Family Practice Training Research Articles

Southwest Florida and COVID- 19: A Large Community Experience

COVID-19 is a novel virus initially reported from Wuhan, Hubei province in December 2019 that has spread globally. As the virus spread, clinicians were trying to assess the populations at risk, how to treat and follow best practice guidelines as they were evolving. We sought to examine our community hospital experience, identify predictors of mortality and establish guidelines that would help the system in the future including EVALUATION of service line effectiveness for those high-risk populations, and how COVID-19 impacted our Family Practice training program.

Small Is Beautiful: Health Care With a Human Face.

> Man is small, and, therefore, small is beautiful.[1][1] > > —E. F. Schumacher As I was preparing to enter family practice training in 1979, I read 2 books that left an indelible stamp on my thinking about health and health care. The first was Wendell Berry's The Unsettling of America ; the

A Better World in the Future

A Better World in the Future

Mental health professionals\u2019 family-focused practice with families with dependent children: a survey study

BackgroundMany people with a mental illness are parents caring for dependent children. These children are at greater risk of developing their own mental health concerns compared to other children. Mental health services are opportune places for healthcare professionals to identify clients’ parenting status and address the needs of their children. There is a knowledge gap regarding Thai mental health professionals’ family-focused knowledge and practices when working with parents with mental illness and their children and families.MethodsThis cross –sectional survey study examined the attitudes, knowledge and practices of a sample (n = 349) of the Thai mental health professional workforce (nurses, social workers, psychologists, psychiatrists) using a translated version of the Family-Focused Mental Health Practice Questionnaire (FFMHPQ).ResultsThe majority of clinicians reported no training in family (76.8%) or child-focused practice (79.7%). Compared to other professional groups, psychiatric nurses reported lower scores on almost all aspects of family-focused practice except supporting clients in their parenting role within the context of their mental illness. Social workers scored highest overall including having more workplace support for family-focused practice as well as a higher awareness of family-focused policy and procedures than psychiatrists; social workers also scored higher than psychologists on providing support to families and parents. All mental health care professional groups reported a need for training and inter-professional practice when working with families.ConclusionsThe findings indicate an important opportunity for the prevention of intergenerational mental illness in whose parents have mental illness by strengthening the professional development of nurses and other health professionals in child and family-focused knowledge and practice.

Examining patterns in medication documentation of trade and generic names in an academic family practice training centre

BackgroundStudies in the United States have shown that physicians commonly use brand names when documenting medications in an outpatient setting. However, the prevalence of prescribing and documenting brand name medication has not been assessed in a clinical teaching environment. The purpose of this study was to describe the use of generic versus brand names for a select number of pharmaceutical products in clinical documentation in a large, urban academic family practice centre.MethodsA retrospective chart review of the electronic medical records of the St. Michael’s Hospital Academic Family Health Team (SMHAFHT). Data for twenty commonly prescribed medications were collected from the Cumulative Patient Profile as of August 1, 2014. Each medication name was classified as generic or trade. Associations between documentation patterns and physician characteristics were assessed.ResultsAmong 9763 patients prescribed any of the twenty medications of interest, 45% of patient charts contained trade nomenclature exclusively. 32% of charts contained only generic nomenclature, and 23% contained a mix of generic and trade nomenclature. There was large variation in use of generic nomenclature amongst physicians, ranging from 19% to 93%.ConclusionsTrade names in clinical documentation, which likely reflect prescribing habits, continue to be used abundantly in the academic setting. This may become part of the informal curriculum, potentially facilitating undue bias in trainees. Further study is needed to determine characteristics which influence use of generic or trade nomenclature and the impact of this trend on trainees’ clinical knowledge and decision-making.

Working with the whole family: What case files tell us about social work practices

AbstractPractice theories to support child protection social work in the United Kingdom, as in the United States and Australia, are being squeezed out by a focus on performance targets and procedural timescales. This study examines an innovative programme designed to reverse this trend initiated by an English local government authority. The programme aimed to embed systemic family practice in situations where children are deemed to be at risk of harm. The findings, derived from an analysis of a case file sample, indicate that the social worker interaction with family members is predicated on who is living with the child in conjunction with the risk status of the case file. Conversely, practitioner interactions with family members are divorced from family structure and the lived experiences of kin relationships. This study concludes by examining why, despite training in systemic family practice, it was problematic for social workers to integrate it into their encounters with families.

Integrated care and training in family practice in the 21st century: Taiwan as an example

Integrated care and training in family practice in the 21st century: Taiwan as an example

Implementation of an Evidence Based Guideline for Assessment and Documentation of the Civil Commitment Process.

The purpose of this quality improvement project was to implement an evidence-based practice guideline for assessment and documentation of the civil commitment process. Participants included six civil commitment examiners who conduct court ordered psychiatric evaluations at two crisis intervention centers in rural area of southeaster state. Data collection was conducted utilizing a chart audit tool both pre and post intervention of 100 civil commitment evaluations. The intervention included the development of an evidenced based form for documentation of civil commitment evaluations and a one on one educational training session was conducted for each participant. Descriptive statistics (t test) was utilized to analyze the data collected. The project demonstrated a significant increase as 25.5% of evaluations contained the America Psychiatric Association's recommended 11 domains of assessment prior to implementation compared to 65.6% (p value=0.018) post implementation. Moreover, participants with family practice training showed an increase in commitment rates from 60 to 77.3% (p value=0.066). Whereas, psychiatric trained participants showed a decrease from 83.75 to 77.66% (p value=0.38). Demonstrating that court ordered evaluations guided by a standardized form based on evidence affected examiners recommendations for commitments.

Antibiotic prescribing for respiratory infections: a cross-sectional analysis of the ReCEnT study exploring the habits of early-career doctors in primary care.

Antibiotic resistance is among the most important current public health issues. Most antibiotics are prescribed in primary care. There is strong consensus that they are overprescribed, especially for conditions such as upper respiratory tract infections (URTI) and acute bronchitis, where they provide limited benefit. Interventions to alter prescribing patterns have shown limited effect. Trainees in family practice may be an appropriate target, as their prescribing habits are still developing. To establish prevalence and associations of trainee prescribing of antibiotics for URTI and acute bronchitis/bronchiolitis. A cross-sectional analysis of the Registrar Clinical Encounters in Training (ReCEnT) study. ReCEnT is an ongoing cohort study of Australian General Practice (GP) trainees documenting the nature of their consultation-based clinical experiences. Trainees record details of 60 consecutive patient encounters every 6-month training term. Univariate and logistic regression analyses were conducted on data recorded in consultations related to URTI and acute bronchitis/bronchiolitis in six collection periods during 2010-12. Data from 401 trainees (94.7% response rate) were analysed. Antibiotics were prescribed in 21.6% of encounters for URTI and 73.1% of encounters for acute bronchitis/bronchiolitis. Trainees prescribing antibiotics were more likely to order tests, and to seek in-consultation advice. Logistic regression analysis demonstrated older patient age, Indigenous patient background, and practices in higher socioeconomic areas were significant predictors of antibiotic prescribing. GP trainee antibiotic prescribing is higher than justified by guidelines. Understanding factors contributing to this pattern will assist in developing educational interventions to improve evidence-based prescribing habits during the early stages of these doctors' careers.

Palestine: a week in November.

The Occupied Palestinian Territories (population 4.5 million) has no system of postgraduate training for family practice. Primary care is provided by GPs without specific training and specialists based in the community. The hero of this story, Dr Samar Musmar, is a Palestinian who was trained and licensed as a family practitioner in Florida, and has returned to her first home to build specialist family medicine there. An invitation for her to speak at a Society of Academic Primary Care meeting in 2011 and then at a ‘dangerous ideas’ session at the Royal College of General Practitioners conference in Glasgow in 2012 sparked off a commitment from some UK doctors to support her efforts. With Samar having set up a training programme for 19 primary care doctors, the first step was to plan an intensive 1-week …

Transition of adolescents with chronic health conditions to adult primary care: factors associated with physician acceptance.

To assess the willingness of adult primary-care physicians to transfer young adults with special health care needs (YASHCN) into their practices, and the relative impact of patient characteristics and transition supports. Survey of primary care internists and family practitioners using randomized patient characteristics and transition supports in clinical vignettes to assess physician willingness to accept a YASHCN into their practice. 404 responses were received from 601 surveys (response rate 67%). Only 44% rated themselves "willing" or "enthusiastic" to accept a YASHCN. Using four-way ANOVA testing, provider and practice characteristics significantly associated with willingness to accept included gender, years in practice, presence of YASHCN in current practice and whether the practice was accepting new patients. Patient condition and transition support significantly affected willingness to accept; training in internal medicine versus family practice did not. Physicians providing primary care for adults express limited willingness to accept YASHCN into their practices. Provider, practice and patient characteristics affected willingness to accept. Although transition supports affected willingness to accept, effects varied markedly across diagnoses and physician gender. Findings have implications for patients and healthcare teams and policy planners.

Improving the Diagnosis of Acute Otitis Media: “Seeing Is Believing”

Acute otitis media (AOM) should remain an entirely visual diagnosis for all of us. A muchimproved guideline on the diagnosis and management of AOM was recently published in Pediatrics.1 The new diagnostic emphasis in AOM is now the presence of infected middle ear effusion (MEE), as it appears with different levels of a bulging or convex tympanic membrane (TM). In the guidelines, the child with moderate to severe bulging TM or otorrhea is definitely considered to have AOM, whereas the child with mild bulging TM (once termed “fullness”) should also have concomitant recent ear pain or intense TM erythema. Remember that straight-forward otitis media with effusion, or serous otitis, should not be treated with antibiotics, but rather followed up over several months. As every pediatrician is keenly aware, AOM is the most common reason for prescribing antibiotics in every general clinical practice. In fact, before routine PCV7/13 vaccination, an AOM episode developed in 94% of all children in a non-inner city population by the age of 24 months.2 So, one would assume that probably the most important aspect in the entire discussion of AOM and its treatment would be how to correctly diagnose AOM and the optimal methods needed to obtain its diagnosis; however, one would be mistaken. Shaikh and Hoberman3 briefly addressed this problem in 2010. We are all painfully aware of how poorly diagnosed or misdiagnosed AOM can often be. Just ask any otolaryngologist or general pediatrician who sees patients in follow-up from many of their own lessexperienced health providers, community emergency rooms, urgent care centers, and even from other too-busy pediatric offices. Unfortunately, for such an everyday problem, the amount of time spent on teaching the correct diagnoses and management of AOM in medical school is negligible. Even in most pediatric and family practice training programs, training is minimal. So, why do we give such short shrift to such an important, ubiquitous pediatric assessment that must be ascertained in nearly every young pediatric patient’s well or sick visit? Do not kid yourself; this is one of the most technically difficult tasks to perform on young children within a general pediatric practice. It requires a confident, firm parent to restrain the child, as well as your own extreme diligence, patience, a lot of upper arm strength, and a stable eye to Improving the Diagnosis of Acute Otitis Media: “Seeing Is Believing”

Transforming health professional education through social accountability: Canada's Northern Ontario School of Medicine

Background: The Northern Ontario School of Medicine (NOSM) has a social accountability mandate to contribute to improving the health of the people and communities of Northern Ontario. NOSM recruits students from Northern Ontario or similar backgrounds and provides Distributed Community Engaged Learning in over 70 clinical and community settings located in the region, a vast underserved rural part of Canada.Methods: NOSM and the Centre for Rural and Northern Health Research (CRaNHR) used mixed methods studies to track NOSM medical learners and dietetic interns, and to assess the socioeconomic impact of NOSM.Results: Ninety-one percent of all MD students come from Northern Ontario with substantial inclusion of Aboriginal (7%) and Francophone (22%) students. Sixty-one percent of MD graduates have chosen family practice (predominantly rural) training. The socioeconomic impact of NOSM included new economic activity, more than double the School's budget; enhanced retention and recruitment for the universities and hospital/health services; and a sense of empowerment among community participants attributable in large part to NOSM.Discussion: There are signs that NOSM is successful in graduating health professionals who have the skills and desire to practice in rural/remote communities and that NOSM is having a largely positive socioeconomic impact on Northern Ontario.

Differences between rural and urban primary care units in Turkey: Implications on residents′ training

Context:Family practice training takes place at primary care based training centers linked to Education and Research State Hospitals in Turkey. There is a discussion if these units are adequate to train primary care staff and if the patients of these units reflect the applicants of primary care.Aims:The aim of our study is to investigate the demographic characteristics, the effect of distance on primary care utilization, and most common diagnosis of the patients who applied to two different outpatient clinics: One urban and one rural.Settings and Design:Study was conducted from the electronic health records of the patients applied to outpatient clinics of Ankara Diskapi Yildirim Beyazit Training and Research Hospital Department of Family Medicine between 1 January and 31 December 2009.Results:Total number of patients applied to both of the outpatient clinics was 34,632 [urban clinic: 16.506 (47.7%), rural clinic: 18.126 (52.3%)]. Leading three diagnoses were upper respiratory tract infection (URTI), general medical examination (GME), and hypertension (HT) in the most common 10 diagnosis.Conclusion:In our study, the rural outpatient clinic is regarded as a primary care unit in the neighborhood of living area and the urban clinic as close to working environment. We found statistically meaningful differences in most common diagnosis, gender, age, and consultation time between the rural and urban clinics. According to our results, family practitioners’ field training should take place at different primary care units according to sociodemographic characteristics of each country.

Los estudiantes de medicina españoles y la medicina de familia. Datos de las 2 fases de una encuesta estatal

ObjectiveTo examine the perceptions and expectations about Family Practice (FP) and Primary Care (PC) in 1st, 3rd and 5th year students in medical schools. DesignAn observational study in two cross sections with intervals of two years. LocationSpanish Medical Schools. Participants1st, 3rd and 5th year students of 22 schools (1st phase) and 15 (second phase). Primary measurementsSelf-report questionnaires completed during the first quarter of the 2009-2010 and 2011-2012 academic years. It had 70 items in three blocks: perceptions of FP (19 items), training in FP (26 items), expectations and preferences (25 items), plus 13 specific items for 3rd and 5th year students. Most of the items were answered in a 6 point Likert scale. ResultsA total of 5299 responses in phase I, and 3869 in phase II were received. Students perceive FP and PC as essential areas of the health system and professional practice, but with little scientific and technical appeal. The large majortiy, 87%, consider training in FP necessary and compulsory, and it should start in third year. They prefer hospital medical specialities (88-89%), followed by surgical and paediatrics. FP is preferred by the 37-39%. Only between 24% and 28% of students have a clear preference for a specialty when they start medical studies. ConclusionsFP and PC are key areas and should be part of the curriculum, but are perceived to be of low scientific appeal.

Study protocol: the Registrar Clinical Encounters in Training (ReCEnT) study.

BackgroundPatient encounters are the core learning activity of Australian general practice (family practice) training. Exposure to patient demographics and presentations may vary from one general practice registrar (vocational trainee) to another. This can affect comprehensiveness of training. Currently, there is no mechanism to systematically capture the content of GP registrar consultations. The aim of the Registrar Clinical Encounters in Training (ReCEnT) study is to document longitudinally the nature and associations of consultation-based clinical and educational experiences of general practice registrars.Methods/designThis is an ongoing prospective multi-site cohort study of general practice registrars’ consultations, entailing paper-based recording of consultation data. The study setting is general practices affiliated with three geographically-based Australian general practice regional training providers. Registrars record details of 60 consecutive consultations. Data collected includes registrar demographics, details of the consultation, patient demographics, reasons for encounter and problems managed. Problems managed are coded with the International Classification of Primary Care (second edition) classification system. Additionally, registrars record educational factors related to the encounter. The study will follow the clinical exposure of each registrar six-monthly over the 18 months to two years (full-time equivalent) of their general practice training program.ConclusionsThe study will provide data on a range of factors (patient, registrar and consultation factors). This data will be used to inform a range of educational decisions as well as being used to answer educational research questions. We plan to use ReCEnT as a formative assessment tool for registrars and help identify and address educational needs. The study will facilitate program evaluation by the participating training providers and thus improve articulation of educational programs with practice experience. From the research point of view it will address an evidence gap – the in-practice clinical and educational experience of general practice trainees, determinants of these experiences, and the determinants of registrars’ patterns of practice (for example, prescribing practice) over the course of their training.

The mentoring needs of trainees in family practice

This qualitative study examined medical students' and family practice residents' ideas, perceptions, and experiences of being mentored and their expectations of the mentoring experience. Eight focus groups and 16 individual interviews were used to collect data from 49 medical students and 29 family practice residents. Interviews and focus groups were audiotaped and transcribed verbatim. The analysis was iterative and interpretive, using both individual and team analyses. The analysis of the data revealed two central but related themes. The first theme reflected participants' overall experiences with mentors composed of three distinct elements: mentor roles (e.g. coach, advisor) and attributes (e.g. openness and approachability), interactions with mentors, and early exposure to family practice mentors (e.g. observing patient encounters). The second theme explicated the trainees' specific learning needs to be addressed by mentors that were categorised into three distinct yet overlapping levels: 1 practice level (i.e. guidance regarding the logistics of practice management) 2 system level (i.e. knowledge about the medical community as well as community resources) 3 personal level (i.e. guidance in balancing personal and professional responsibilities). Having the option of selecting multiple mentors to address unique aspects of the mentees' personal and professional development is critical in respecting the evolutionary nature and fluidity of the mentoring experience.

Family Practice in Turkey: Views of Family Practice Residents

Turkey's family practice training program is aimed at providing further training to clinically proficient family physicians who serve the community. A survey conducted in 2001 revealed that there was a need for providing additional training and more time in a specially dedicated family practice placement for family practitioners. Recent changes in the Turkish health care system have also impacted the training environment of family practice residents. Clearly, training needs to change with time. The aims of this study are to investigate the attitudes of resident family practice physicians regarding their training in the health care system in order to gather their views on the hospital learning environment, and to estimate their burnout levels. For this research, the design included a 1-phase cross-sectional study. This study was undertaken in 2008 in departments of family medicine at universities (n = 21) and training and research hospitals of the Ministry of Health (n = 11). Approximately 250 family practice residents in Turkey were approached. In total, 174 residents participated (70% response rate). The survey instruments included a questionnaire with 25 queries and 2 scales: The Postgraduate Hospital Educational Environment Measure and the Maslach Burnout Questionnaire–Human Services Survey. The average age of the participants was 32.2 years (standard deviation, 4.5 years; range, 24–57 years). The gender distribution was 57.6% women and 42.4% men. Marital status was 34.7% single, 62.9% married, and 2.4% divorced/widowed. In our results, residents affirmed that university hospitals were the best facilities for residency training. Their future plans confirmed that most would like to work in family health centers. This sample showed average levels of emotional exhaustion, depersonalization, and lack of personal accomplishment. Perceptions of professional autonomy, quality of training, and social support were below average. It may be concluded that certain milestones in the development of family practice in Turkey have been fulfilled. The new regulation for postgraduate training has increased the share of family practice training to 50% (18 months). Establishment of educational family health centers has been planned. Introduction of the formative and summative assessment processes in family practice training is anticipated. It is expected that an assessment such as the Membership of the Royal College of General Practitioners (International) (mRCGP[INT]) examination would be helpful for Turkish residents in reaching these goals.

Psychosocial evaluation of physicians receiving adaptation training in family practice

To identify the psychosocial conditions of physicians who received the first phase of the transition period adaptation training for family medicine practice in Bursa, and develop an efficient and reliable scale to take measurements during subsequent training processes. Materials and methods: A pilot test was given, using survey methodology, to physicians (442 people) who attended the first phase of the transition period adaptation training for family medicine practice in province of Bursa, Turkey, in 2008. The survey questions were designed to assess 3 factors: A- Adaptation to the program, B- Occupational self-confidence, and C- Non-exhaustion. Each factor was represented by 10 to 11 questions. A 5-point Likert-type scale was used for assessment (I-Strongly agree, II- Agree, III-Neither agree nor disagree, IV- Disagree, V-Strongly disagree.). Questions involving age, gender, length of professional experience, opinions about the training, knowledge and opinions of the family practice system, as well as views about the future work practice of each participant were asked. The contents of the 31-question survey to be used for the Pilot Test, along with its validity in terms of scope and content investigated, taking the views of 3 specialist doctors. Then, the survey was given to 442 doctors who participated in adaptation training, both before and after the training program. The results were analysed using the SPSS (Statistical Package for the Social Sciences) program. Reliability analysis was performed for all the factors in all 31 questions. Having removed the questions lowering the reliability in each factor, the remaining 17 questions were classified in 3 factors, by applying Factor Analysis (Quatrimax Method). Results: Two hundred seventy-one male (61.3%) and 171 female (38.7%) physicians participated in the survey. Mean age and length of professional experience was higher in males than females. While the majority of the participants (72%) thought the training they received was just an activity that would improve their adaptation, a small percentage (7.9%) thought that it would increase their professional competence. Statistically speaking, mean occupational self-confidence factor scores were higher in post-training tests compared to the mean scores before training (P < 0.001). Conclusion: Findings show that the first phase of the transition period adaptation training for family medicine provides a positive beginning and psychosocial improvement for these family medicine practitioners.

Perceptions, attitudes and knowledge of evidence-based medicine in primary care in Spain: a study protocol.

BackgroundThe philosophy of evidence-based medicine (EBM) was introduced in the early 90s as a new approach to the practice of medicine, using the best available evidence to make decisions about health care. Despite ongoing controversy, EBM has developed enormously and physicians' attitude towards it is generally positive. Nevertheless, in Spain little is known about this topic. We will therefore undertake a study to explore perceptions, attitudes and knowledge about EBM among primary care physicians.Methods and designA mixed-method study combining qualitative and quantitative designs will target family practitioners in Spain with the objective of evaluating current attitudes and perceptions about evidence-based medicine. The project will consist of two phases: a first phase running focus groups to identify perceptions and attitudes of participants, and a second phase assessing their attitudes and knowledge about EBM by means of a survey. Both phases will explore these issues in three different subgroups: family practitioners, with or without previous formal education in EBM; members of working groups that formulate healthcare recommendations; and physicians in charge of training family practice residents. Additionally, we will undertake a systematic review to identify and synthesize the available evidence on this topic.DiscussionThe study will identify and gain insight into the perceived problems and barriers to the practice of evidence-based medicine among general practitioners in Spain. The project will also evaluate the main knowledge gaps and training needs, and explore how evidence-based medicine is being taught to family medicine residents, the medical practitioners of the future. Our results will aid researchers and health care planners in developing strategies to improve the practice of evidence-based medicine in our country.