ABSTRACT
We report on the Sexual Health Curriculum Enhancement project at Case Western Reserve University School of Medicine. Using a US dollars 100000 grant from Pfizer Pharmaceuticals, Inc., we have developed and are in the process of implementing a comprehensive, cross-disciplinary and innovative curriculum that is based on three primary objectives for teaching sexual health: attitude change, behavior change, and knowledge acquisition. Five general strategies to incorporate specific sexual health content into the medical school curriculum have been implemented: (1). Faculty Development; (2). Additional Didactics; (3). Cased-Based Learning; (4). Testing and Assessment; and (5). Electronic (Computer/Web-Based Enhancements).
Subject(s)
Education, Medical/methods , Education, Medical/organization & administration , Sex Education/methods , Sex Education/organization & administration , Sexual Dysfunction, Physiological/therapy , Curriculum , Educational Measurement , Faculty, Medical , Humans , Program Evaluation , Research Support as Topic , SexualityABSTRACT
BACKGROUND: The field of family medicine has been enriched by a family-oriented approach and the inclusion of family systems concepts. Keeping the family as a central focus of care has been a fundamental commitment of family medicine. This research examines how exemplary physicians ("exemplars") integrate a family-oriented approach into the routine care of individual patients. METHODS: Four family physician exemplars were observed. A total of 16 days was spent observing the physicians; 137 physician-patient encounters were audiotaped, transcribed, and analyzed. Grounded theory was used for analysis, and a model of a family-oriented approach was developed. RESULTS: Visits were classified by the reason for visit and the intensity of family-oriented talk and actions. There was modest variation among the physicians in terms of intensity and time spent with patients. Overall, 19% of patient encounters had a high intensity of family-orientedness; 34% were of low intensity. The average time spent with patients was 13 minutes, with visits ranging from 3 to 39 minutes in length. CONCLUSIONS: Our study demonstrated that physicians integrate family systems concepts into routine individual patient care. The findings identify characteristics of the family-oriented approach and those circumstances that promote and hinder it. Family physicians can adapt specific components of the family-oriented approach into their routine individual patient care.
Subject(s)
Family Practice/organization & administration , Family/psychology , Patient-Centered Care , Physician-Patient Relations , Professional-Family Relations , Communication , Female , Humans , Male , Office Visits , Philosophy, Medical , Systems Theory , Time and Motion Studies , United States , Videotape RecordingABSTRACT
International medical graduates (IMGs) represent an increasing proportion of residents in all US residency training programs. Family practice residencies have experienced significant increases in IMG enrollment in the last 3 years. Residency programs in family practice need to make curricular adjustments to enhance the transition for IMGs. Adjusting the psychosocial curriculum, through changes in orientation, behavioral conferences, and family consultations, contributes to a culture-centered approach to teaching both IMGs and US medical graduates. Faculty need to identify both personal loss and cultural issues for IMGs in various stages of the resident's life cycle. Lifestyle changes and loss of self-esteem, country, and accessibility to family can be demoralizing for IMGs coping with the demands of internship. Specific stages of the family life cycle can exert additional stresses for IMGs and their families. Understanding the specific challenges for IMGs during each life cycle stage can be instructive and helpful. Faculty can introduce initiatives that encourage cultural pride and respect. Support groups, international meals, cultural retreats, adjusted advising systems, and ongoing faculty reflection on treatment of IMGs demonstrates residency appreciation of diversity and leads to a healthier, culturally rich learning environment for all involved in residency education.
Subject(s)
Foreign Medical Graduates , Internship and Residency , Culture , Family Characteristics , Female , Foreign Medical Graduates/psychology , Humans , Life Style , Male , Self-Help Groups , United StatesABSTRACT
The importance of stories has been receiving great attention in the family and family medicine literature. Less emphasized is the presence of multiple listeners to patients' illness stories in the clinical context. This paper affirms the importance of patients' sharing their illness stories with the various members of the health care system. Through clinical examples and discussion, the paper seeks to sensitize primary care residents and teachers to the community of listeners a patient encounters in an individual clinic visit. Factors influencing patients' selective disclosure of their illness stories are identified. Methods of enhancing greater communication among the recipients of patients' illness stories are proposed.
