Defining the need for faculty in family medicine: results of a national survey.

BACKGROUND: Although numerous anecdotal reports are being offered about the growing number of unfilled faculty positions in US family medicine departments, virtually no literature exists on faculty recruitment. The objective of this study was to define the scope and nature of current faculty recruitment needs in family medicine. METHODS: A national survey was sent to all family medicine department chairs and family practice residency program directors concerning faculty positions unfilled at their sites and positions for which recruitment would occur within the next 5 years. The survey asked for information on currently available positions; academic title of position; percentage of time to be devoted to clinical, educational, administrative, and research activities; primary focus of the position; date when the position became available; and the length of time the position has been unfilled. Similar information was collected on positions anticipated to be available within the next 5 years. RESULTS: A total of 364 surveys were returned, for an overall response rate of 70%. Information from the survey revealed a current, substantial demand for family medicine faculty throughout the country, with an even greater demand anticipated for the near future. Respondents reported 496 currently unfilled positions for family medicine faculty and another 677 positions anticipated to be available within the next 19.5 months on average. A total of 89.7% of those anticipated positions were reported as either "certain" or "somewhat certain," in terms of likelihood of availability. CONCLUSIONS: The demand for family medicine faculty is increasing, and much of the demand is financially motivated. Clinical expectations appear to be higher among departments than for residencies. Finally, it was revealed that most positions had minimal allotments for research time. Family medicine must recommit itself to the development of a scholarly agenda as it recruits new faculty.

Fluoxetine in family practice patients.

BACKGROUND: Many patients with depression are seen only by family physicians, yet it is unknown how their physicians prescribe newer antidepressants. METHODS: Charts of family practice patients receiving fluoxetine were reviewed using a standardized format. Information reviewed included patient demographics, diagnosis, prescriptions, and course of treatment. RESULTS: Depression was documented in 92.5% of the 40 patients studied. There were significantly more female patients in the fluoxetine sample than in the base sample of depressed patients (P < .04). Fluoxetine patients weighed significantly more than the base sample, with a mean difference of 20.8 pounds (P < .03). Side effects were documented in the charts of 12 (30%) patients. Prescription practice was considered optimal in 43% of patients who were told to take fluoxetine in the morning. No differences in improvement or side effects were found based on optimal prescribing behavior. Improvement was documented in 68% of patients. Fluoxetine was discontinued in 6 (15%) cases because of adverse side effects. CONCLUSIONS: An improvement rate of 68% among patients taking 20 to 40 mg of fluoxetine per day indicates that an adequate response can be achieved without the risk of side effects that typically accompany higher doses. In this study, fluoxetine was prescribed more often to obese patients. This prescribing pattern may indicate that primary care physicians perceive overweight patients as good candidates for fluoxetine regardless of inconclusive evidence about the effectiveness of this drug for weight loss.

A decentralized clerkship: strategies for standardizing content and instruction.

Course decentralization in a required family medicine clerkship occurred because additional teaching and clinical resources were needed to meet the educational goals and objectives of an entire class of medical students. The decentralized teaching effort, which consisted of a variety of practice models, had the potential for an inconsistent exposure to the required educational content of the clerkship. Course monitoring and evaluation also was difficult because of the logistics of the various teaching sites. In order to minimize inconsistent content exposure, efforts to standardize course requirements occurred through criterion-based faculty and teaching site selection, initial faculty development, and provision of appropriate library resources. Continuous standardization consisted of required periodic faculty development, frequent evaluation of faculty and teaching sites, and comparative studies of student performance. Standardization of some of the students' patient care experience resulted from the use of predetermined list of required clinical encounters. A computer assisted evaluation of students' patient experience log defined the actual student patient care population at various teaching sites and compared this to course requirements. Deficits in patient care experiences were addressed by providing either the appropriate patient encounters or alternative experiences through print, audiovisual, or teaching sessions.

An intradepartmental teaching effort at a medical university.

Over a period of four years, 693 third-year medical students were offered the opportunity to receive half of their required internal medicine clerkship clinical experience by rotating on a well-established family medicine inpatient service in a university hospital. This learning experience was designed and evaluated by the physician and behavioral science faculty of the department of family medicine. The family medicine inpatient experience provided the student with a greater number of individual patient encounters and a greater variety of clinical problems than an internal medicine experience. Scores on an internal medicine national board test showed no statistical difference between those students who completed a traditional internal medicine clerkship and those receiving a portion of their internal medicine experience by rotating on a family medicine inpatient service. The success of this student experience was a significant factor in the eventual acquisition of curriculum time for a third-year required family medicine clerkship.

Influence of pork consumption on human infection with Mycobacterium avian-intracellulare.

The hypothesis that eating pork from animals infected with organisms of the Mycobacterium avium-intracellular complex is a significant cause of human mycobacteriosis was examined by skin testing students with purified protein derivative from M. intracellulare to determine their sensitivity to M. avium-intracellulare. No significant differences in sensitivity could be demonstrated between those individuals who had never eaten pork and those who ate pork routinely. It was concluded that sensitivity to purified protein derivative from M. intracellulare in this population did not involve eating pork.