Public health educational intervention in a family medicine residency.

Emerging infections and bioterrorism pose increasing threats to the health of our communities. To protect patients, frontline providers like family physicians must learn and use core public health skills such as disease detection, surveillance, and response activities. This paper describes a unique approach to teaching these core public health skills by incorporating residents into ongoing disease surveillance and reporting activities in coordination with the local health department. Comparison of pre- and post-intervention surveys of residents demonstrated that this intervention increased resident self-perceived competency in disease detection and surveillance, knowledge of reportable conditions, and ability to engage response activities.

Osteoporosis: point-of-care testing.

OBJECTIVE: To review the literature concerning the utility of point-of-care (POC) testing devices for the diagnosis and management of osteoporosis. DATA SOURCES: Articles were identified from a MEDLINE search (1993-June 2003). Additional references were obtained from cross-referencing the bibliographies of selected articles. STUDY SELECTION AND DATA EXTRACTION: After evaluation of clinical trials and select review articles, articles comparing peripheral dual-energy absorptiometry (pDXA) or quantitative ultrasound (QUS) with central DXA (cDXA) measurements were emphasized in this analysis. DATA SYNTHESIS: Sensitivity for detecting osteoporosis by QUS or pDXA varies widely (range 35-75%). Using adjusted T-score cutoffs increases sensitivity to 85-95%, at the price of reducing device specificity to 23-49%. Many states require a radiology technician to perform pDXA tests. CONCLUSIONS: POC testing with peripheral devices should only be considered in areas with limited access to cDXA or for women who initially refuse cDXA testing. T scores of-1.0 or less with POC testing typically require further evaluation via cDXA. Many states require pDXAs to be performed by certified radiology technologists, making QUS use more feasible for pharmacists. POC testing should not be used for assessing response to osteoporosis therapy.

A study of closure of family practice residency programs.

BACKGROUND: Between July 1, 2000, and July 1, 2002, the Residency Review Committee for Family Practice had received requests for voluntary withdrawal from 27 residency programs. This number represents a significant increase in the rate of program closure over previous years. OBJECTIVES: We compared descriptive data on these closing programs and explored factors contributing to the closure. METHODS: Descriptive program data were collected from the Accreditation Council for Graduate Medical Education, National Resident Matching Program, the American Academy of Family Physicians, and the American Board of Family Practice. Program directors from closing programs were invited to participate in a semi-structured interview to discuss factors contributing to the closure of their program. RESULTS: Seventy-five percent of closing programs were community based, median program age was 11 years, board pass rate averaged 98%, and 69% cared for underserved communities. Financial, political, and institutional leadership changes were most frequently cited by program directors as primary reasons for program closure. CONCLUSIONS: The rate of program closure is increasing, affecting programs that meet most measures of high quality. Quality programs are being lost, and the ultimate impact is yet to be seen. Program directors offer warning signs and advice that is generally applicable to other family practice residency programs.