparison

Residency Training in Public Health and General Preventive Medicine: A Preliminary Comparison

Physicians Gather in Atlantic City

Physicians Gather in Atlantic City

Preventive Medicine

The Section on Preventive Medicine is the American Medical Association's home of those special interests in medicine that have been identified under the American Board of Preventive Medicine —currently public health, aerospace medicine, occupational medicine, and general preventive medicine. Discontent with the term "preventive medicine," with the specialty groupings under preventive medicine, and with the emphasis of various residency programs is frequently expressed. Is this discontent purely one of semantics or are there differences in goals and purposes that preclude a unified approach? If we could agree on goals and purposes, are the means of attaining these goals so diverse that the means themselves determine widely different professional capabilities? These are issues which can be reviewed superficially at best in the space allotted. I believe examination of the major components will identify more that unite than divide us and that the jobs to be done in the years ahead call

Public Welfare Organization in Canada

AT PRESENT the central problem of organization in Canada is the question of the responsible branch of government — Dominion, province, or municipality. 2 This paper will be concerned chiefly with the distribution of functions between the Dominion and the provinces, with some attention being paid to the distribution between the province and its local authorities. In addition, it will touch briefly upon the question of Dominion and provincial administrative machinery. Major problems will be outlined under these two headings, distribution of functions and administrative organization, and an attempt will be made to throw out some suggestions and questions regarding future policy. Since the term public welfare is used loosely in Canada, it is necessary to set up a working definition. For the purposes of this paper will be taken to include those services of government that may be described separately as assistance (unemployment and poor relief, pensions and allowances, medical services and hospitalization, etc., granted to destitute persons after application of a means test); child welfare; mental hygiene (mental hospitals, institutions for mental defectives, psychiatric clinics, etc.) ; corrections (jails, industrial schools, probation services, etc.) ; and (including tuberculosis and venereal disease control and general preventive medicine). The term health and welfare is frequently used to describe this broad sector of administration, particularly by those who do not agree that should be included under the general heading public welfare. However, considerations of time and space preclude lingering here