A national survey of vasectomy training in family practice residency programs.

To investigate the prevalence of vasectomy training in family practice residencies, a national survey of program directors was undertaken, with a response rate of 93%. Of the respondents, 44% had specific residency programs to provide vasectomy training. Of the residencies with specific training programs, training was a requirement in 18%. A majority of programs with training (54%) had both lecture and surgery components, with the remainder having only surgery. In 45% of the programs with training, residents performed five or fewer vasectomies, and in only 22% of the programs did residents perform more than 10 vasectomies. Among the programs where training was elective, 63% of the residents took the training. Only one program reported a medicolegal problem, which resulted in an out-of-court settlement.

Initiating a vasectomy training clinic in a family practice residency.

The development of and initial experience with a vasectomy training clinic in a family practice residency program are presented. A literature review and faculty consensus resulted in the acceptance of a standardized technique in which the ends of the vas are cauterized and not tied. An appropriate time block per patient to allow for counseling and for teaching of the technique was 90 minutes. Patients were recruited by instituting reduced charges and advertising through the local Planned Parenthood office and county health service. A partial prepayment was required to reduce broken appointments. Review of the first 50 cases indicates a good resident experience, an appropriately low complication rate, and no failures.

How patients and physicians address each other in the office.

Six hundred four patients in three primary care office settings were asked whether they preferred to be addressed by their physician by their first or last name and whether they preferred to address their physician by first or last name. Actual use of first vs last name by the physician addressing the patient and the patient addressing the physician was also recorded. Of the patients expressing a preference, 96 percent preferred that their physician address them by first name while 87 percent noted that this gesture actually occurred. Forty percent of the patients preferred to address the physician by first name while 14 percent actually did so. These findings suggest that physicians can feel comfortable addressing almost all of their patients by first name and that many of their patients may desire to address them by their first name. It is suggested that the physician at the time of the patient's first visit clarify the manner in which each addresses the other.

Maternal response to daily fetal movement counting in primary care settings.

Maternal counting of fetal movement (FM) to assess fetal well-being was studied in 394 pregnancies followed by family physicians. Counting was well accepted, with 85% of women finding it reassuring and 91% wanting to include it in subsequent pregnancies. Eighty-eight percent of women reported counting five or more days per week. Thirteen women reported decreased activity a total of 20 times. A nonstress test (NST) was performed 20 times and an oxytocin challenge test (OCT) was performed four times as a result of these reports. One of the 20 reports of decreased activity was followed by a nonreactive NST and suspicious OCT, and led to the induction of a viable 38-week fetus. There were no stillbirths in the group and only one neonatal death of an anencephalic infant.

Content of the model teaching unit ambulatory care training and continuity of care in six family practice residency programs.

This article summarizes the practice content and continuity for 35 senior residents in six family medicine residency model teaching units utilizing a computerized information management system. Comparisons are drawn with the content of family practices in the National Ambulatory Medical Care Survey (NAMCS), showing that family medicine third-year residents provide a large proportion of pregnancy care and general medical examinations and treat a smaller number of chronic illness patients compared with family physicians in practice. Third-year residents performed few surgical procedures in the model teaching units. Continuity of care, though espoused by family medicine residencies in principle, was deficient in the model teaching units studied. Intensive training to compensate for these deficiencies is recommended.

The fetal non-stress test.

The non-stress test has become a widely accepted method of screening for fetal distress in high-risk pregnancies. The procedure is technically simple, noninvasive, and when reactive (negative), a highly reliable predictor of fetal well-being for up to one week. This paper outlines the indications, performance, interpretation, and limits of the non-stress test as a standard evaluative tool for use by family physicians.

Teaching venous cutdown techniques with models.

A venous cutdown may be required in emergency situations in order to establish an intravenous line. Subclavian vein catheterization is now widely used, but may result in significant complications and is often inappropriate when a safer distal vein cutdown could be performed. Inanimate models can be used to teach this valuable technique and have the advantage of availability for repeated practice.