US Family Medicine Research Articles

Reduction and Management of No-Shows by Family Medicine Residency Practice Exemplars

We wanted to describe the methods used by family medicine residency practices with low no-show rates (rate exemplars) and those able to keep visit rates high despite no-shows (management exemplars). Program directors of US family medicine residency programs were asked to respond to a survey questionnaire. Telephone interviews were conducted with the administrators of rate exemplars (no-show rates of 10% or less) and management exemplars (average of 8 to 10 patient visits per half-day plus high administrator satisfaction with no-show management strategies). Directors of 14 rate and 8 management exemplars, identified from among the 141 practices (31.5%) that returned the initial survey instrument, were interviewed and subsequently resurveyed. All of the rate exemplars used multiple strategies, including patient education, patient reminders, patient sanctions, and some degree of open-access scheduling. Practices that managed no-shows well encouraged walk-ins and work-ins and overbooked resident schedules either equally or based upon individual no-show rates. Practice exemplars of both types were highly committed to addressing the no-shows problem and were diligent about following their policies and procedures regarding no-shows. Some family medicine residency practices are able to achieve low no-show rates or keep them from affecting practice volume. Those that do use combinations of well-established methods.

Use of computers and the Internet by residents in US family medicine programmes

Computers, personal digital assistants (PDA), and the Internet are widely used as resources in medical education and clinical care. Educators who intend to incorporate these resources effectively into residency education programmes can benefit from understanding how residents currently use these tools, their skills, and their preferences. The researchers sent questionnaires to 306 US family medicine residency programmes for all of their residents to complete. Respondents were 1177 residents from 125 (41%) programmes. Access to a computer was reported by 95% of respondents. Of these, 97% of desktop and 89% of laptop computers could access the Internet. Residents accessed various educational and clinical resources. Half felt they had 'intermediate' skills at Web searches, 23% had 'some skills,' and 27% were 'quite skilled.' Those under 30 years of age reported higher skill levels. Those who experienced a Web-based curriculum in medical school reported higher search skills and greater success in finding clinical information. Respondents preferred to use technology to supplement the didactic sessions offered in resident teaching conferences. Favourable conditions exist in family medicine residency programmes to implement a blend of traditional and technology-based learning experiences. These conditions include residents' experience, skills, and preferences.

Chronic kidney disease care delivered by US family medicine and internal medicine trainees: results from an online survey

BackgroundComplications of chronic kidney disease (CKD) contribute to morbidity and mortality. Consequently, treatment guidelines have been developed to facilitate early detection and treatment. However, given the high prevalence of CKD, many patients with early CKD are seen by non-nephrologists, who need to be aware of CKD complications, screening methods and treatment goals in order to initiate timely therapy and referral.MethodsWe performed a web-based survey to assess perceptions and practice patterns in CKD care among 376 family medicine and internal medicine trainees in the United States. Questions were focused on the identification of CKD risk factors, screening for CKD and associated co-morbidities, as well as management of anemia and secondary hyperparathyroidism in patients with CKD.ResultsOur data show that CKD risk factors are not universally recognized, screening for CKD complications is not generally taken into consideration, and that the management of anemia and secondary hyperparathyroidism poses major diagnostic and therapeutic difficulties for trainees.ConclusionEducational efforts are needed to raise awareness of clinical practice guidelines and recommendations for patients with CKD among future practitioners.

Family Medicine in Cuba: Community-Oriented Primary Care and Complementary and Alternative Medicine

Family physicians in Cuba and the United States operate within very different health systems. Cuba's health system is notable for achieving developed country health outcomes despite a developing country economy. The authors of this study traveled to Cuba and reviewed the literature to investigate which practices of Cuban family physicians might be applicable for US family physicians wishing to learn from the Cuban experience. We found that community-oriented primary care (COPC) and complementary and alternative medicine (CAM) are well developed within the Cuban medical system. Because COPC and CAM are already recommended by US family medicine professional bodies, US family physicians may want to learn from the Cuban experience and perhaps incorporate elements into their individual practices.

Does exposure to medically underserved areas during training influence eventual choice of practice location?

There are an increasing number of communities within the United States that have limited or no access to primary healthcare. In recognition, many medical schools now provide opportunities and activities that offer exposure to these demographic areas in order to increase the presence of and community access to medical care and to promote these locations as practice site choices for graduating students. Evaluation of these enhancements has led to doubts whether this exposure timing is optimal in promoting practice in these settings. The purpose of this study is to identify whether early exposure(s) to medically underserved settings prior to medical school is associated with eventual choice of practice location. Utilising a cross-sectional design, 450 US Family Medicine residency programmes were surveyed. From these, 775 participants responded to a standardised self-administered questionnaire on indicators associated with medically underserved area (MUA) exposure. Early MUA exposures combined with medical training experiences in underserved settings have a positive effect on later practice site choice. Identification of these attributes may be useful in considering determinants that impact eventual choice of practice location.

Japanese and United States Family Medicine Resident Physicians' Attitudes about Training

OBJECTIVE This is the first research known to compare residents’ attitudes about training in two countries. The objective was to examine and compare Japanese and US family medicine residents’ attitudes about their residency training. METHODS A cross-sectional survey was conducted at two Japanese sites and one US site in 1991, and repeated in 1995 at these sites, as well as two additional US sites. Family practice residents completed a self-administered, Likert scale format questionnaire containing items on demographics, identity as a family physician, resident education, the doctor-patient relationship, personal life, economic and women's issues. RESULTS The response rates were Japan, 1991: 92%(12/13); US, 1991: 76%(13/17); Japan, 1995: 89%(34/38); and US, 1995: 91%(60/66). Fewer Japanese residents reported feeling like an outsider, or discriminated against while on outside rotations. More US residents reported expectations for training were being met, and being satisfied with their education. More Japanese residents reported that outpatient training was inadequate. US residents responded more positively about the rewards of clinical decision making, patient management and the doctor-patient relationship. Japanese residents were less likely to report training as compromising their physical or mental health, or feeling overworked. Financial concerns were similar for both groups. Most female residents reported feeling that being a woman provider was an advantage. CONCLUSIONS Some aspects of family medicine training are transculturally similar, while others are influenced by the medical culture of the respective countries. Family medicine residents’ perspectives on training may be valuable to educators planning curriculum development.

Vitamin K for neonates: the controversy

<h3>Objective</h3> This study aimed to explore how new family medicine graduates who want to include obstetrics in their scope of practice identify and select jobs and to understand how employment influences scope of practice in family medicine, particularly the ability to provide maternity care and deliver babies. <h3>Design</h3> Mixed-methods study including a survey and qualitative interviews conducted in 2017. <h3>Setting</h3> We electronically surveyed US family physicians and followed up with a purposeful subsample of these physicians to conduct in-depth, semistructured telephone interviews. <h3>Participants</h3> 1016 US family medicine residency graduates 2014–2016 who indicated that they intended to deliver babies in practice completed a survey; 56 of these were interviewed. <h3>Main outcome measures</h3> The survey measured the reasons for not doing obstetrics as a family physician. To identify themes regarding finding family medicine jobs with obstetrics, we used a team-based, immersion–crystallisation approach to analyse the transcribed qualitative interviews. <h3>Results</h3> Survey results (49% response rate) showed that not finding a job that included obstetrics was the primary reason newly graduated family physicians who intended to do obstetrics were not doing so. Qualitative interviews revealed that family physicians often find jobs with obstetrics through connections or recruitment efforts and make job decisions based on personal considerations such as included geographical preferences, family obligations and lifestyle. However, job-seeking and job-taking decisions are constrained by employment-related issues such as job structure, practice characteristics and lack of availability of family medicine jobs with obstetrics. <h3>Conclusions</h3> While personal reasons drove job selection for most physicians, their choices were constrained by multiple factors beyond their control, particularly availability of family medicine jobs allowing obstetrics. The shift from physician as practice owner to physician as employee in the USA has implications for job-seeking behaviours of newly graduating medical residents as well as for access to healthcare services by patients; understanding how employment influences scope of practice in family medicine can provide insight into how to support family physicians to maintain the scope of practice they desire and are trained to provide, thus, ensuring that families have access to care.