ABSTRACT
BACKGROUND AND OBJECTIVES: Continuity of care is one of the presumed advantages of longitudinal residencies. However, it is not clear how well such residencies provide continuity of care, and, further, there is no recognized acceptable rate of good continuity. We compared traditional and longitudinal residencies to determine the extent to which the residents provided their patients with continuity of care. METHODS: We conducted a systematic chart review at three longitudinal and three matched traditional block-rotation programs. In total, 628 charts were reviewed, and 6,256 visits were evaluated. Continuity with a primary resident was evaluated over a 2-year period, with continuity defined as the percentage of visits for which the patient saw the same resident. RESULTS: There was no significant difference in overall rates of continuity between longitudinal and traditional programs (59.6% versus 57.8%). One longitudinal program, however, had a 74.8% rate of continuity, which was significantly higher than the rates in the otherfive programs. CONCLUSIONS: There was no significant difference found in continuity of care provided by residents at longitudinal programs, compared with those at traditional programs. Our results do not support the hypothesis that longitudinal residency programs achieve superior rates of continuity of care. Further comparison studies of longitudinal and traditional programs would be useful.
Subject(s)
Clinical Competence , Continuity of Patient Care/statistics & numerical data , Family Practice/education , Internship and Residency/statistics & numerical data , Analysis of Variance , Confidence Intervals , Data Collection , Educational Measurement , Female , Humans , Internship and Residency/methods , Internship and Residency/organization & administration , Longitudinal Studies , Male , Program Development , Program Evaluation , United StatesABSTRACT
BACKGROUND AND OBJECTIVES: Most family practice residency training consists of 2-4-week block rotations in specific curricular areas, supplemented by training in the family practice center. An alternative model, longitudinal residency training, emphasizes training in curricular areas over a 3-year time period. This study determined the frequency of longitudinal training in family practice residency programs. METHODS: We conducted a survey of 477 residency program directors listed in the American Academy of Family Physicians 2000 Directory of Family Practice Residency Programs. RESULTS: Sixty-eight percent (n=320) of program directors responded to the survey. A total of 3.6% of program directors described their program as "mostly longitudinal," and 14.2% described their program as "half block/half longitudinal." An additional 15% of program directors indicated interest in adopting or moving toward a longitudinal program in the next 2 wears. Responses suggest some inconsistencies in program directors' understanding of what constitutes a longitudinal curriculum. CONCLUSIONS: Longitudinal residency training is reported in 18% of family practice residency programs. Further work is needed to develop a definition of longitudinal residency training.
Subject(s)
Clinical Competence , Family Practice/education , Internship and Residency/organization & administration , Adult , Analysis of Variance , Data Collection , Educational Measurement , Female , Humans , Internship and Residency/standards , Internship and Residency/trends , Longitudinal Studies , Male , Program Development , Program Evaluation , United StatesSubject(s)
Alkaline Phosphatase/blood , Bone Diseases/blood , Cholestasis/blood , Inflammatory Bowel Diseases/blood , Pregnancy/blood , Adult , Aged , Bone Diseases/diagnosis , Cholestasis/diagnosis , Diagnosis, Differential , Evidence-Based Medicine , Female , Humans , Inflammatory Bowel Diseases/diagnosis , Male , Middle Aged , Reference Values , Risk FactorsSubject(s)
Mass Screening/economics , Mass Screening/standards , Papanicolaou Test , Uterine Cervical Neoplasms/diagnosis , Vaginal Smears/economics , Vaginal Smears/standards , Cost-Benefit Analysis , Evidence-Based Medicine , Female , Humans , Incidence , Reproducibility of Results , Sensitivity and Specificity , Uterine Cervical Neoplasms/epidemiologySubject(s)
Family Practice/standards , HIV Infections , Quality Assurance, Health Care , Family Practice/methods , Humans , TexasSubject(s)
Chlamydia Infections/diagnosis , Chlamydia trachomatis/isolation & purification , Drug Monitoring/methods , Immunologic Tests , Nucleic Acid Amplification Techniques , Adult , Anti-Bacterial Agents/therapeutic use , Chlamydia Infections/drug therapy , Female , Humans , Male , Sensitivity and SpecificitySubject(s)
Colic/diagnosis , Crying , Diagnosis, Differential , Gastroesophageal Reflux/diagnosis , Humans , Infant , Infant, NewbornABSTRACT
BACKGROUND AND OBJECTIVES: The standard medical ethics model of decision making is based on the four principles of beneficence, nonmaleficence, autonomy, and justice. The recognized relationship is the physician and patient. This study considered the role(s) family plays in medical decision making. METHODS: Thirteen semi-structured interviews were conducted with a total of 39 patients and family members. Codebook and template analysis of the transcripts identified common themes. RESULTS: Patients and families identified three roles for family involvement in medical decision making--supporting the patient, being affected by the decision, and advocating for autonomy. CONCLUSIONS: Through these roles, patients acknowledge the context of family life in medical decision making, while families actively promote patient autonomy. Consideration of nonmedical burdens related to family roles and relationships takes an equal or higher priority than consideration of medical burdens. Family is, and should be treated as, a significant moral participant in medical decision making.
