The role of distributed education in recruitment and retention of family physicians.

BACKGROUND: Distributed medical education (DME) programmes, in which training occurs in underserviced areas, have been established as a strategy to increase recruitment and retention of new physicians following graduation to these areas. Little is known about what makes physicians remain in the area in which they train. OBJECTIVES: To explore the factors that contributed to family physician's decisions to practice in an underserviced area following graduation from a DME programme. METHODS: Semistructured inperson interviews were conducted with 19 family physicians who graduated from a DME residency training programme. Programme records were reviewed to identify practice location of DME programme graduates. RESULTS: Of the 32 graduates to date from this DME programme, 66% (N=21) and all of the interview participants established their practices in this region after completing their residency training. Five key themes were identified from the interview analysis as impacting physicians' decisions to establish their practice in an underserviced area following graduation: familial ties to the region, practice opportunities, positive clerkship and residency experiences, established relationships with specialists and services in the area and lifestyle opportunities afforded by the location. CONCLUSIONS: This study suggests that DME programmes can be an effective strategy for equalising the distribution of family physicians and highlights the ways in which these programmes can facilitate recruitment and retention in underserviced areas, including being responsive to residents' personal preferences and objectives for learning and shaping their residency experiences to meet to these objectives.

The impact of analgesic modality on early ambulation following total knee arthroplasty.

INTRODUCTION: Total knee arthroplasty is associated with moderate to severe pain, and effective analgesia is essential to facilitate postoperative recovery. This retrospective cohort study examined the analgesic and rehabilitation outcomes associated with 48-hour continuous femoral nerve block, local infiltration analgesia, or local infiltration analgesia plus adductor canal nerve block. METHODS: Patients undergoing total knee arthroplasty under spinal anesthesia, during an 8-month period, were retrospectively assessed with a targeted review of 100 patients per group. Records of eligible patients were reviewed to identify the analgesic technique used and the primary outcome of distance walked on postoperative day 1. Secondary outcomes included ambulation on days 2 and 3, numeric rating scale pain scores, opioid consumption, and adverse effects and discharge disposition. RESULTS: Two hundred ninety-eight eligible patients were reviewed. Local infiltration analgesia and local infiltration plus adductor canal block were associated with longer distances walked on postoperative day 1 than continuous femoral nerve block (median values of 20, 30, and 0 m, respectively; P < 0.0001). The addition of adductor canal block was associated with further improvement in early ambulation benchmarks and a higher rate of home discharge compared with only local infiltration (88.2% vs 73.2%, P = 0.018). Local infiltration with or without adductor canal block was associated with lower pain scores at rest and during movement for the first 24 hours and lower opioid consumption than continuous femoral nerve infusion. CONCLUSIONS: Local infiltration analgesia was associated with improved early analgesia and ambulation. The addition of adductor canal nerve block was associated with further improvements in early ambulation and a higher incidence of home discharge.