Responses to questions about the specialty of family practice as a career.

This article provides answers to many of the questions medical students ask about the specialty of family practice. It is the fourth update of a previous article and was developed in response to feedback from medical students at the 1997 National Congress of Student Members held by the American Academy of Family Physicians. Students at the 1998 Congress also identified areas of interest and concern. This article discusses the hours and income of the family physician, the scope of medical practice in the specialty, required continuing medical education and board certification, family practice residency training and combined-specialty training.

Health care system reform and the changing physician-patient relationship.

The increasing management of medicine has meant an increasing intrusion into the physician-patient relationship. This has caused a shift in the balance of the basic principles of medical ethics and of the major aspects of the physician-patient relationship.

Family practice graduate medical education and hospitals' patient care costs in New Jersey.

BACKGROUND: More generalists are needed for the American health care system. Will training these practitioners add to hospital costs? Although graduate medical education has been shown to add to hospital patient care costs, the authors questioned whether this were true for the hospital training of family physicians. METHOD: Based on data supplied by 12 participating New Jersey hospitals with family practice residencies, inpatients in 1991 were separated into three categories by the teaching status of their attending physicians: family practice, other teaching, non-teaching. The hospitals were stratified into two types for analysis: seven community and five multiresidency hospitals. Average cost (per case-mix--neutral case) was found for each category of patients within medical, surgical, pediatric, and obstetrical classes. RESULTS: Among community teaching hospitals, the mean case-mix--adjusted cost per case for inpatients associated with family practice training was 6.3% less than that for inpatients with an equivalent case mix not associated with family practice training. Among multiresidency teaching hospitals, there was no difference between mean costs for inpatients associated with family practice training and non-teaching patients. The mean cost for inpatients associated with graduate medical training other than family practice was 8% higher than that for non-teaching inpatients. CONCLUSION: These findings suggest that family practice residencies do not add to the direct inpatient costs of teaching hospitals, and in certain instances may even reduce hospital patient care costs. In times of increasing cost consciousness in health care and medical education, this provides a further rationale for institutions to sponsor graduate training in family practice.

Applying for and renewing institutional CME accreditation status.

The MSNJ-Committee on Medical Education provides accreditation for most of the institutions in New Jersey that sponsor continuing medical education activities. The process of applying for accreditation is described, including the decision and appeal procedures.

Part II: Basic approach to health screening.

It is hoped that practicing physicians no longer will give knee jerk reactions to the variety of national screening recommendations. Screening criteria that need to be fulfilled include characteristics of the disease, characteristics of the test, and characteristics of the population to be screened. In the day-to-day practice of medicine, six key questions regarding the applications of screening recommendations to individual patients have been developed. These include the qualifying questions regarding the patient's age, frequency of testing, cost effectiveness of testing, realistic practice for the physician, appropriate setting, and applicability to the patient in question. In the future, research in the area of screening needs to focus on the demographics of a greater variety of asymptomatic population groups, the effectiveness of current recommendations and guidelines, and the development of new, effective screening tests.

Part I: Basic approach to health screening.

A variety of recommendations exists regarding the screening of disease in asymptomatic individuals. In the first of a two-part series, the authors provide a basic approach to health screening, including historical background, barriers, and criteria.

Teaching medical decision making and students' clinical problem solving skills.

Medical students need to be taught explicitly about decision making to be prepared for the changing health care environment. Medical decision making curricula have received favourable responses from students and have influenced some aspects of student performance. Questions remain about the impact of the teaching on students' general problem solving skills. A 15 hour course covering decision making topics was presented during a preclinical elective preceptorship for 5 years. Problem solving ratings made by clinical supervisors for the third year psychiatry and internal medicine clerkships were not better for the students who had the instruction and clinical experience than for the students in the comparison group. The results suggest that this approach to teaching decision making requires further development and testing.

Functional health status of relocated nursing home residents.

This article presents the functional health status results of 49 nursing home residents who were involuntarily relocated from one institution to another. The purpose of the study was to determine whether there would be pre- to postmove changes in health status. Nursing personnel on both the day and evening shifts completed separate assessments of the residents' functional health status using the Long-Term Health Care Minimum Data Set instrument. These assessments were completed 2 to 3 months before and 3 to 4 months after the move. The interrater reliability was high; overall day-evening agreement was 82 percent. After the move, only receptive communication was rated higher; dressing, transferring, using the toilet, continence, and mobility were rated lower. Six functional activities showed no significant changes. Relocation does not appear to have a uniformly negative impact on functional status.

Testing a model of academic career development.

This study, based on a survey of current faculty members, confirms the previously proposed professional identity model of Knopke and Anderson. This model had predicted that personal and resident learner issues would be influential aspects of a faculty member's professional developmental needs and that during the initial years as a faculty member the influence of institutional issues would be less important. The study found that major concerns of new faculty members appeared to be: 1) acting as a role model; 2) developing teaching skills; and 3) maintaining clinical competency. New faculty were more likely to emphasize issues dealing with resident-faculty relationships if they came directly out of training programs than if they came out of practice settings. The study also demonstrated that the majority of family medicine faculty no longer came from private practice, and that a significant number now come directly from training programs.

Curriculum revision using a three-dimensional model.

A three-dimensional model was developed to guide the process of curriculum revision for a freshman medical student course entitled "Introduction to Primary Care." A four-sided base pyramid represented the conceptual complexities found in the delivery of primary care--the individual, the family, the doctor, and organized medicine at the base corners, and health at the pinnacle. The model served as the theoretical framework for organization of the course content, teaching methods, and evaluation materials.

Responses to questions by medical students about family practice.

Medical students frequently have questions about the specialty of family practice. Responses to 30 questions commonly asked about family practice are presented with a review of recent literature. These responses may assist medical students and their advisors in considering the choice of family practice as a career.

Teaching biopsycho-ethical medicine in a family practice clerkship.

The practice of medicine is inescapably value-laden. Principles, norms, and commitments are the goals which determine the specific decisions and actions of care-givers, patients, and families. Therefore, a disciplined understanding of human values is an essential complement to the biomedical and psychosocial components of clinical training. For medical students to acquire such understanding calls for a biopsycho-ethical model for medical education. Building on a review of medical ethics teaching, the authors describe a method of systematically integrating value analysis into a family practice clerkship. By combining interdisciplinary seminars with clinical experience, both the rigor and relevance of value analysis are maximized. The specific educational and evaluational objectives and strategies are presented for a course in biopsycho-ethical education.