Program For Primary Care Physicians Research Articles

Ability of primary care physician's to break bad news: A performance based assessment of an educational intervention

Objective We have previously described a breaking bad news (BBN) training program for primary care physicians [Ungar L, Alperin M, Amiel GE, Beharier Z, Reis S. Breaking bad news: structured training for family medicine residents. Patient Educ Couns 2002;48:63–68]. In this paper, we present the assessment of an educational intervention aimed at improving this important skill. Methods The assessment tool was an eight station objective structured clinical examination (OSCE) utilizing standardized patients (SPs). Intervention and control groups of 17 general practitioners (GP) each were evaluated before and after an educational intervention, or a Balint group (control). Results Intervention group GPs significantly increased their average grade on the post-test as compared to the pre-test (58.5, S.D. 12.7 versus 68.4, S.D. 9.2), effect size 0.94. Improvement in the control group was minimal (pre-test 57, S.D. 10.4 versus 58.1, S.D. 9.5 for the post-test), effect size 0.23. Reliability of the OSCE was α = 0.81. Conclusion The performance assessment used in this study proved to be a reliable and valid tool to assess the ability of physicians to break bad news. It provided evidence of the effectiveness of the intervention. Practice implications BBN training can and should be evaluated by valid and reliable measures. SPs can serve as reliable evaluators of BBN training.

Fragility Fractures

“Our hope is that Americans can live long and live well. Unfortunately, fractures—the most common and devastating consequence of bone disease—frequently make it difficult...” “Much of the burden of bone disease can potentially be avoided if at-risk individuals are identified and appropriate interventions... are... timely.... (H)ealth care providers frequently fail to identify and treat individuals at high risk for osteoporosis or other disorders of bone...” “... a number of `red flags'... signal potential problems with an individual's bone health at different ages. One of the most important flags is a previous fragility-related fracture.”1 In releasing the Surgeon General's report, Bone Health and Osteoporosis , Secretary Tommy Thompson of the Department of Health and Human Services declared: “Osteoporosis, fractures, and other chronic diseases no longer should be thought of as an inevitable part of growing old.” Seniors should “live long and live well.” To achieve that goal, Secretary Thompson contends, we must move beyond the traditional focus on providing health care and emphasize prevention. “By focusing on prevention and lifestyle changes, including physical activity and nutrition, as well as early diagnosis and appropriate treatment, Americans can avoid much of the damaging impact of bone …

FRAGILITY FRACTURES

FRAGILITY FRACTURES

Postgraduate educational program for primary care physicians in remote areas in Lebanon.

Continuing medical education (CME) is a requirement in many developed countries. Lebanon lacks such a rule; hence, the dictum "once a doctor always a doctor" holds. This article describes a pioneering postgraduate educational program for primary care physicians in remote areas of Lebanon. The Lebanese Society of Family Medicine introduced a 2-year structured CME program to four remote Lebanese areas. Thirteen family physicians provided 33 activities to 1,073 primary care physicians tackling 22 subjects chosen from a list of 53 common clinical problems approved by community medical leaders. Each attendee was requested to complete an evaluation form at the end of each session. The activities were attended by 1,073 physicians, 914 of whom filled out the evaluation forms (85.2% response rate). The analysis of the response of the attendees revealed that 65% of the attendees completely agreed that they benefited from the activities, 68% completely agreed that the presentations were clear, 86% thought that the methods used were adequate, 57% agreed completely that the presenters were prepared, and 69% replied that enough time was available for interaction. The CME programs were conducted with minimal costs. They were well received by attendees. It is recommended that the Lebanese health authorities make CME a requirement to promote the knowledge and behavior of primary care physicians and improve health.

Outcomes of combined internal medicine-pediatrics residency programs: a review of the literature.

To evaluate the outcomes of combined internal medicine and pediatrics (IMP) residency programs using the published literature. A literature search was conducted using Medline. Published articles were categorized as research or non-research (commentary, program requirements, program descriptions). Research articles were summarized and the results grouped under ten outcome variables. Of the 32 articles located, 18 were research articles, of which only four had been published since 1993. All the research conducted was cross-sectional and most involved surveys of program directors (seven studies) or graduates (four studies). At the time the studies were conducted, 20-33% of IMP residents did not complete their combined training; attrition rates have not been documented recently. Approximately 80% of IMP graduates achieved certification in both specialties, one third subspecialized to some degree, and 80% provided care to both adults and children. One fourth of the graduates felt that more training was needed in ambulatory settings and less was needed in intensive care. Very few studies of the outcomes of IMP physicians were found. The outcomes of IMP residency programs are important for health workforce policy, and this study documents a need for more extensive research on the outcomes of training programs for primary care physicians.

The MacArthur foundation depression education program for primary care physicians: background, participant's workbook, and facilitator's guide

In order to improve the assessment and management of depression in general medical care, the f ohn D. and Catherine T. MacArthur Foundation supported the development, evaluation, and dissemination of an eight-hour depression education program (DEP) for primary care physicians. This publication includes a paper describing the background and educational rationale for the program structure, the complete participant's workbook, and a facilitator's guide for teaching the program. Given in two separate four-hour workshops by a psychiatrist and a primary care physician, DEP is delivered to small groups of learners (about 12) using an interactive adult learning model and multiple teaching techniques including targeted yet flexible objectives, two lectures, videotape demonstration and discussion, role-play exercises, a focused monograph on depression, an interview checklist, structured assessment and outcomes tools, clinical case studies, and audiotape review of actual patient interviews. DEP has been shown in a prospective' randomized trial to improve physicians' interviewing skills as well as' simulated-patient satisfaction scores. Over 150 PCPs in four states have taken DEP in more than 30 separate programs given by 24 trained facilitators. Participants, despite a wide diversity of background knowledge and skills, have uniformly reported remarkably positive learner satisfaction with all dimensions of the Program.

Current practice patterns of primary care physicians in the management of patients with hepatitis C.

Approximately 4 million Americans are infected with the hepatitis C virus (HCV). Most patients with hepatitis C have no symptoms until cirrhosis is established. Thus, initial diagnosis and management of hepatitis C rely on primary care physicians identifying and screening high-risk individuals. We administered a survey to 1,233 primary care physicians in a health maintenance organization (HMO) in April 1997 to assess their knowledge of the risk factors for HCV infection and approach to the management of 2 hypothetical HCV antibody-positive patients, 1 with elevated and the other with normal alanine transaminase (ALT). Four hundred four (33%) physicians returned the survey. Ninety percent of respondents correctly identified the risk factors for HCV infection, but 20% still considered blood transfusion in 1994 as a significant risk factor for HCV infection. Sixty-two percent of respondents would refer HCV antibody-positive patients with abnormal transaminase levels, but 33% would follow these patients themselves, even though none of the respondents had treated any hepatitis C patient on their own. Forty-three percent of respondents overestimated, while 29% did not know the efficacy of interferon treatment. Sixty-five percent of respondents would retest patients for HCV antibody, regardless of risk factors and transaminase levels. We found that most primary care physicians correctly identified the significant risk factors for HCV infection and appropriately managed the 2 hypothetical patients, but there was considerable confusion about the use of HCV tests and the effectiveness of treatment. Educational programs for primary care physicians are needed to implement hepatitis C screening and to initiate further evaluation and management of those who test positive.

CME Program for Primary Care Physicians: How I Do It

Educational objectives: To provide a format for hosting a CME program for primary care physicians and to be able to use the resources of the Academy in preparation for CME programs.

Flexible fiberoptic sigmoidoscopy training for primary care physicians: results of a 5-year experience

The first 5 years of a flexible fiberoptic sigmoidoscopy (FFS) training program for primary care physicians was analyzed in an attempt to assess clinical competence and develop a procedure learning curve. A total of 47 primary care physicians (26 third-year family practice residents, 15 family practitioners, and 6 internists) were successfully trained in 60-cm FFS by five gastroenterologists. Didactic teaching methods included 5 hours of videotapes, slides, endoscopic models, and the use of a photo atlas. Following a patient demonstration, each trainee completed 25 examinations supervised with a teaching attachment. Criteria used to assess trainee competence included unassisted length of scope insertion and examination duration. Mean depth of scope insertion was 35.9 cm for the first five examinations, increasing to a mean of 51.7 cm for the final five examinations. Average examination duration decreased from 19.1 min for examinations 1 through 5 to 17.0 min for examinations 21 through 25. Out of 1236 examinations, one or more polyps were found in 222 patients (18.0%). Carcinoma was found in 15 of 1236 examinations (1.4%). In summary, experienced endoscopists can teach primary care physicians to perform 60-cm FFS. Completion of 25 supervised cases appears to be adequate for achieving technical competence in flexible fiberoptic sigmoidoscopy.

Evaluation of a continuing medical education program for primary care physicians on the management of alcoholism.

Evaluation of a continuing medical education program for primary care physicians on the management of alcoholism.

Models of mental health training for primary care physicians.

Of the 15% of the population with DSM III diagnosable disorders, 54% are seen exclusively by their primary care physician or by other health professionals. To understand how primary care physicians are prepared for this task the authors attempted to develop a taxonomy of mental health training programs for primary care physicians by: review of the literature, interviews with program sponsors, review of NIMH training grants, and site visits to teaching programs. From this process six program types were defined: consultation, liaison, bridge, hybrid, autonomous, and postgraduate specialization. The characteristics and emphasis of these model types are described as well as program needs for future training. Competence in psychosomatic medicine, psychophysiologic reactions, and the interactions of biologic, psychologic, and social factors in health and disease can be imparted to primary care physicians by such mental health training program designs.

Family physicians' perceptions of psychosocial disorders: survey report and educational implications.

One-hundred seventy-seven family physicians were surveyed regarding their perceptions of the types of psychosocial problems encountered in their practices, the amount of time they felt they devoted to each problem, and their interests regarding continuing psychiatric education. Patients with "multiple somatic complaints" and "symptoms of emotional distress" were reported as being encountered most frequently. Marital and family problems, alcoholism and sexual dysfunction were also ranked highly. The physicians indicated the highest interest in managing these disorders in addition to treatment of the suicidal patient. The implications of these results for psychiatric educators and liaison psychiatrists are discussed. The authors recommend using DSM-III diagnostic criteria applicable to these syndromes in formulating educational programs for primary care physicians.