Primary Care Track Research Articles

Where Have All the Primary Care Applicants Gone?

NOT all aspects of the 1960s can be viewed with nostalgia. Nevertheless, many people have such feelings for the deep social concern of the times. During the 1960s Congress implemented Medicare and Medicaid and also initiated primary care programs for underserved rural and inner-city populations. Convictions about a shortage of physicians led first to an expansion in the size of medical school classes and then to a recognition that more primary care physicians were needed. With state and federal support, residency training in family practice expanded rapidly during the 1970s,1 followed by the introduction of primary care tracks in internal . . .

Evaluation of Developmental/Behavioral Training in Primary Care

Primary care and regular track residents in one pediatric program were compared with respect to knowledge, perceived level of competence, and attitudes relative to developmental and behavioral pediatrics from beginning to end of the residency. Measures of knowledge and self-perception of competence showed a common pattern characterized by (1) no differences between primary care and regular track residents on entry into the program, (2) significant progress in both groups over the period of the residency, (3) significantly greater progress by primary care residents. Ratings regarding relevance of developmental and behavioral issues for pediatric practice showed that ratings of relevance were significantly higher at the beginning of the residency among primary care residents and remained higher throughout.

Ten Years of Graduates Evaluate a Pediatric Residency Program

Ten years of graduates (1979 through 1988) from a pediatric residency program with a primary care track were surveyed for their perceived level of comfort gained in training for 28 different content/specialty areas of pediatrics and for their recommendations for increasing emphasis/time during residency for these areas. The response rate was 73%. The highest levels of comfort and fewest recommendations for increasing emphasis were for neonatal problems and health maintenance. The lowest perceived comfort levels and the most recommendations for increasing emphasis were for economics of pediatric practice and sports medicine/orthopedics. Graduates from the primary care track of the pediatric residency program expressed more comfort than did regular track graduates for some, but not all, areas of pediatrics emphasized in the primary care track program. Graduates of the first 5 years of study were not as comfortable with their training overall as were graduates from the most recent 5 years. This survey method and its results can provide useful information to medical educators faced with evaluation and revision of pediatric residency training programs.

Practice preferences of primary medical care and traditional internal medicine house officers.

In an academic medical centre between 1980 and 1985, the attitudes, preferences and career goals of house officers in a primary medical care residency training programme were assessed at entry and at the end of each house officer year. Primary care trainees who went on to practise in a general medicine setting were compared to primary care trainees who subsequently received subspecialty training and also to traditional internal medicine trainees. House officers in the primary care programme generally maintained attitudes and preferences central to the practice of primary care, and scored significantly higher than traditional track house officers on attitudes and preferences compatible with the practice of medicine in a primary care setting. However, primary care house officers who later went into subspecialty training received scores similar to those of traditional track house officers on practice preferences relating to specialty care. There were no significant differences between primary care and traditional track house officers on standard measures of knowledge and clinical skill.

Curricula and organization of primary care residencies in internal medicine.

This report describes the differences in organization and curricula of primary care and traditional residencies in internal medicine. Representatives from 59 of 337 internal medicine residencies responding to a survey in 1977-78 (17.5 percent) described a residency program which emphasized primary care. The mean number of first-year residents in each program was 4.9; second-year, 4.6; and third-year, 4.3. A National Resident Matching Program number different from the number used by the traditional residency program at that institution was used for the primary care track by 47 percent of the respondents. Residents in primary care programs spent 38 percent of their training in ambulatory care, significantly more than the 21 percent spent by traditional residents. Primary care residents spent 48 percent of ambulatory care training time in continuity of care experiences, compared with 39 percent for traditional residents. Primary care programs also offered more electives in specialties outside of internal medicine. Out-of-hospital ambulatory practices and neighborhood health centers were also utilized more frequently by primary care programs.

A Career in Primary Care

The stated objective of the authors is to propose a new approach to medical education in the primary and continuing care of ambulatory patients. In developing this concept, there is a large amount of historical, analytic, and normative material presented— sometimes not clearly differentiated. The plan consists of six distinct phases or steps: (1) career choice and commitment on graduating from high school, (2) selection on the bases of interest, aptitude, and personality, (3) two years of collegiate and some clinical environments, (4) four years of a primary care track in medical school, including brief periods on hospital wards, (5) one year in an internship following graduation, and (6) continuing education. On completing this course of study, a person would be qualified to participate in a group or association of those involved with all levels of care. The area of specialization of the primary care physician would be that of