Education in quality improvement for practice in primary care during residency training and subsequent activities in practice.

BACKGROUND: Quality improvement (QI) is an integral aspect of graduate medical education and an important competence for physicians. OBJECTIVE: We examined the QI activities of recent family medicine residency graduates and whether a standardized curriculum in QI during residency resulted in greater self-reported participation in QI activities in practice after graduation. METHODS: The family medicine residency programs affiliated with the South Carolina Area Health Education Consortium (N  =  7) were invited to participate in this study. Following completion of introductory educational activities, each site implemented regularly occurring (at least monthly) educational and patient care activities using QI principles and tools. Semiannually, representatives from each participating site met to review project aims and to provide updates regarding the QI activities in their program. To examine the impact of this project on QI activities, we surveyed graduates from participating programs from the year prior to and 2 years after the implementation of the curriculum. RESULTS: Graduates in the preimplementation and postimplementation cohorts reported participating in periodic patient care data review, patient care registries, QI projects, and disease-specific activities (57%-71% and 54%-63%, respectively). There were no significant differences in QI activities between the 2 groups except in activities associated with status of their practice as a patient-centered medical home. CONCLUSIONS: Most but not all family medicine graduates reported they were actively involved in QI activities within their practices, independent of their exposure to a QI curriculum during training.

Anxiety and anger among family practice residents: a South Carolina family practice research consortium study.

PURPOSE: To study the dimensions of anxiety and anger experienced by a statewide sample of South Carolina family practice residents. METHOD: A total of 350 family practice residents from seven programs participated. Each resident completed the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Profile of Mood States, the Hassles Scale, the Maslach Burnout Inventory, and the State-Trait Anger Expression Inventory (STAXI) on at least one occasion. We analyzed reported anxiety and anger by gender, year of training, race, marital status, type of program (community hospital versus university), location of program, and season of the year. RESULTS: Residents reported lower levels of anxiety and anger across most dimensions compared with the adult populations on which the tests were standardized and with other resident and practicing physician populations. The residents did not demonstrate excessive levels of anger as a trait or in response to situations, nor did they significantly suppress anger. Although the residents reported a higher frequency of hassles than did normal populations, they did not consider these hassles severe. A higher than normal level of depersonalization was found among male, Caucasian, and third-year residents. CONCLUSIONS: These family medicine residents did not experience excessive levels of anxiety or anger during residency training either as a trait, state or somatic response. Extensive social and emotional "in-house" support, attention to stress-management skills, and the moderate personality characteristics of family practice residents help explain these findings. Initial assessment of psychological functioning and early remediation and program support during training may significantly reduce the potential for residents' impairment.

Improving family practice residents' compliance with asthma practice guidelines.

OBJECTIVES: This study primarily determined the effect of an educational and system intervention on residents' documentation of the severity classification of asthma. Secondarily, the study assessed the effect of classification on pharmacologic treatment, as outlined by national asthma treatment guidelines. METHODS: We reviewed the charts of all patients with asthma seen by the residents in the Center for Family Medicine (CFM) between October 1, 1998, and March 31, 1999. Data gathered from each chart included, but was not limited to, disease severity classification and medication regimen. Between July 1999 and October 1999, efforts at increasing residents' knowledge of asthma severity classification were made via formal and informal teaching. A post-intervention chart review was performed on all patients with asthma seen by the residents in the CFM between October 1, 1999, and March 31, 2000. RESULTS: A total of 8.5% of 198 and 51% of 271 patient visits were classified with respect to asthma severity in the pre- and post-intervention periods, respectively. Classified patients were treated appropriately 100% of the time in the pre-intervention period and 76% of the time in the post-intervention period. CONCLUSIONS: A comprehensive protocol significantly improved compliance with national asthma treatment guidelines with respect to severity classification but not pharmacologic treatment.