Using a novel small-group approach to enhance feedback skills for community-based teachers.

BACKGROUND: As medical education expands into distant settings, challenges in providing faculty development to busy clinical teachers increase-especially for those who have difficulty accessing sessions offered at academic centers. DESCRIPTION: Sixty-five clinical teachers participated in six small-group workshops, using a printed module on the topic of delivering feedback. The modules included teaching-learning "cases," tools, and a summary of medical literature. The group facilitator did not require expertise in delivering feedback. Surveys inquired about impact immediately after the session and at 3 months. EVALUATION: Analysis confirmed that participants found the workshop format valuable, and the majority committed to making changes in their approaches to providing feedback. At follow-up, most participants reported that planned changes had been implemented. CONCLUSIONS: A low-tech approach to faculty development, using facilitated small-group discussion of a specially prepared educational module, is feasible for any site and can enhance teaching approaches in both urban and rural practice settings.

Lifestyle management for type 2 diabetes. Are family physicians ready and willing?

OBJECTIVE: To determine practices and perceptions of family physicians regarding lifestyle interventions to prevent and manage type 2 diabetes (T2D). DESIGN: Confidential mailed survey. SETTING: Canadian family practices. PARTICIPANTS: Random, stratified sample of 1499 respondents to the 2001 National Family Physician Workforce Survey. MAIN OUTCOME MEASURES: Physicians' self-reported practice patterns and perceptions of lifestyle counseling for patients at risk for, and diagnosed with, T2D. RESULTS: Response rate was 53% (749/1410). Respondents frequently asked patients at risk for, or diagnosed with, T2D about physical activity and weight loss, but far fewer provided written advice, particularly about physical activity. Respondents thought counseling with such interventions as generic patient handouts was preferable to more intensive lifestyle management strategies, such as appointments to provide stage-matched counseling on physical activity. Most respondents thought family physicians should perform lifestyle interventions but realized they are confounded by such barriers as patients' lack of interest and limited referral resources. CONCLUSION: Family physicians keen to implement lifestyle interventions for T2D are hampered by barriers and use of ineffective strategies.

Lifestyle interventions for type 2 diabetes. Relevance for clinical practice.

OBJECTIVE: To review evidence from literature on type 2 diabetes pertinent to physical activity and diet and lifestyle modification, and to determine the relevance of this evidence to clinical practice. QUALITY OF EVIDENCE: Direct (level I) evidence supports interventions for physical activity and diet modification for primary prevention and management of type 2 diabetes. Few studies examine the effectiveness of primary health care providers' making such interventions. MAIN MESSAGE: Family physicians have an important role in identifying people at risk of developing type 2 diabetes and managing those diagnosed with the disease, yet they struggle to deliver practice-based interventions that promote sustainable behaviour change among their patients. CONCLUSION: It is evident that supporting patients to make changes in their physical activity and dietary habits can prevent onset of type 2 diabetes. Translating this finding into effective recommendations for clinical practice requires further effort and evaluation.